Self-Prescribing

I have been living in the Medical Intensive Care Unit this month (aka, "MICU", "M.I.", "Mic Uoo"). The sickest of sick people come through here. I have seen many people die this month despite the most valiant efforts of the best of Western Medicine. Yesterday was a crazy morning, for example. At one time we had someone being intubated (a breathing tube getting put down their throat) and 2 "Code Blues" going on at the same time (that's when someone is actively dying--not breathing and no pulse). The 1st Code was on a patient that was an alcoholic "found down" and unresponsive in his apartment by his friends after a binge of drinking. He was hypothermic (body temp was 90 degrees) and had no brain stem function. You can't declare someone dead, however, until they are normal body temperature. When he got warmed up, he actually started waking up some, but was very, very sick. That Code lasted for a long time. He regained his pulse and blood pressure a few times, but a few coding-episodes later, he died.

Simultaneously, I was cheering on a fellow resident preparing for a non-urgent intubation. While I was outside the room, the nurse from the room next door calls for my help stating his patient's blood pressure is only 29/13! I quickly went in there to find out he had no pulse, and I quickly initiated chest compressions (this patient was already intubated). It took a couple minutes before more people came in to help out. Thankfully, this code did not last that long--the patient quickly regained his pulse and blood pressure after some intervention.

All this happened before 10am.

FYI: some stats regarding "Codes": [Saklayn:]
- It's bad news. The survival rate is far, far, higher on T.V. than it is in real life.
- Only 30% survive at 24 hours.
- 13% survive 1 month.
- 6% survive 6 months.
- Survival to hospital discharge is only 10-15% for ALL patients, but <5%>15 minutes, patients don't live to 6 months.

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Seeing these many sick patients in the hospital has inspired me to compose a preventative medicine list.

Preventative Measures I Have Decided to Take:

1. Never smoke.

2. Don't become an alcoholic.

3. If it is ever slightly suspected that I might have sleep apnea (daytime sleepines, snoring, etc.), get a sleep study ASAP, and USE my CPAP every night. [Right heart failure is AWFUL, AWFUL. Preventing this is also coupled with #1 and preventing COPD.]

4. When I get to be 40 years old, taken an aspirin every day. [Prevent heart attacks and strokes.]

5. If there is any concern about my heart (ie: chest pain, exercise intolerance, etc), get a stress test.

6. If I start to feel really sick, don't feel bad for going to the hospital sooner than later.

7. Unless I am having a heart attack, take me to University Hospital for care. Other private hospitals are scary in their treatment decisions, and often doctors are not in the hospital overnight. Multiple residents are here overnight just waiting for admissions to come in.

8. If I develop a blood clot to my lungs, take my blood thinners every day. (to prevent right-sided heart failure from developing).

9. Double-glove during invasive procedures--take every precaution to not get Hepatitis C through a finger stick. End stage liver disease is one of the worst ways to go.

And finally . . .

If it looks like my condition is terminal, change my resuscitation orders to DO NOT RESUSCITATE. Staying stuck on a ventilator is NOT cool.