The very first day of my problem based course in medical school, our Dean of Medical Education went around the table and guessed what each of us would end up doing for the remainder of our medical careers. When he got to me, he said, “Dale, you’ll be a critical care intensivist.” I smiled in agreement although I had absolutely no idea what that was. 11 years later, as a practicing Pulmonary & Critical Care Intensivist, I know exactly what that is. Dr. Hosakawa was right.

During my residency training, I was determined to focus my career on things pertaining to business and entrepreneurship within medicine. I had applied to and was accepted into a Health Service Research Fellowship and was one step away from matriculating into one of the nation’s best MBA programs. Then I did my ICU rotation. Where I trained, the ICU was a beast to deal with. Q3 call (i.e. every 3rd night we stayed in the ICU for a 30 hour shift) with some of the world’s most complicated medical patients. The loud beeps, oddly shaped machines, and unconscious patients were enough to give me nightmares. But the rush of the code, the gratification of revival, and the smile on a patient’s face were more than enough to give me pleasant dreams. After seven straight weeks of q3 call in the ICU, the decision had been made. I’d go on to do my pulmonary & critical care fellowship while at the same time, working to bring my entrepreneurial visions to fruition (but that’s a story for another time).

When my doctor hat is on, my greatest joy comes from being in the Intensive Care Unit (ICU). There’s an understanding that the “buck stops here.” When everyone else has done what they can for the patient, if things aren’t going well, that patient will likely end up in the ICU. Everyone looks to you, and if you and your team can’t figure it out….

My typical ICU day begins at 6am. That’s when I wake up 😉 (not when I get to work). By 6:50am I’m on the road and at work around 7:30am. Some people would say that’s a long car ride, but it’s just time for personal growth as I listen to tons of audiobooks in attempt to be my very best. From 7:30am to 8am, I do a cursory review of the patients in the ICU to make sure there were no major issues overnight or anything that needs to be handled immediately (e.g. actively dying patient). Then at 8am, the games begin.

One of the things I love most about my job is I get to teach residents, fellows, and medical students. I also allow premeds to shadow (so if you’re in the Dallas area send me a message on PreMed StAR). Mornings rounds begin at 8am as the team gathers around a large table. Typically, the post-call resident (the one who worked overnight taking care of patients) then presents their patients. We get all sorts of things in the ICU. Heart attacks, ILD flares (somebody look that up and post a comment/reply to this blog explaining what it is to everyone), pulmonary embolisms, septic shock, etc. It’s really exciting to sit down at that table and have no idea what the resident is going to tell me. It’s almost like playing detective.

We typically do our sit-down rounds from 8am to around 9am. This is when we hear the case presentations of the new patients, look at labs, EKG, X-Rays, and all other supporting data that helps of take care of our patients. It’s an ideal time to do short lectures/chalk talks to teach the new physicians various pearls in caring for critical patients. Often times we teach in the form of “pimping”. No we’re not putting them out on a corner. Pimping is a method of teaching in which we choose a trainee and ask them question after question after question. When intense enough it’ll make anyone sweat. Personally, I’m not much of a “pimp” myself because I remember the anxiety that comes along with the string of questions, but it is an effective way to teach. Trust me, when you’re pimped in front of your peers, you’ll remember the answers to the questions you missed and read up ahead of time to make sure you’re ready for the next session. However, there are plenty of other effective methods that can be used to teach.

From 9am to about 11am, we do our walk rounds. During this time, we get up and walk through the ICU. Before we enter each patient’s room, the resident presents the events that occurred overnight. We then look over vital signs, consultant notes and ask the nursing staff if there are things they need us to know or orders we need to write for them. Next, we enter the patient room to examine them, look over the various life support machines (e.g. ventilator, dialysis machine, etc.), and ensure the IV medications are appropriate. Once walk rounds are over, the trainees usually do any procedures we need done and if they need any extra assistance, I’m there to help. The rest of the day is spent putting out fires (e.g. code blues, respiratory codes), writing notes, and doing more teaching.

There are few things I enjoy more than serving critically ill patients. The life of a physician is wonderful and once you find the perfect field for you, there is plenty of joy to be found. Perhaps next time I’ll share my passion for entrepreneurship in a blog.

My question to you this week is; What field of medicine are you interested in and why? Post your comments below so others can learn more about you!  

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