Week #4: Staying on pace

The Medical Intensive Care Unit (MICU, 5-South) is a challenging environment. The first nurse I met there said, “If you can make it here, you can make it anywhere in the hospital.” When I asked how it stacked up against the ER he said, “The ER is heavy, but a different kind of heavy. You have every opportunity here to make a bad impression.” The social component of being a medical caregiver in the MICU is magnified, as most patients are chronically ill and require long-term care. Family members are often anxious and frustrated and rely on clear communication and constant reassurance from doctors and nurses.

In the MICU, I witnessed cases of renal disease, diabetes, cancer, infection and systemic health problems related to obesity. One of the big problems was that of antimicrobial resistance. In these cases, antimicrobial drugs become ineffective and the risk of spreading infection increases. Patients with such infections can end up sequestered in the MICU, which can be both a cost and a space issue. I was impressed by the variety of cases and the versatility of the staff to manage everything that was going on. For example, there was one patient with severe Type II Diabetes who was also suffering paranoid schizophrenia. He stopped eating because he thought his wife was trying to poison him. Another patient had End Stage Renal Disease (ESRD) along with arthritis and an infected leg. Interventional Radiology was called in order to install a vascular access for hemodialysis (all of the past accesses were unusable) before the patient’s BKA (below the knee amputation). Another case involved an elderly patient who the doctors said essentially died weeks ago; however, the daughter refused to let go. From a legal perspective, it is much easier for the doctors to comply with the family, but what is right ethically? One potential engineering endeavor suggested to me by the head resident was to make the Ergotron portable computer “less ghetto.” These systems are big, bulky, require frequent charging and there are not enough of them to go around. Perhaps a tablet-based system with docking stations throughout the wing would be an effective solution.

My adventure for the week continued on the 4^th floor where I wandered into some Cath Lab procedures. I watched an angioplasty (opening up of a blocked vessel) via a balloon catheter inserted through the femoral artery. Another patient scored very low on a cardiac stress test (level 2); however, her cath procedure did not reveal any cardiac abnormalities and she did not need an angioplasty. At this point Ashley and I met up with Jason and traveled across the floor to the Electrophysiology (EP) wing. We ran into cardiologist Dr. Stephen Markowitz who invited us to observe a pacemaker implantation procedure that he was about to perform. The patient had a history of atrial fib and many cardiac ablations. Because of this, her SA node would get stressed and her heart would stop for ~8 seconds causing her to faint. This procedure featured a nice combination of X-ray imaging, biomaterials and surgical skills to get the job done. Dr. Markowitz used the cephalic vein as an entryway into the heart for the pacemaker leads which were screwed into strategic locations in heart wall. The impedance was checked, as well as the voltage threshold required to jumpstart the heart. Aside from some bleeding due to an artery puncture (which was treated using a thrombin/collagen mixture), the procedure went well. With a new pacemaker in place, there is no more need for faint-heartedness.