Ask an Intensivist

[El_Machinae]

You might want to look into ischemic post-conditioning, then! It's obviously not voodoo. It's pretty good at reducing the size of the infarct area.

 

[shadowplay]

Were you a really good student in your high school days? At what age did you realize you wanted to pursue a future in medicine?

 

[Neonanocyborgasm]

What is the hardest part about your job?

Oddly enough, the hardest part is not the patient care. That usually follows a well established script. What's hardest is having to deal with other physicians who don't know anything about critical care, and yet think they know better. It's quite exasperating to deal with them. I try to be tactful, but most of the time, it pays just to avoid confrontation altogether.

What is the saddest thing you've ever seen?

A young woman, 20, who died only of pneumonia.

 

[Neonanocyborgasm]

That's depressing to hear. Are they usually difficult to deal with?

It depends on how quickly the patient recovers from the original illness. The longer they remain debilitated this way, the more episodes of infection they will have, and each will have increasingly antibiotic resistant bacteria. You can guess the final outcome.

You might want to look into ischemic post-conditioning, then! It's obviously not voodoo. It's pretty good at reducing the size of the infarct area.

I'll keep my eye on it.

Were you a really good student in your high school days? At what age did you realize you wanted to pursue a future in medicine?

I have always been a bad student. There was a time in high school that I excelled, but it was rather brief. I was a bored... I mean bad student in school and college. Only in medical school did I bother to make the effort to get good grades. That should tell you how predictive grades are.

I had an inkling to do medicine when I was 11. I was fascinated with the immune system, and how it's a war that rages for all time. But mainly, it was my family that pushed me into it. Jewish doctor and all that...

 

[Singularity]

I'm not sure if you can answer this question, but do you have some system that checks for the potential for deliberate termination of a patients life? It's certainly a highly controversial phenomenon, and can probably take many forms where the patient themselves don't want to live any longer, their family if the patient can't communicate for whatever reason but is in a state of perceived constant pain or in the worst cases where the staff for whatever reason does it on their own accord.

 

[Neonanocyborgasm]

I'm not sure if you can answer this question, but do you have some system that checks for the potential for deliberate termination of a patients life? It's certainly a highly controversial phenomenon, and can probably take many forms where the patient themselves don't want to live any longer, their family if the patient can't communicate for whatever reason but is in a state of perceived constant pain or in the worst cases where the staff for whatever reason does it on their own accord.

There's no system, exactly. It's a judgement call, based on the situation. The usual clue is a patient who has end-stage disease for which no treatment is possible. What often happens is that when we identify such a patient, we present it to the family. The family then has to decide whether they wish to continue standard care or palliative care. Once they decide on palliative care, the patient is then treated to relieve only pain and suffering, with all the drugs available that can do that. Nature then takes its course.

 

[bombshoo]

What's the ratio of men to women? Is it higher or lower than most other doctors? I'm asking because a friend of mine (a girl) wants to do exactly this, saw me reading this thread and was curious.

 

[Neonanocyborgasm]

What's the ratio of men to women? Is it higher or lower than most other doctors? I'm asking because a friend of mine (a girl) wants to do exactly this, saw me reading this thread and was curious.

Probably 50:50

 

[jtb1127]

You're Jewish?

 

[Neonanocyborgasm]

You're Jewish?

Technically.

 

[Glassfan]

There should never have been a TV show called "ER." That show so exaggerates what the ER is capable off that it doesn't deserve that kind of favorable image. Instead, there should been a series called "The Intensivists." I can see it now. You would have a team of intensivists, each of which have their particular specializations. One might be a trauma surgeon, another a medical intensivist, and another perhaps a pediatric intensivist. (I'm being someone obtuse for dramatic purposes, since all those guys wouldn't work in the same ICU.) Common premises on an episode might revolve around issues such as:

* intensivist contending with emergency physician over care of a patient, and how the ER never does anything, sending up the near-dead.

There was a program on Cable about (real) Trauma Centers around the US (Can't remember title). My favorite - the guy walking around with the knife in his skull.

One episode stands out, however. A patient comes in with bullet wounds in his leg, and this female resident starts poking around without using anesthesia. An intern starts telling her the guy's in pain (howling heard in the background) and the resident virtually screams at him to get out and continues torturing the patient. Eventually we learn that she reported the intern and he got in trouble for it (typical). There was evidently some extreme viewer response, and soon after we got those new directives (I work in a hospital) about pain management - colors, numbers, mandatory patient pain checks, etc. ...life imitates art.

 

[Nobody]

I saw this TV show about vitamin c being a magic cure that saves alot of people who are going to die, but doctors won't let people try it. Ever heard of this?

 

[bernie14]

I saw this TV show about vitamin c being a magic cure that saves alot of people who are going to die, but doctors won't let people try it. Ever heard of this?

seriously, in your facility, do u get more traumatic, metabolic or infectious type cases? do u end up with GOMERS or are they quickly triaged elsewhere?

 

[Pokurcz]

With all those people dying all the time at you work place you might like this: http://i.imgur.com/4UZ0f.gif

 

[Quackers]

What is the most disturbing thing you've ever seen?
Do you ever get depressed by all the suffering you see?
Do you enjoy your job?

