The worst ten weeks of my life were spent on my acute care rotation. I was in surgical ICU for five weeks, followed by the medical ICU for five weeks. The former was run by an angry masculine woman named K, she had a no-nonsense persona and didn’t hesitate to give you direct criticism to your face. But K’s criticism was at least about your performance on rotation. The medical ICU was run by a madwoman with serious personality flaws whose criticism came behind closed-door sessions where she would attack my personality. I call her Hitler. She appeared nice at first but she actually hated me pretty thoroughly, I guess I remind her of her ex-husband. She looks like a witch with jet black hair and she decorated the walls of her workstation with the art of her gravely untalented child.
I started every day at 6:30 am and left at 3. Then I would go home and try to learn everything about what I saw that day because they grill you every day on every medication on every patient you saw. Then they’d have a topic discussion where they’d talk about some random topic and grill you a bunch about that. So you had a prepare a ton of stuff at home; I was spending 3 to 4 hours a day at home, so this was a 12 hour a day thing. Even when I was at home I’d have so much anxiety about the next day. K’s expectations were high but realistically achievable. Hitler didn’t even grill me on actual useful information; she would grill you about rare zebra shit like famotidine causing thrombocytopenia or penicillins causing acute interstitial nephritis. The student who preceded me shared my opinions on the entire experience as well, see below.
The group dynamic in the surgical ICU was alright. There were several other medical and PA students as well. The critical care nurses were on the floor, one nurse for every two rooms, they were good. The attending physicians were overall good. Some of them were comprehensive at rounds and we went slowly; others walked up to the room, talked for 2 minutes, then moved on with the patient examination. They were respectful and I wouldn’t hesitate to work with any of them again. They also had a jovial PA whose buoyant mood was well accented by his morbid obesity. Standing for the length of rounds was clearly a genocide on his knees so he sat down a lot. The one problem working in the surgical ICU was that I was physically isolated in a little storage room. All the residents and everyone else associated with patient care were in the resident room sitting next to each other. They all could talk and discuss treatment plans among themselves, so the patients I had worked up were based on old information.
The medical ICU was a different beast. I had to deal with Hitler there, whom I shall eternally loathe. The first week was neutral; everything was about the same as the SICU, but only because I didn’t realize how it was fucked up. The most senior resident was a cool Indian dude who liked Prince and acted really outgoing and friendly. They also had a nurse practitioner on staff, a youngish blonde girl who seemed wholesome at first glance. I mention these two in particular because I suspect they are backstabbing informants who demonstrate no loyalty to their peers. Stuff that I said to the group as a joke or in confidence was reported to Hitler who had a fun discussion with me about my personality. Something to the effect of “Stop having fun, stop being sarcastic, nobody likes you, I can fail you for lack of professionalism.” When you were getting grilled while presenting patients, she would just randomly go hostile on you if she didn’t like what you had to say. That made it really hard to continue presenting.
During this section of my rotation, I cried for 4 hours at home and 1 hour at the hospital. The hour I cried at the hospital, one of the attending physicians was in the room writing a note. His back was turned and I was crying really quietly so he didn’t notice anything I think. One of the most important skills is to realize when you’ve left reality to stumble into the legacy of totalitarianism. Like you thought you were just talking to your friends, but then a policeman comes and takes you to a baffling court where the charges against you are absurd and inscrutable. The ability to recognize which office has Kafkaesque politics is needed to identify where you must remain silent. Anything you say can be used as evidence at your trial; silence is the only logical behavior in this situation. I stopped talking to everyone else on the team; enforced silence turned my stressful situation into an alienating and frightening experience. I needed a good cry at lunch when the residents had left.
All I did after that was work hard and keep to myself. When I moved to the next care team, the group dynamics were better, but I had committed to silence so I remained silent. I feel like their members were genuinely nice people, but I couldn’t open up because then I would gamble on Hitler’s wrath. Hitler also had the fun habit of insulting me just randomly. Like I was presenting a patient and going through the chart when she was just like, “Apathyfactory, I feel like you don’t care.” That actually was unnerving because I was spending something like 75% of my waking hours on this stupid fucking rotation.
