They All Have Cancer

...and that pretty much sums up my first few days of my required ICU rotation. I'm in a special cancer ICU, on the "solid tumors" team. As one of our PA's said yesterday, we either have "easy" patients--or not. The easy patients are mostly craniotomies for intracranial tumors--ie, brain cancer. They come to the ICU after their surgery, stay overnight, and generally get transferred to the floor the next day. Thus far, I've only managed this kind of patient, as they're not on a ventilator and have fewer serious issues (although I still write a 2 page progress note, detailing labs, meds, and physical exam for every body system + ID & oncology--they're not easy patients yet for me!)

The other kind of patient, according to my PA, come into the ICU from the floor "crazy sick", get a ton of money spent for a 1-2 day ICU stay, then DNR/DNI/withdrawal of care papers are signed and the patient disappears from the list. I believe she (the PA) was talking about what a waste that is.

The "liquid tumors" team (lymphomas, leukemias, bone marrow transplants, etc.) supposedly has a 30+% mortality rate. One of my friends is following a patient with a total bilirubin of 35; his skin is a strange neon green color. Another patient has a strange bacteria I'd never even heard of before--Stenotrophomonas maltophilia--which is apparently resistant to EVERY SINGLE ANTIBIOTIC TESTED EXCEPT BACTRIM. Still another patient has a virulent varicella pneumonia on top of her end-stage metastatic colon cancer.

I could go on and on and on. But I won't. Suffice it to say that it sucks. Yes, I am taking my antidepressant; otherwise, I don't really think I'd make it through this month.

The only thing that could make tomorrow more awesome would be if my nurse practitioner, who introduced herself as "the boss", decided to assign the medical students another learning issue. My 2 minute regurgitation of UpToDate on astrocytoma was spectacular, let me tell you.

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In happier news...

UPDATE ON THE MATCH:
Interview Count: 6
Letters of Reference in ERAS: 1, scanned in today
Letters of Reference NOT in ERAS: 2
First Interview: October 19
Anxiety Level About Lack of Letters: 10 out of 10