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CSCH

critical care residency log

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Thanks for all this insight. I love reading about your experience. I am starting a very similar sounding Critical Care residency in April. I have some time off before. What do you suggest for preparation?

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The most important advice I can give you is to read The Ventilator Book by William Owens. Maybe twice. Maybe three times. It's short, easy to read, and has all the info you need to get started on day 1 with vents. (That man owes me money for the number of times I have recommended his book to some intern.)

If you want more reading, Marino is the classic. I like how opinionated he is. When you first start out, you don't have experience upon which to build your own opinions, so I think it's good to borrow opinions and try them on for size. The full-size is good, but frankly the "mini" Marino is probably all you need.

However (similarly to before PA school), I think it's really important to just enjoy your time off. Residency is exhausting, and there's no reason to go into it tired because the exhaustion is cumulative. Go travel or visit friends and family, or enjoy the hobbies you won't have time for. Or just sleep. I dream about sleep 😉

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Also, you need to read House of God. But start it when you're at least 4-5 months in. It's a great book, but it'll really hit you right in the feels if you read it while you're in the midst of residency and you can really relate to the characters. It took me months to finish because of so little free time, but literally everything he goes through I went through (emotionally--and no, not *literally everything*).

Another thing I've been musing on today is the way I move around the unit these days. Everything used to be scary. Everything. Now I know what I know, and I know what I don't know. I can recognize most real emergencies, and I know when I can walk down the hall to the patient's room and when I need to run. The machines aren't scary, and neither are their beeps. Questions from nurses don't feel like I'm being pimped (even being pimped doesn't feel like I'm being pimped anymore). But on the flip side, the real emergencies get my blood pumping much more than they used to. As I've taken on more and more responsibility, my spidey senses have become more acute, and there are certain vitals/labs/imaging/etc that (I think I stole this phrasing from someone) make my butt pucker. I always imagined myself going through this process and becoming increasingly more objective, thinking through things in a clear and efficient way. And I'm not saying I haven't grown that skill. But the funny thing is that I've also become much more instinctual, and I've stored all this factual knowledge in a casing of emotional knowledge, and the emotional side is the first thing to appear in my mind. Am I explaining this at all well? Maybe someone else has experienced this and can explain it better.

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3 minutes ago, CSCH said:

Also, you need to read House of God. But start it when you're at least 4-5 months in. It's a great book, but it'll really hit you right in the feels if you read it while you're in the midst of residency and you can really relate to the characters. It took me months to finish because of so little free time, but literally everything he goes through I went through (emotionally--and no, not *literally everything*).

"Jo" was a collaboration of several residents, all others were based on individuals known by the author who was a Harvard grad.  A GI specialist that I used to occasionally work with here in Dallas knew the author, as well as the others for whom the characters were based on.

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30 minutes ago, CSCH said:

Also, you need to read House of God. But start it when you're at least 4-5 months in. It's a great book, but it'll really hit you right in the feels if you read it while you're in the midst of residency and you can really relate to the characters. It took me months to finish because of so little free time, but literally everything he goes through I went through (emotionally--and no, not *literally everything*).

Another thing I've been musing on today is the way I move around the unit these days. Everything used to be scary. Everything. Now I know what I know, and I know what I don't know. I can recognize most real emergencies, and I know when I can walk down the hall to the patient's room and when I need to run. The machines aren't scary, and neither are their beeps. Questions from nurses don't feel like I'm being pimped (even being pimped doesn't feel like I'm being pimped anymore). But on the flip side, the real emergencies get my blood pumping much more than they used to. As I've taken on more and more responsibility, my spidey senses have become more acute, and there are certain vitals/labs/imaging/etc that (I think I stole this phrasing from someone) make my butt pucker. I always imagined myself going through this process and becoming increasingly more objective, thinking through things in a clear and efficient way. And I'm not saying I haven't grown that skill. But the funny thing is that I've also become much more instinctual, and I've stored all this factual knowledge in a casing of emotional knowledge, and the emotional side is the first thing to appear in my mind. Am I explaining this at all well? Maybe someone else has experienced this and can explain it better.

All so true. House of God becomes more relevant every time I read it.

the best metaphor I’ve seen for this kind of thinking, which really describes all types of thinking, is that we have an emotional reaction that immediately sets our decision making on an initial pathway. It can be overcome with logical reasoning, but this takes much longer and takes effort to come over the emotional reaction. The metaphor is your emotional reaction is like an elephant. Based on paths you’ve taken before, when it comes to a fork in the road it starts to lean where you should go. You pulling on the reins is the logical reasoning.

personally I rather liken it to muscle memory. It’s the thing that reacts when you are woken at 2 am on your 30 hour shift when you can’t even begin to logical process in reasonable time.

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Thanks, Lt Oneil -- That's exactly what I was trying to say. My amygdala is starting to retain medical knowledge haha

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On 12/29/2018 at 12:09 PM, CSCH said:

The most important advice I can give you is to read The Ventilator Book by William Owens. Maybe twice. Maybe three times. It's short, easy to read, and has all the info you need to get started on day 1 with vents. (That man owes me money for the number of times I have recommended his book to some intern.)

If you want more reading, Marino is the classic. I like how opinionated he is. When you first start out, you don't have experience upon which to build your own opinions, so I think it's good to borrow opinions and try them on for size. The full-size is good, but frankly the "mini" Marino is probably all you need.

However (similarly to before PA school), I think it's really important to just enjoy your time off. Residency is exhausting, and there's no reason to go into it tired because the exhaustion is cumulative. Go travel or visit friends and family, or enjoy the hobbies you won't have time for. Or just sleep. I dream about sleep 😉

Thanks for the recs! 🙂

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Hey,

I just want to say thank you for these posts and updates. I enjoyed reading through your year of residency and hope to hear more of your story. I'm currently an ICU nurse in pediatric cardiology and what you say about hemodynamics really rings true. I'm still learning a lot, and I have had thoughts of going to the PA route for rural medicine. However, after reading your experience, I think the idea of being a PA in critical care sounds like a suitable role for me also. I enjoy critical care nursing, but I also see myself in the role of calling the shots. I hope to read more of about your writings and what happens after the residency!

One question I have is, what is after residency?

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After residency, I take two weeks off to recover, and then I start my permanent position at a MICU. I'm very excited to be working there! Down the road, I'd like to precept and teach, but also flesh out a few hobbies and get back in shape. I also definitely see myself picking up extra shifts from time to time in the various units I've rotated through in order to keep up the unit-specific skills I've gotten to learn through the year. (Being used to working pretty much every day, I think I'm going to have to really adapt to having so much free time!)

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