PCU: Flying solo

This month I'm working in the Progressive Care Unit, known here as the PCU. It's the step-down unit from the ICU, but is also a place where patients go when they're not quite sick enough for the ICU but need closer monitoring. I thought that a month of MICU would prepare me for PCU, but as it turned out, the two units were quite different from each other. First and foremost was the patient load: I saw 4-5 patients on average in the MICU, while in the PCU I have about 10-13. Next, the entire PCU is run by only one resident and one intern, and for what seems like the last week or so, I feel like I've had to run the floor by myself (which is NOT a good thing).

First and foremost was my resident, who was probably one of the laziest people I've ever met. Intern and resident start dates are staggered by one week so that the exiting resident can teach the intern about how the service is run and what is expected of the intern. My resident flat-out said on the first say there'd be no teaching and the goal of each day was to leave by 5:00 pm (a great rule to have). And while I was struggling to get my notes written (to give him credit, he saw 3-4 patients for me when our patient load was greater than 10), he'd be on the internet checking his email, chatting online, or otherwise being unproductive unless it's to his cause (like doing dictations). My second day of PCU, he left the floor for about 30 minutes for a meeting without telling me and left me freaking out when two separate attendings arrived for rounds. He was also lazy about documenting central line placements and important telephone conversations with patients' families (he rolled his eyes when I documented a central line removal), which caused him to butt heads with 1-2 attendings (one of them later told me my resident was flat-out stupid). To make things worse, he'd worked a black weekend before I signed on, and so I had to work a black weekend my first week as a PCU intern.

On weekends the earliest I can sign out is 2:00 pm, but I didn't leave the hospital until 6 pm on Saturday and 4:30 pm on Sunday (and that was only because I prewrote all 11-12 notes the night before). And because I was the only doctor in the unit, there was rarely any time for rest. I didn't even have time to eat, drink, or pee on Saturday aside from eating a granola bar here and some graham crackers there. Sunday was a little better b/c my patients were more stable, and today I got a new resident (fortunately it was someone I'd worked with in the MICU and I knew she was good). Unfortunately for me, she had worked the night before and left at noon, leaving me to run the PCU for the afternoon. And as expected, I didn't leave the hospital until 6:00 pm.

The PCU nurses have told me that I'm doing a good job and keeping myself together, but most days I just can't wait to go home. One of my patients became very hypotensive yesterday (among other problems), and I went home secretly hoping I wouldn't have to deal with her the next morning. Got my wish; she'd been transferred to the MICU. One of these days I'll have to tell you about this patient; it's a very sad case.

Hopefully today is my last day to work alone until this weekend, when I'm guaranteed at least ONE day off.