In the few weeks in the department, I have learnt that intensive care medicine is different realm entirely. Patients here are sicker, often requiring multi-organ support. There are fewer patients and many more staff. The ward is wider, more sterile and machines are in an orchestrated beeping frenzy. There are a multitude of machines keeping patients alive, and the sounds that they make are louder than that people make.
Some of the machines include masks that support the air sacs in the lungs to stay open, there are lines that monitor blood pressure accurately and there are big dialysis machines that take over a kidney's filtration role when one or both start to fail. Assessing a patient's medical condition on intensive care is largely a numerical exercise. What is her PaC02 today? What is the patient's mean arterial pressure? How much is the urine output in the past 24 hours? What is the tidal volume for that patient on pressure support? Is his cumulative fluid balance positive?
And because patients are very ill, ward rounds are a lot quieter, less rushed. Coming from acute medicine, this feels like such a luxury. Doctors and nurses on the rounds move slower, combing through the smaller details of each patient's case with a fine toothed comb. Some of the patients have been on the wards for many weeks, so staff are very familiar with them and their families. Escalation plans are discussed more in this department, and twice a week, we discuss and learn from those who passed away on the ward, and we talk about possible alterations to current practice in order to improve overall patient care.
It is, I feel, a very interesting area of medicine - where man and machine truly work hand in hand. The practical skills that I have managed to gain even in these short weeks have also been invaluable - I managed to assist in placing a central line in a patient last week, and I flew solo in inserting my first ever arterial line. The cases are some of the most complex I have ever encountered, which makes it even more intellectually stimulating.
So I do see and appreciate the attraction to anaesthetics and critical care as a speciality. One can be really hands on in acute emergencies and one can be present to offer additional support when a patient's organs stop working independently. Despite really enjoying this rotation, my heart is still in paediatrics. But who knows, maybe I'll be back in the future!
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