nANIMOv

I was able to actively participate during a code today for the first time today (I know it only took all of Med School). It was pretty different from all the Mock and Sim codes I’ve done or the BLS/ ACLS training I’ve done, but understandable so. I was recruited to do chest compressions, though I wasn’t the first one so I didn’t experience the rib cracking. It was a bit more tiring than the Mock codes I’ve done and definitely a lot scarier with an actual life on the line. The defibrillator/ heart monitor wasn’t hooked up correctly at first or didn’t have good contact or something based on the signal, so it kept saying “push harder” which definitely added to the stress. It hard to maintain a steady pace without actively thinking about my rate. And at the same time I was trying to listen to everything else going on so I could learn. It was only 3 minutes but it felt like a long time and a short time at the same time. After my round of compressions we checked a rhythm and got a pulse (or as we say return of spontaneous circulation or ROSC). Was it my excellent compressions or was it the meds he was getting who’s to say??? Let’s just say it’s good we were in a room full of seasoned professionals.

At the end I wasn’t sure how I felt, or how I thought I was supposed to feel. I feel like there were maybe less emotions than I was expecting given this was my first real code. The only prominent emotion was excitement which feels wrong. Of course I felt bad for the patient and it is terrible that this happened, but at the same with him being sedated through the whole thing there was no emotional feedback to go off of, and everyone around me was super professional and if not stoic or in some cases kidding around with each other. So that was the emotional energy that I was feeding off of I guess. Still feels a bit weird, but only because I feel like it should. A man almost died in front of my eyes. If anything the person who was at the forefront of my mind was the patient’s mother who had constantly been at bedside and was in the room when they decided to intubate which eventually led to a code (she was out of the room when they lost the pulse thankfully). I was constantly trying to think of the right words to say to her if I were the one to tell her what was going on, what happened, or what might’ve happened if it came to that. I kept drawing blanks beside the basics and cliches, so definitely something I need to work on, and then be able to do it in Spanish.

Otherwise it was a pretty standard day, besides me coming back in from the weekend and us starting with a new attending who seems pretty badass.

It was an eventful day. I got to help out a bit with an emergent chest tube for a pneumothorax which I never had seen before. Though the circumstance under which this occurred were not ideal (there was a breakdown in communication that lead to rapid worsening of the patient’s existing pneumothorax which we were already treating). Today was also my last day with the attending who has been on since I started in the ICU. I liked him a lot as an attending, he was super patient and encouraging with all of us and really made it a point to teach and also give us autonomy with out patients. Being my last day working with him we did feedback. He said I did a good job and was surprised that this was my first ICU rotation and said I was working at the level of a first or second year resident, which felt good even though he was probably being generous. That said I do think I’ve come a long way from where I once was. I definitely have a lot more confidence than I did a year ago. Whether that confidence is proportional to growth in my clinical ability is a whole other story.

This was an interview for a program that I was not particularly interested, especially after the “social event” the night prior, just given that I felt like it didn’t vibe with the culture. But I actually really enjoyed this interview as well. The program has a lot of the things I’m looking for and most of the people I was able to talk to today definitely passed the vibe check. Definitely will keep this one in mind.

A lot of residents were off today so I kinda was helping pick up some of the slack as best I could as a medical student. And since I was gone the yesterday and both my patients were downgraded I had to pick up all new patient, and I also took on one of the news as a third. So far I’ve enjoyed my time on ICU. It’s a good mix of pure, broad scope medicine with also the action and drama and procedures of high acuity and the sentimentality and care of interacting with patients and families around sensitive topics.

My first residency interview was today. It was for my home institution’s program which was a good one to start with. My thought was that I would be able to get past some of the earlier interview cycle jitters with a program that I know relatively well and know a good amount of the faculty and residents. I was still super nervous. Last night I had pre-Disneyland-like insomnia, but fortunately did get decent sleep and woke up pretty refreshed and with time to do my usual morning routine. Overall the interview went pretty well I thought. Everyone I spoke with I have spoken to and/ or worked with before, except the one person who did my community member interview. It was also good to get a more formal presentation on the program and the experience reiterated in my mind how much the culture and environment of the program match with my own values and philosophies toward medicine. Part of my really wants to stay because I this program is almost exactly what I’m looking for. Another part of me wants to venture off for a new experience (not that residency in and of itself won’t be a new experience). I guess I’ll have to see if any other programs can compete.

