Zero to Sixty: Starting Intern Year in the ICU During a Pandemic
- Apr 23, 2020
Are you about to begin life as an intern during the biggest pandemic in a century? In the intensive care unit, perhaps?
Here are some tips to make your COVID-19-era ICU rotation a little smoother.
How to Prepare for a Pandemic ICU Rotation
Don’t try to do too much.
Life as an intern means you are going to absolutely stink at the medicine for (usually) six months or so until you get the basics down. You, me, and everyone in between has to get the learning curve and it’s just the name of the game. After that, you spend another six or so months getting your basic style down so you can stink at the intermediate level medicine. The point is not to expect to come in and be a plug-and-play doctor during the crisis. Work on your basics and read a ton, which brings me to my next point.
Don’t forget other diseases exist out there.
We have this weird hyper focusing thing in our society where we have one hot topic and that is it. Our society is also incredibly statistically illiterate. Remember when vaping nationwide killed a total of … sixty people and it was all anyone talked about for six months?
Now, COVID-19 is the real deal so the prevalence in real life actually approximates the prevalence in the media. That, again, doesn’t mean other diseases don’t exist out there. A former med school colleague of mine told me about an elderly male with positive urine and confusion (slam dunk urosepsis) on a COVID floor. The patient ended up getting COVID-19 from being exposed on the floor. Don’t anchor on coronavirus for everything. It didn’t sprain the ankle of the jogger running on an uneven sidewalk.
Read as much as you can about the basics of the disease.
I stress this. The basics of the disease. Stop reading experimental trials about weird stuff that probably won’t work. Unless you start in the ICU, it won’t be very relevant to you anyway. Read about ARDS diagnosis, management, the ARDSnet trial, proning, and how to manage conditions similar to this. Learn about all the different modalities of oxygenation. Learn about basic ventilator physiology and settings. Start small with assist control; do NOT try and learn Airway Pressure Release Ventilation first if your intensivist is using it.
Know your background and find areas where you can offload the burden of the rest of your team.
Some people really like critical care (me). Some are terrified by it (many others). Some take zero rotations in it during med school. Some take three (me, again). The point is, if this is all entirely novel to you, don’t expect to manage several patients all at once. Focus on areas where you can be helpful. Update families on their loved one’s conditions. Try to Facetime with them if your institution allows. Assist the nurses with getting supplies if they are already inside the negative pressure room with isolation gear on so they don’t have to come out and go back in.
Value those around you, and show it.
Modern medicine is a team sport, and, whether they let you know or not, everyone is rooting for you. This is not something you can learn or do on your own; the patients and nurses and techs and other doctors are far more important teachers than your textbooks. Be kind, be patient with their foibles, and show them your appreciation, whether that means passing out chocolate at 4 a.m., or taking the time to help them get IV access under ultrasound, or simply saying thank you when they bail you out of a problem of your own creation.
You’re here to help people, and you simply cannot do so with thoughtfulness and compassion if you don’t take the time to maintain your own humanity. What does this look like when you’re working 80 hours a week, exhausted, and struggling to just sleep and eat regularly?
It can mean tiny pauses to be a person: I often stopped to appreciate a small garden on my walk to work — a 90 second period of peace that helped me stay centered through whatever the day might bring. It can also mean breaking through the waves of exhaustion to go Live, with a capital “L,” when you get the opportunity; I sacrificed some sleep to spend a day in a boat on a lake with friends on one of my only days off, and it was a happy memory that stayed with me for many days afterward.
Obviously this list is subject to your individual situation, but the point is to try and be as helpful as possible while trying to learn as much as possible. Stay academically curious, remember the core tenets of mental health, and try to help the team. Be human. Be happy when you can. Take joy in your successes and the kindness of others, and remember that you can’t do this alone. You’re part of a team now, and everyone is quietly cheering you on. Together, we will all get through this!
The views expressed in this article are do not represent the positions or policies of any program, institution, or other entity.