MICU: The Burden of Atlas

Today was probably my worst day in the ICU to date. My team had seven patients, three of whom were very sick (one with new-onset sepsis, one who coded last night, and one with abd pain and a giant gallbladder). My resident and sub-I were post-call so they left before 1pm, and the fellow who watches over my team had clinic in the afternoon. So for one afternoon, it was just me in the unit covering all seven patients.

It was a disaster. The patient who coded had 3-4 consults I needed to follow up on. My attending was on my back to call the surgery team about two vasculopaths on our team who had an aortic dissection and no line access. I had to contact IR to ask them to put a line in our lady who coded since she had no veins. Then one of my long-term patients was found to be septic from a possible permacath infection so I had to call nephro, pulm AND infectious disease to coordinate whether they wanted the permacath removed or not (since pt was on dialysis) Then the MICU3 resident (whom my resident had asked to help me in case I got overworked, but I barely saw her at all because HER team was busy as well) got annoyed with me for not getting back to her in time about whether my patient needed a new line to get put in ("I'm not going to be here all day.") I had no time to rest. It was one thing after another, and by the time of signout at 5:00 pm I still had work to do. Then one of the fellows got mad at me for not calling IR about removing my septic patient's permacath; it was because I was calling his attendings about him until 5:30 pm and the IR department stopped taking calls at 5:00 pm.

I didn't leave until 7:00 pm (sign-out was at 5:00 pm) because there was so much to do, and I was never so exhausted and burnt out in my life. And to think I'm on call tomorrow! But hopefully things will be better then; I can't take another day like today.

(anyone want to guess what inspired the title of this post?)