The Canadian Inuit people have 50 different words for snow. The truth of this much-touted claim is questionable, but one can readily justify why it might be true. Consider that if this snow portends easy travel and that snow portends dangerous travel whereas their snow offers good hunting and tomorrow‘s snow is ideal for an igloo and the top snow tastes best and the blue snow is …. Well, who wouldn’t want to have 50 terms to describe it?
Patients in the hospital are sick. Doctors have 50 words for the sick. As a student aspiring to enter Internal Medicine, I am learning to appreciate the differences between these terms. I need to recognize which patients are sick and which ones are sick. The difference is not semantic. Just as with variations of snow, variations of sick also portend different outcomes and require different management. The former sick patient you see in the late morning, you increase their basal insulin dose and you sympathize about the bad hospital food and uncomfortable beds. The latter sick patient you see first thing in the morning, you scrutinize their overnight labs and imaging, and you stay by their bedside for as long as it takes to ensure that they are stable. And in the afternoon, you return to their bedside frequently to put out smolders before they flame up.
I’ve spent the last month on a Critical Care team in the Methodist ICU. The experience has redefined for me the term ‘sick’ and has altered my appreciation for the depth of medical intervention. It was my first experience with non-OR intubations. My first experience with the use of vasopressors. And it was the first time that I watched a patient’s MAPs trend 60…50…40…30…and then I learned how to call a code and start compressions.
Beyond its shock factor, the ICU is a tremendous opportunity for a student to develop their treatment plans. Because of their high acuity, ICU patients are continuously monitored. I had minute by minute access to my patients’ vitals, cardiac telemetry, heart pressure, and outputs. This oversight, along with a 1:1 or 1:2 nurse to patient ratio, creates a remarkably safe environment. Therein, poor patient trajectories are rapidly identified and corrected before they cause significant problems. As such, the decision whether to diurese a post-op patient can be left to the medical student. If the wrong choice is made and the UOP drops then you’ll hear about it within an hour and be able to intervene before any squelae develop.
Overall, the Critical Care service was an invaluable experience. I witnessed treatments and interventions that I had previously only read about in UWorld questions. I learned how to prioritize patient problems from the pressing to the urgent to the emergent. I began distinguishing patients with substantial reserve from those who were deconditioned and this prone to more complications. And I started to develop a hunch for which patients were at risk for an acute exacerbation of their condition. In so doing, I broadened by understanding of patient wellbeing and feel more prepared to distinguish sick from sick next year when walk out into the snow blizzard that is the IM residency.
