Saturday, July 10, 2010

It's not easy being green.

I feel for the new residents this summer. I really, *really* feel for them.

In addition to working in the NCCU, which isn't really very critical yet, I'm picking up days in the CCU. I've only been there six months, so I'm still a total newbie, and my newbieness is compounded by the fact that I'm not there all the time. I have to really think about things like pressors and vent settings and boluses, rather than just having them come natural-like.

So I'm not that different from a new resident. All of the residents at Sunnydale start out in the CCU; it's a trial-by-fire sort of thing. They do their first year at El Giganto, working trauma units and medical CCU, then come over to us to handle surgical critical care and Shit You Won't See Anywhere Else, It's So Weird. By the time they get to us, they're totally competent in things like coding patients and following protocols, but at sea when it comes to dealing with stuff like your average everyday demented crani patient with a potassium of six.

I'm totally competent in management of stroke, hemorrhage, and spinal injury, and totally incompetent when caring for a patient whose middle name is Crump and who's on three pressors, CRRT, and racemic epi. With an open belly. And cardiomyopathy.

We're makin' it so far. So far, nobody's tried to bolus a patient with potassium (yes, that happened once, and yes, the dude grew up to be an excellent intensivist). Nobody's tried to push fluids on somebody with flash pulmonary edema and kidney failure. The acute pancreatitis and general-shutdown dude with the coup/contrecoup injury is doing okay. Two folks got off the Prisma and one person came off the vent. I've managed not to mistake norepi for dopamine.

And we're all *so careful*. We walk softly, talk softly, round carefully, ask lots of questions, and have facial expressions like surprised mice. The new intensivist fellow sat with me during lunch, and we talked about what's been going on in our lives with the determination of people who wanted to take a mental break. He gave me a nickname, I gave him a nickname. I explained the concept of the "dope slap" to him. He gave me a recipe for potato curry.

It's gonna be okay. I know that. By the end of August we'll all be comfortable in our roles. We'll have exchanged cell phone numbers. We'll know who tends to sleep through her beeper. But for now, we are all in the same leaky-seeming boat, unsure if anybody's going to grab us when we're about to fall over the side.

Get an oar, you guys. Start rowing. That frog in the middle of the swamp warned you about aaalll-eeee-gaaay-torrrs for a reason.


messymimi said...

It takes courage to become a medical professional for just this reason. Everyone starts out new and scared.

Yes, July, when the new interns and residents come in, is the scariest time of all, and just the time you need the patients to be patient with the learning curve.

Brian said...

Hee! I can't tell you how much I appreciate this post. I'm a student nurse and I just started clinicals recently. Very recently. Yesterday, in fact.

It's great to be reminded that even the awesome kickass nurses didn't start out knowing everything.

Robert said...

Excellent post.