ICU continued...

After finishing the early morning rounds, we set out to do our tasks. For us medical students we had to get a PiCCO (pulse contour cardiac output) measurement on some of our patients. Typically you would want this if you were wondering about the volume status of the patient. Using the numbers generated, you could add, remove, or stay with the current fluid measurement. A very simple procedure; flush cold saline solution through a central venous catheter with a special sensor attached. The sensor should detect both the temperature and fluid amount and compare it to a second sensor attached to a femoral arterial line. Using this data, the program calculates the cardiac output and index of the patient as well as further indices of heart and circulatory function. It's an interesting tool that can be useful, though my feeling is that its function should be reserved for a select few patients. Patients with questions of circulation or cardiac function should be prime candidates, ie. sepsis (due to vasodilation), severe CHF (cardiac dysfunction), etc.

Every time I enter a new hospital or join a new team, I get the feeling that I am lost, incompetent, and should not belong. I'm sure I am not alone in this. Everyone is new, everything is somewhat different, and you don't want to be a wrench to the machine that had worked without you for some time. But as I get further and further in my training, I realize that sitting around for someone to direct you is not something you should wait for. Be active. Take an initiative to do something. Doesn't mean that you have to go and just mess around with the patient without approval. Think critically of things that might need to be done. Does a line need to be changed or put in? Does a nurse need help drawing medication? Sadly, I wish I was as forthcoming as I advocate here.

Around 10am, we have früschtück (breakfast) with the team. A basket full of different bread types, jams of all kind, and meat and cheese to one's heart's delight are the order of for the morning. This is the most important thing to learn on any rotation. Keep your belly happy. The breakfast every morning is set up by the medical students (German version of scut work anyone?), but its not bad. Just a 5 min process of setting the table, grabbing things from the fridge, and putting the bread out. I can't complain because we get to enjoy in the deliciousness as well. But I must comment on one thing. I've come to realize that silence at a table is common and normal. Not the general 5 sec pause while you chew the food, but the 5 min, all-you-hear-bread-crunching silence type. As someone raised in a rowdy Russian household and talkative American life, silence is nail-on-chalkboard cringing. You don't know where to look because otherwise you would stare. So you stare at your sandwich, wondering when the awkwardness will end. This is something I could never get used to.

After breakfast we have a few minutes to gather our notes, lab results, and thoughts before we set off on "grand rounds."