Week Two: I See You in the ICU

I spent most of this week shadowing different teams in the ICU. At the beginning of the week I joined the Infectious Disease Consult team as they discussed and visited patients with cases of complicated infections. The case I found most interesting was of a gentleman who had a relapse of malaria. This is very uncommon especially considering the patient claims to have followed his first round of treatment perfectly. The working theory is that he may be part of a small population of people who has a genetic mutation that could be preventing the malaria treatment from being fully effective. Additionally, there was a young boy who was severely obese with a skin infection. The attending explained to me how they have hard trouble testing his blood and getting any imaging done because they can’t access his veins and he does not fit in MRI machines. Additionally, one of the medications the team wanted to prescribe did not have much obesity data, so they had a difficult time deciding what dosage to prescribe. This made me realize how an unrelated problem can prevent all standard medical treatment plans and escalate the severity of the case.

              

       Later in the week I shadowed with the medical ICU team. It was a relatively calm day by their standards, but I was still overwhelmed by the amount of beeping and alarms, primarily because I didn’t know which ones were bad and who was responsible for responding to them. I felt helpless. It was emotionally draining to see so many patients who struggled to respond or were just lying unconscious, sometimes with their eyes open.

     

       During the week I visited the ER a few times. It was hard to walk through the hallways because they were lined with patients in beds. I was very interested in their point-of-care testing station where they run rapid blood samples on suspected sepsis patients. I hope to be able to shadow one of the technicians who does this sample process in the coming weeks.

           

      I had the opportunity to attend Microlab Plate Rounds, where the doctors gather to learn about what happens to cultures when they send them to the pathology lab. Largely this seems to be the slowest part of the diagnosis process because microbes can take days to culture. Preliminary results can be obtain using a machine called the BioFire in roughly one day but usually some form of broad spectrum antibiotics is started prior to this. This week has really gotten me thinking about how we can rapidly identify pathogens and their resistance and susceptibility to antibiotics. Additionally, I learned that the length of antibiotic regimens is not always an exact science, which was surprising to me especially given the fear of antibiotic resistance.

Figure 1. Alternaria spp. Probably Alternarai alternatum a type of fungi that causes opportunistic infections in humans. Taken during Microlab Plate Rounds

          I am still waiting to receive the data I need to start analysis for Dr. Glesby, but I did accompany him to the clinic again on Wednesday. All the patients made their appointments this time and I was once again surprised by the breadth of types of patients seen here. Many of the patients seem to be current or former hard drug users and many of them request frequent STI testing.  Attending case studies by the fellows and research presentation competitions again this week was very worthwhile.

               

        When not working I have been enjoying exploring NYC, despite the heat and humidity. Last week a group of us visited the Statue of Liberty, Ellis Island, and the 9/11 memorial. It was an incredible but emotional day of history and views. My favorite place thus far is Central Park and when I wander I often find myself ending up there.

Figure 2. Left: Statue of Liberty, Right: 9/11 memorial