MICU

Well everyone, the rotation is over. Unfortunately, I no longer have access to a computer that can download my images, so my pictures will be posted when I get back home on Feb. 10th. This will be my entry on the MICU.

My last week was in the medical intensive care unit (MICU). Since I like the ICU, I'm a little biased, but this rotation is tied with the village rounds as my favorite part of my time here. The cases are incredible, the situations sad, and the impact on people's lives are on a grand scale. The incredible part was the cases and the physicians that work there. From Dengue Fever, DIC (diseminated intravascular coagulation), to attempted suicide by organophosphate poisoning (drinking pesticides) they have things we only read about in the U.S. The physicians are light-hearted, but extremely caring.

Of course, 3rd world medicine has its depressing moments as well. Everyone is self-pay, so many who cannot afford ICU level care don't get it. I found out this is why patients are on vasopressors and ventilators on the wards. I also found out that the ventilators on the wards don't have any pressure support (sorry for the medical terminology for the laymen reading) so weaning is difficult. Monitoring is also intermittent, so no arterial lines, CVP monitors, and such are on the ward. On a few occasions patients requiring ICU level care were transferred out of the ICU because they cannot afford it. Physicians are also upset about it, but in order for the hospital to stay afloat, it must operate in such conditions.

I would also like to comment about the attempted suicides. This is a large problem in India, with organophosphate poisoning ranking the top choice to end one's life. The critical care attending mentioned they saw in their ICU last year 217 attempted suicides...a whopping 18 attempts per month. The most common reason is failure to cope with life's circumstances, and usually those circumstances are extreme poverty, debt, or loss of health. One of our attempted suicides fit such a case: a 19 year-old male who lived on the streets as a beggar. With no apparent family, no home, he tried to end his life. The other was a sort of odd profile: a 58 year-old woman who became upset that their daughter or granddaughter (I couldn't sort out which) refused to marry a man the family had arranged because she was in love with another man. Apparently, she did not feel she could live with with this dishonor. Making matters even more complicated is that there is no form of home health in India, so once patients are discharged from the hospital, they are no longer in the system. Within this framework, the physician must attempt to help the patient cope with their life. It is a tedious and often discouraging job, but the physicians at CMC tirelessly hold the hand of their patient and do their best to show that someone in a seemingly hopeless world cares for their souls.