 

[holy king]

what medical tasks do nurses take on in your state in the icu and are all of them legally safeguarded?

No, because they are usually too moribund to even talk, or even be conscious. A deathbed confession is a Hollywood movie, not real life.

that of course is true for icu's. not so much for palliative care units?/departments?/wards?.

 

[Neonanocyborgasm]

With all those people dying all the time at you work place you might like this: http://i.imgur.com/4UZ0f.gif

LOL!

seriously, in your facility, do u get more traumatic, metabolic or infectious type cases? do u end up with GOMERS or are they quickly triaged elsewhere?

All too many GOMERS. I have noticed a script that plays out consistently with them. Whenever some patient is admitted with end-stage disease, the family will insist that "everything be done." After exactly 2 weeks, they will realize that doing "everything" is achieving nothing, so they switch to palliation. Or, the patient will somehow squeak by and recover before 2 weeks comes about, will be transferred out of the ICU, and then return with some other acute illness on top of their end-stage illness, and we play out the script again. 2 weeks is a magic number that I have arrived at.

We don't get much trauma because we are not a certified trauma center. Most trauma seen here is only minor, and is treated in the ER and sent home, and not admitted. The ambulances know not to bring major trauma patients here, and will go to the nearby university trauma center.

The vast majority of acute illness here is infectious, usually sepsis from either pneumonia or urinary tract infection.

I saw this TV show about vitamin c being a magic cure that saves alot of people who are going to die, but doctors won't let people try it. Ever heard of this?

I have watched an episode of Game of Thrones, so I have watched fantasy.

There was a program on Cable about (real) Trauma Centers around the US (Can't remember title). My favorite - the guy walking around with the knife in his skull.

One episode stands out, however. A patient comes in with bullet wounds in his leg, and this female resident starts poking around without using anesthesia. An intern starts telling her the guy's in pain (howling heard in the background) and the resident virtually screams at him to get out and continues torturing the patient. Eventually we learn that she reported the intern and he got in trouble for it (typical). There was evidently some extreme viewer response, and soon after we got those new directives (I work in a hospital) about pain management - colors, numbers, mandatory patient pain checks, etc. ...life imitates art.

That initiative comes from complaints from patients that doctors are undertreating pain. There used to be this myth that use of opioid analgesics easily causes addiction, but more recent studies show that appropriate use of opioids (to treat pain) hardly ever causes addiction. Doctors would let just patients suffer with pain out of some misguided fear of inducing addiction. This is another one of those campaigns that aims to treat a dysfunctional medical culture through propaganda. I don't know that it's necessarily worked. The older physicians still undertreat pain, while the younger ones never needed to be propagandized to treat pain. It's one of those things where eventually, the older generation will die or retire, leading to changes in practice from the new.

What is the most disturbing thing you've ever seen?
Do you ever get depressed by all the suffering you see?
Do you enjoy your job?

I enjoy my job very much, despite contending with its many flaws. I like to believe that those flaws will resolve themselves with time, as critical care medicine gains more influence. Much of the obstruction to our management comes from political resistance.

I don't get depressed by the suffering because it is just the natural course of life. The natural course of life is mostly good living, interspersed with disease, suffering, and eventual death. The overwhelming majority will only die after a long and well lived lifespan. Those that die earlier are either unlucky or took themselves out with bad habits. I don't dwell on the reasons.

As I've said, I am not disturbed so much by the patients and their diseases. That's why I became a doctor. If I was shocked by disease, I should not have gone into this profession. I am more disturbed by the poor and negligent behavior of some medical staff, who should know better, and have lost any sense of duty to their profession.

what medical tasks do nurses take on in your state in the icu and are all of them legally safeguarded?

I don't know what this means. Everything nurses do is a medical task.

that of course is true for icu's. not so much for palliative care units?/departments?/wards?.

If managed properly, true even there.

 

[classical_hero]

Technically.

Explain.

Also what is the best moment you have had working in intensive care?

 

[Scratch]

What rough estimate would have of percentage of your patients that are in your care because of diabetic complications? Your OP mentioned the kidneys and that's certainly one of the diabetic complications I got warned about when I was diagnosed as a type 1 diabetic a little over 26 years ago.

How much more difficult is it to manage a diabetic patient in your section of the hospital? Or is there no appreciable difference, as each situation has its own difficulties in a myriad of difficulties?

 

[Neonanocyborgasm]

Explain.

Technically, I am Jewish. Practically, I am atheist.

Also what is the best moment you have had working in intensive care?

Whenever there is a rescue of a patient from certain death, that is always a great moment. Those moments happen all the time. Usually it is a patient in shock or respiratory failure. It will often involve an intubation or placement of some other device.

What rough estimate would have of percentage of your patients that are in your care because of diabetic complications? Your OP mentioned the kidneys and that's certainly one of the diabetic complications I got warned about when I was diagnosed as a type 1 diabetic a little over 26 years ago.

How much more difficult is it to manage a diabetic patient in your section of the hospital? Or is there no appreciable difference, as each situation has its own difficulties in a myriad of difficulties?

I would say about 75-90% of patients are admitted with a problem that is in some manner a complication of diabetes, either directly or indirectly. There is no real difference between a diabetic and a non-diabetic admission. They just have worse disease.