Towards the last week, it got a little better. I had good working relationships with the people on my care team and got to meaningfully participate in patient care. Hitler lightened up a little bit, but I didn’t trust her at all so I still did my gargoyle impression the whole time. I couldn’t tell whether she warmed up or whether she entirely gave up on me. She tried starting a few conversations along the lines of “Are you interested in hospital pharmacy now? Aren’t I a great preceptor?” My responses were always prevarications that students are forced into returning as feedback in a small insular pharmacy community to the effect of “Thanks, I learned a lot.”
The following was written over several months by the student who preceded me, which I present with minimal editing. I corresponded at length with her because of how uniquely isolating the experience was, and how much we both suffered at the cause of it.
FYI – I’m straight up gonna KILL [Hitler], and I don’t mean that in a haha sort of way…I am literally going to stop her heart!! She is so nitpicky, overbearing, is a control freak of the highest magnitude, and does not take well to others not accepting her recommendations. I think she is so used to the residents and interns and med student kissing the ground she walks on, that she freaks out if her recommendation isn’t accepted.
Not the be the bearer of awful news, but MICU is 100 times worse than SICU, and, honestly, it’s because of [Hitler]. I have awesome days whenever she isn’t there and I am working with a reasonable pharmacist…you’ll see what I mean in 2 short weeks. She is obnoxious. I only tell you so you can prepare yourself. [Hitler] acts all nice and smiley on the outside, but she is bat shit crazy.
K isn’t going to make you go to the team and recommend that they TKO the patient’s fluids, because many patients get fluid overloaded in the ICU….that is the level of nit picky. She goes far beyond a pharmacist’s scope of practice. She even pulled up a CXR today and started saying that there is no reason to be suspicious of PNA, because, despite what the radiologist said, there weren’t infiltrates visible on the X-ray.
Also, if someone doesn’t want to take her recommendation, she harasses the shit out of them until they give in. Fortunately for her, most of the people she is dealing with directly are the residents/interns/students, who are easily bullied.
And I’ve tried ignoring some of her questions before and hoping she will forget, but she hounds the shit out of me. Woman is obsessive. She writes about 5-10 recommendations for you to approach the team with on rounds, and I would say 50% of them are necessary, but she makes you recommend it anyway.
She also may harass me more, because I give her some pushback, which she doesn’t like, and I don’t know all of the details she does. You may know all of the details she expects (liken at Keppra has a 28% risk of causing irritability, and famotidine causes thrombocytopenia). If she thinks you know all the details, she may back off.
Why does the patient has bradycardia? Well, it must be because in some rare subpopulation of humans, famotidine causes bradycardia. Gaaaawwwwwd.
Whatever. Be happy I know it is renally dosed. And isn’t necessary after extubation, unless the patient has baseline GERD or something. I will leave you with one of her favorite quotes: “every drug every day”…in reference to knowing the dosing, all adverse effects, and possible d/d interactions… As if we have time to do an interaction check on every patient and all of their 20 plus medications every day. I’m gonna go ahead and assume that the pharmacist who approved this order knew what they were doing, and didn’t disregard any interactions that the computer alerted him or her to.
Can you imagine that being your job full-time? How can I fuck with their sedation today, wen though they are perfectly fine where they are at?
[Apathyfactory], don’t get me wrong, I can be dramatic, but I am on par with my assessment of this lady… Not trying to stress you, just want you to be forewarned, because maybe it won’t be so bad if you go in thinking the worst.
I feel really bad for [the pharmacy resident]. I agree that she is definitely intelligent, it’s too bad that [Hitler] makes everyone feel so uncomfortable and nervous. Watching her go through this residency crap made me realize I would not want a residency, and especially not at [this hospital].
“It’s ironic that the patients in the ICU are dying because we’re getting killed by acute care.” – Me, to the other student