Saturday, April 30, 2005

End of a Chapter

Last call for MICU. In fact, last call for my career (coverage for sick colleagues excluded). The rest of my medical training here will no longer involve in-house call.
I have a few more hours to go before I'm done and rid of the ICU. But I spent a great deal of time today reflecting.
One, on rounds, reflecting on the miracles (and curse) of modern medicine, of the amazing technology we have that allows us to help the very sick. Airlift helicopters that bring patients directly to our hospital. The most modern of ICU medications or protocols that as far as I know are not yet available in Malaysia (activated protein C for sepsis, hydrocortisone infusion for severe pneumonia). Out-of-this-world gadgets (HFO: high frequency oscillator which ventilates ARDS patients with ultrahigh respiratory rates. This one lady is being ventilated with 300 breaths a minutes, with baby breaths!!). The curse is, with our abilities we sometimes prolong death when there is no more life to sustain. Case in mind, when an elderly lady coded at 230am today with no electrical rhythm (asystole, notoriously difficult to bring back) we resuscitated her for 10 minutes until someone shouted back, "Pulses!". She was transferred to the ICU where I took over care. When she was being wheeled to my unit, all of us doctors were feeling pretty good about ourselves, almost to the extent of high-fiveing each other for bringing her back. Until I did a thorough exam on her in the ICU. Fixed dilated pupils, no gag, blink or doll's eye reflexes. In other words, she was probably brain dead, and our medical know-how allowed us to bring her back despite that. Just before I left the ICU for good, I had a talk with her family and suggested we withdraw support.
Also did a lot of reflecting on my residency. Tonight was our official senior graduation dinner; I was able to leave the ICU for 5 hours to attend that. One realizes that this place holds a lot of memories, good as well as bad. Many good friendships that were fostered. And, despite where we all go, how our paths diverge, friendships that will last a lifetime. And no matter what happens, nothing can change the fact that we were trained at Mayo. That was in our program director's speech. True.
Officially, residency has another 2 months. But, our graduation dinner has come and gone. Internal Medicine, Class of 2005.

Henry, Rachel and I. Enjoying a pre-banquet cocktail.

Group photo, some of my classmates and I.

Dinner at the banquet hall, Foundation House