A few weeks ago I finished my Pediatric ICU rotation. Before beginning this rotation, I was forewarned by several of my classmates that the hours were going to be long, the patients were going to be complex, and many of the cases were going to be sad. Having not had much of a break between third and fourth year, as well as taking both my Step 2 CS and CK within a few weeks of each other, I was feeling a little burned out. However, I reminded myself, “It’s just four weeks. You can do anything for four weeks. After this rotation, you can relax a little.” During the first few days of PICU, I realized that the words of my classmates all turned out to be true. The hours were long — 28 hour calls every 4 days. The patients were complex — it seemed every organ system was often going awry and there were so many medications, lines, and ventilators to keep up with! Many of the cases were sad — this is where I first experienced having patients pass away. However, my classmates neglected to mention some key information to me which they may or may not have foreseen — that I was going to find my place in medicine on this rotation.
Up to this point (this being in August – September of 2018 aka application season), I actually had not officially chosen a specialty yet. I had searched throughout third year to find the place where I belonged, but no specialty quite fit the way that I wanted it to until I hit PICU. I fell in love with the complexity of the patients, the thinking process behind how we manage care in these sick kids, and most of all, the patients, parents, nurses, and physicians that I was able to work with on this rotation. Perhaps once I start residency I’ll find another area that I like more, but for now, pediatric critical care has left a very strong impression on me and helped me feel confident in my choice as I submitted my applications for residency.
Just to illustrate how this rotation left such a strong impression with me, I’ll share with you some of the memories that I brought with me. During my first week on service, I was able to take on the case of an infant who presented with some devastating effects of non-accidental trauma. Unfortunately, this came to be something that we frequently saw in the PICU. What I loved about this was how we were able to help fight for this little baby. We were able to advocate for him and love him when his family was unable to. As a bonus, we would carry him around during rounds or if there was a quiet window of the day or night, I would sit there and feed him his bottle, sing to him or rock him back to sleep. As I mentioned earlier, this is the rotation where I had my first patients pass away. I had always imagined that my first patients to die might be someone in their upper 80’s with many comorbidities. Rather, it was children who passed from diseases or accidents that had occurred without any control of their own. They were simply vulnerable kids who happened to have something awful happen to them. Although it was heartbreaking to see this, it made me value the incredible privilege it is to be able to walk through this experience alongside families during what will likely be the darkest hours of their lives as they lose a child. Lastly, over the course of the four weeks, I saw children come in who hovered over the line between life and death. Their prognosis looked so incredibly grim. As I left PICU at the end of my rotation, some of them remained there with questionable futures. Several weeks later, I was on my preventive medicine rotation working on a quality improvement project in the Children’s Hospital. During this time, I had to go to many of the patient rooms on our general pediatrics wards. While here, I ran into several of those patients whose futures I thought I would never know. I was convinced that majority of them were going to pass, but alas, they were before me talking and walking. This was the greatest reward. The last time I had seen these patients, they were on ventilators with multiple medications running to maintain their blood pressure. Yet here they sat, telling me about their progress, what they’re going to do and eat when they get home, and what level of Fortnite they are on. These were miracle children. I wish I could say that all of my patients had outcomes like these, but as you learned earlier, that is not the case.
As I reflect back on this experience, I think back to my thoughts of, “This is just four weeks. You can do anything for four weeks.” The four weeks passed quicker than I hoped. After over a year of searching for my place in medicine, it was these four weeks that made all the difference.