MICU: First Week

I've been in the MICU for one week, and already there are many differences from the floors here. We have fewer patients per team, but they are sicker and require lots more attention. I'm also fortunate in that there are fewer MICU patients in the summer than there are in the winter (when pneumonia runs rampant). My team currently has about 5 patients, 2 of whom have been here since July. Most of them have trachs and PEGs and just need to be weaned off the ventilator.

There are 4 MICU teams in the unit. Call here is q4 overnight; the intern from one team is paired with the resident of another team depending on whether their team is an even or odd number (i.e. I'm MICU4, so I'm on call with the MICU2 resident) so that there are doctors from two teams here at all times. Some residents cover their own teams and expect the intern to cover all the others during the night, while others will split the teams in half and say, "I'll cover 1 and 2, you cover 3 and 4." I cover all the routine calls (medications, orders, etc), but if something serious is going on with my residents' patients or if I have a question, then I call the resident.

On my first call, one of the patients on my team with small cell lung cancer/MRSA pneumonia coded (eventually brought back and put on a transcutaneous pacemaker), and there was a disagreement about which of his children could make decisions about him. One son was the power of attorney but he was overseas, and his daughter said she had papers saying that he wanted everything done (but despite being asked many times, she never brought those papers to us). It took an entire afternoon to finally reach the son with POA, and he asked if we could keep his dad alive until he got home. The pulm/CC fellow said that the patient was unlikely to survive the night, and after the son spoke with other family members (namely, a stepbrother who came to visit the patient), he told us that he wanted us to withdraw care.

The patient had his vent removed and his pacer turned off, and the nurses placed him on a drip to keep him comfortable. I poked my head into the room a few times and saw his heart rate fall to 28 while his breaths became slower. Time passed as I continued working, when suddenly I heard a loud scream. Fearing the worst, I turned and saw our patient's daughter run into his room, throwing herself over his body and begging him to wake up. Apparently the patient had just passed away and she arrived with no idea that he had been taken off life support.

One of the fellows went in the room to talk to her after giving her some time to grieve, and she went berserk on him. "Why did you pull the plug?" she screamed, stamping her foot and flinging things around the room. "You were NOT supposed to pull the plug on my daddy. He wanted everything done for him! I got papers!" And with that, she pulled out the forms that we had needed for so long, too late. "He said he wanted everything done until his heart stopped. WHO said you could pull the plug?!" I was afraid that she was going to start hitting the fellow or something like that, but he just explained that our team had directly contacted her brother who had the power of attorney, and he had made the decision along with her stepbrother to withdraw care.

"___ would never do that!" she screamed, referring to her biological brother. "And ___ isn't even his real son!" That, of course, was referring to her stepbrother. "WHY?!?" With that she broke down, continuing to alternate between screaming and holding her father, and when the paramedics came to take the body to the morgue, it took a while to get her to let go. She tried to follow the body as it was wheeled away but the security guards stopped her. "You can't keep me here, that's my daddy!" she yelled. The guards explained that she wasn't allowed to go to the morgue and she screamed they had no right keeping her here. After yelling at the guards, she turned and headed straight for the nurse's station. I was afraid she was going to find a random nurse and start screaming, but instead, she found an unguarded door leading to the lobby and promptly exited the ICU. The nurses inside the station looked started, like WTF just happened, but the security guards were alerted to go out and find her. This was sometime around 8 pm, and I was told that she was still down in the lobby at 10 pm arguing with about 5-6 security personnel. *sigh* This is why I don't want to specialize in critical care.