First day in the ICU. I have a patient who looks like an elephant. 500 pounds, thick, wrinkled skin, legs like tree trunks. Besides just the health consequences of being that big, there are problems beyond that-- there's a limit to what we can do to treat him. He doesn't fit in the CT scanner. He needs a scan, but we can't give it to him. X-rays aren't revealing because he has so much soft tissue. We can't get much of a read with the echocardiogram-- it can't penetrate all the fat. He's in the hospital with a problem that should have been found early and treated-- but he has so much skin and so much of it is hidden from view, folded over itself, that problems can fester without being identified. He can't really clean himself, he's barely mobile, and we can't really get to the bottom of things because we can't give him the diagnostic tests he needs. Beyond that, there are psych issues-- it's pretty hard to get as large as he is without psych issues. He's going to die here-- hopefully not this visit, but unfortunately if it's not this, it will be something else, and probably soon.
The ICU is terribly sad. After months on the outpatient service and on normal hospital floors, it's been easy to forget just how sick a lot of patients are. There are rapid responses every day here. People die. They don't get better and leave. But, oddly enough, from the doctor's perspective, in a lot of ways this is a better rotation than normal floors. They put better nurses here, there are more fellows, more attendings here for more hours, you're not as alone. Fewer patients, fewer notes to write. Shorter hours, even. Although the overnights will not be much fun. At all.