We “fixed” my patient!* She was meeting all the milestone that we arranged for de-escalating her care, namely lowering her triglyceride levels with an insulin drip and so we were able to take her off the drip. She still had some abnormalities on her labs and possible an infection brewing, but nothing that was going to keep her in ICU level of care for much longer. I will say getting regular tangible results like this is a cool thing about ICU. That said, for a lot of the other patients on our unit, things are not at all cut-and-dry and I feel like there will certainly be a degree of intellectual dissatisfaction no knowing whether or not you are treating the right thing, whether or not the patient is doing better because of something you did, or what the actual cause of death is in some patients.

Any ways so far I have been enjoying my time in the ICU. I really like my team so far and the attending and fellow are also super nice and good teachers. Looking forward to working with everyone more. Though I’m going to be off tomorrow for my first residency interview. I’m really nervous, but it is also with my home institution so I think it will definitely help to see some familiar faces throughout this first residency interview experience. We had the pre-interview social with some of the residents tonight, all of whom I had met before (and I just want to be friends with all of them, but that’s beside the point), not sure if the event helped my nerves or not though.

*”Fixed” is a term we use a lot in medicine, often jokingly especially when patients get better inexplicably, or sometimes sarcastically. I’ve always felt it somewhat dehumanizing so I personally try to avoid it, but I also think it is very important to have a sense of humor in this line of work. Also saying “my patient” also is kinda a weird thing.

I regained access and was back in action. I picked up my first ICU patient who was pretty straightforward but and interesting pathology that I hadn’t see before; hypertriglyceridemia-induced acute pancreatitis. It was a good one for me to get my feet back in the water, with a relatively straight forward course and minimal confounding comorbidities and stuff, but still a good learning case that I had to read up on.

I felt pretty confident with my presentation, event though we present a bit differently in the ICU compared to on wards, and I think I did pretty well. The attending and fellow asked some questions and I think I did a decent job of answering appropriately. Personally I felt like my presentations were on par with at least the interns, but that’s probably bias, and also most of the other patients were more complicated than mine. My seniors said I did a good job though which always feels good.

As far as first impression, while I like the acuity, complexity, and the turnover in the ICU, I don’t get to interact with patients as much or as directly simply because these patients are just so much sicker. They are either intubated or sedated (often both) or just straight up sleepy/ not mentally all there at baseline. That said I can imagine my self finding conversation with family and patients (in whatever capacity they are able to participate) regarding goals-of-care and just treatment plans, so we’ll see how much opportunity I get to see/ do that.

This is my first time back in the hospital in almost 2 months. I had a hard time sleeping last night because I was afraid I had forgotten all of medicine and how to work in the hospital. Fortunately when I got there, everyone was super nice helping me get oriented. The only issue was my access to the EMR was disabled so basically was locked out of the one thing that makes me useful as a medical student. So I spent the majority of the day figuring that out, but did follow the team for rounds, then got sent home early. It felt good to be back in the hospital and think about medicine-y things again.

Overall I’m looking forward to this rotation because I’m thinking I’ll get to see some pretty interesting pathology and hopefully see/ participate in some cool procedures.

Artificial intelligence, large language models, and generative AI are likely going to be a part of our future as a society whether we like it or not. Just like with any new technology, there seems to be a lot of concern that this kind of technology is going to take people jobs and ruin livelihoods and the economy, or even destroy humanity as we know it.

What I do know is that in the past, when emerging technologies (such as automated machining tool, weaving mechanism, etc) were presenting similar concerns, it changed how people worked instead of replacing people outright.

I think AI is going to change how we practice medicine and how people engage with their health, with doctors, and with health systems, but I don’t (or perhaps can’t/ refuse to) believe that this kind of technology could ever replace flesh and blood physicians, at least when it comes to the things that matter. I believe AI will prove to be a powerful tool in our ability to deliver high-quality, evidence-based care and in our ability to analyze large data held in EMR systems, currently limited by the time and volition of exhausted medical students.

What I also believe is that if we don’t acknowledge a place for AI in the future of medicine and take an active role in its integration, the current practice of medicine will be replaced with one that involves AI, whether that involves real physicians at the helm or not. (Check out one example of a company trying to address this)

Let’s talk about it.