MICU adventures

Last week I started in MICU. Fortunately, the motto of MICU is "we only take them to our service if we can improve there quality of life". Throughout the day, many consults come in from attendings on the floor for patients that may need extra help. The consult team has to decide, do we take this patient or not? Last week, an 85 year old man with 4th stage laryngeal cancer was turned down because coming to our floor wouldn't benefit him at all....the guy is on his deathbed and palliative care is a much safer option than bringing him to a floor that does all they can to save people. I am sure there are some in the hospital that do not like the fact that MICU is so picky when it comes to taking patients, but when you have limited resources and staff, you can afford to be picky.

Yesterday was the start of week 2 and it was nothing but exciting (from a medical standpoint). Because of my love of emergency I was given the 23 y/o patient who accidentally overdosed on iron pills. It was quite interesting to see her progression throughout the day....the iron was destroying her liver, GI tract, and kidneys....she was slowly dying before us. My superior senior resident was on the phone with all of the major hospitals (Mt. Sinai, NYU, Columbia) trying desperately to transfer her out because what she really needed we couldn't provide....a liver transplant. The problem: the patient was not a citizen of this country and therefore does not qualify for the $500,000 procedure. As the day progressed she looked worse and worse. The critical care fellow had a great idea to rectify the situation....have the patient sign out AMA (against medical advice) and drive to either Mt. Sinai or NYU and go to the emergency department. Sounds weird but it happens all the time and it works because of federal law....once a patient shows up at the ED care has to be given and if that patient happens to be in liver failure and she shows up at the ED of a liver transplant hospital, well then guess what?? Her chances of receiving the necessary care just increased. The problem with this....the patient was just too unstable even for her family to drive her. Unfortuntely for this patient, she just picked the wrong hospital to come to that morning. Eventually, by mid afternoon, NYU agreed to take her and she was quickly whisked away to their medical ICU. But whether or not she gets the liver transplant is anyone's guess...she may just spend her last days in the MICU at NYU instead of Coney Island.

Oh, I also got to show my superior CPR skills yesterday on an elderly patient who coded on our floor. We got her back....but only long enough for her family to come to the hospital and say goodbye....she passed away about an hour later :(

Okay, back to work. Have a great day!