This month I’m on Neuro ICU.  For those of you who don’t know exactly what that is, I am working with a Neurointensivist who specializes in neurological disorders in a critical care setting.  The majority of our patients have either suffered a stroke or a traumatic brain injury.  Some are in induced comas following cardiac arrest.  And some have other neurological trauma, such as decreased strength or sensation in an arm or leg.

For starters, I LOVE being back in the ICU.  Neuro Critical Care is very different than Pulmonary Critical Care, which is what I’m hoping to go into, and we have a lot of patients who have suffered from trauma – aka car crashes or motorcycle accidents without wearing a helmet, etc.  I’m not a big fan of trauma care, but the neurological part of brain injuries is very interesting to me.

Many of our patients are in a coma – either from their accident or an induced coma for their own brain protection.  As weird as it sounds, I really like patients who are intubated and in a coma.  I love the detective work involved in their care.  They say that 70% of a diagnosis can be made based on the history taken from the patient.  Another 20% comes from the physical exam.  And the last 10% is from labs and imaging.  In patients who can’t talk to you, you’re really only left with the last 30% of the puzzle, and I find that I really like the added challenge.

However, not everybody wakes up from a coma.  And that is really hard.  Many patients have loving and dedicated family members at their bedside and you can see them clinging to any scrap of hope.  In many cases there really is none, and it breaks my heart that they don’t yet realize their loved one isn’t going to wake up.  I often envision my own family members in that hospital bed and try to imagine how that would feel.  Then I start to get teary eyed and have to stop.  In the end I realize it must just be terrible to see someone you love in such a state.

But there are some success stories.  Last week I was able to go with my attending to see a patient who was on the floor.  She had been an ICU patient several months ago after a bad car accident and was in a coma for over a month.  The doctor introduced himself because she obviously didn’t remember him.  But she was doing so fantastic, and I could see how gratifying it was for my physician to see how well she was doing.  Such an amazing success story.

I’m only a week into this rotation, but I’m really loving it, and I’m learning a lot.  There are always exciting things happening in the ICU.  For instance, last week a patient had explosive diarrhea and I was only a few inches away from getting hit!  So, so glad I didn’t get hit.  Should be a fun month if I can continue to avoid getting hit with poop.  And then only 2 more rotations before I’m DONE with medical school.  Is it too soon to start counting the days!?  (…68)

About emilyehoward

My name is Emily, and I am a Hospitalist in Nebraska. I live with my husband and three beautiful daughters. I hope you enjoy my blog!
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