As I arrive in the ICU workroom, coffee in hand, I reflect on the enormous diversity of high acuity patients we have the privilege to care for while rotating on the ICU as upper-level residents at Baylor St. Luke’s Medical Center, a quaternary care hospital. Specifically, we treat patients with mechanical circulatory support devices, such as VADs, Impellas, and various ECMO configurations or who have just undergone heart or lung transplantation. Treating acutely ill patients with such specialized physiology is challenging at times, but by the end of the rotation residents are more than comfortable treating such sick patients both in and out of the operating room.
Mornings consist of chart review, pre-rounding, and then team rounding starting at approximately 7:30 a.m. The team usually consists of two fellows (one cardiac anesthesia fellow and one critical care fellow), two anesthesia residents, and multiple midlevel providers along with an ICU attending who rounds for a week at a time. Because the patient census is on average between ten and twenty, there is a true balance between theoretical and practical learning.
The majority of notes and orders are finished during morning rounds; therefore, most afternoons are spent caring for patients in the immediate post-operative period, performing procedures, or learning from our attendings during informal teaching sessions. From placing arterial lines on VAD patients without pulsatile arterial flow to inserting dialysis catheters, the procedural experience during the month is a perfect addition to skills learned while in the operating room. The world-class attending faculty are great at tailoring teaching to each resident’s interests and taking time during afternoon rounds to point out interesting findings on POCUS or quickly sketch a patient’s VVAV ECMO configuration.
All in all, the BSLMC’s ICU rotation is a tremendous learning opportunity and a unique rotation even within the Texas Medical Center. Although this is an unparalleled experience for any resident pursuing a fellowship in critical care or cardiac anesthesia, every resident who rotates through the service is a much better anesthesiologist at the end of the month than at the start.
