Saturday, September 21, 2013

My Brain Doesn't Work Like This: chronicles of an aspiring primary care provider in the PICU

I am in the throes of my first Pediatric Intensive Care Unit rotation. I was shocked that by Day 2 I wanted to run away and hide under my covers. Shocked that soo early into the rotation, I was hitting  the snooze button soo many times that my husband who sleeps through anything (except my occasional snoring and Zo crying) ordered me out of bed.

I am NOT that Resident. I’m not the one who hates residency. On most days I am so excited to serve patients and work with amazing colleagues. But I fear I have become THAT Resident. The grumpy one. The one who doesn’t want to be here. The PICU and its acuity has brought it out. Stealing the “oomf” from my life. Encouraging family members and friends have given me pep talks as I weep into the phone about how draining dealing with such critically ill children and their families has been; children with devastating neurologic damage or those with genetic syndromes with abysmal prognosis.

And top off the emotional heaviness with the fact that my brain just doesn’t work like this! The Attendings and Fellows are amazing. Without a single written note, they can recall doses of infusions from the prior week, what the Neurologist or Infectious Disease Consultant said 8 days ago, what I and other Residents said at every moment of the day, and various other details that I cannot ever imagine myself being able to recall without very detailed notes. Ventilators and infusions and cardiac physiology after a specific surgery, my brain screams out, “give me 5 minutes, 5 more minutes with the Peds In Review or Up-to-date and I promise I’ll have a detailed explanation!” but no, I have 2.5 seconds before I get the “you are dumb, hush up now” look. And of course I am now tachycardic and sweating and feeling hypoglycemic in the third hour of rounding.

I have tried to somewhat let myself off of the hook. I will never be a great PICU Resident, but I’m getting better and might even be pretty darn good by the end, nor do I endeavor to become a great PICU Attending. As an aspiring primary care provider and maybe even a Nursery or part-time ER Attending I will know how to keep critically ill patients alive until the Intensivists arrive. And even now, I am keeping my patients alive. I am learning how to more efficiently and effectively manage their acute issues and prioritize. I have come up with some good ideas and my brain works really well sometimes. But feeling adequate most of the time, just doesn’t feel good. And then my brain screams that it just can’t work fast enough to be excellent in this setting. And I acquiesce because it’s right and this is something I’ll just have to come to terms with as I snuggle even more under my covers while pressing snooze one more time. Because now more than ever, my brain needs its rest.


  1. Where I trained, unless you were bound for a PICU fellowship, the attendings didn't expect you to be intensivists when you rotated through the PICU. They expected you to be a general pediatrician. I learned more when I recognized exactly that. I was terrified of the PICU but my 3 months in the PICU ended up being some of the most rewarding from both a patient care perspective and an educational perspective. The skills you will learn in the PICU will benefit you in whatever career path you choose. :)

  2. Thanks for your comment. So, how did that work? What do you mean by "they expected you to be a general pediatrician"? Did that mean you didn't have to deal with ventilators, TPN, etc . . . .

  3. I think Beth meant that you learn your job the best you can- the vents, the monitors, TPN, etc. But since you are primary care oriented you should know the core stuff about the patient- pmhx, SH, possible risk factors for the current condition, meds they were taking prior to admission, what is the family's support system? Details that your team members may easily overlook or even have no interest in knowing. Good luck to you; my ICU experience was harrowing but if I could go back in time I would take some of my nerves off the table and focus on the patient and maybe the experience too. I know that is easier said than done when you have extremely emotional families and sometimes staff too, multiple codes, fatigue and extreme pressure to deal with. That is the only rotation in residency where I saw an exchange between a Cointern and resident lead to the intern crying in the middle of the day, right at the patient's bedside (pt was intubated and no family was present). It's just that type of experience sometimes. You will get through!


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