I'm always a little restless the night before a new rotation. Sunday night was no different, and I laid awake in my bed for longer than I'd hoped to, worrying about leaving behind the intensive care unit (the ICU) and switching to the general medicine floors.
At about six o'clock Monday morning, I walked into the room of a 91-year old guy admitted with antibiotic-related diarrhea. "How're you doing?" I asked. "Anyone I can get my hands on," he said, and cracked a little grin. Instantly, I was back.
What I worry about most prior to starting rotations is whether anything in the new place will make me laugh. It's not an issue in adult intensive care units; staff humor in the ICU is notoriously dark and free-flowing, and that's part of the unit's appeal. In my most recent ICU rotation, I overheard a fellow prognosticating based on the shapes of her silent patients' gaping maws: an "O" sign (patient unconscious, mouth open and toothless) was bad, but a "Q" sign (same, but with the tongue hanging out the side) was worse. An intensivist who is locally famous for taking on patients with complex social and medical problems named a quotient after himself to predict his patients' lengths of hospital stay: (age ÷ trailer park lot number) + I.Q. One attending signed out to another that he planned to discharge a patient upstairs within several days (our ICU is on the top floor of the hospital). Others tell dirty jokes with reckless abandon, send residents on false and improbable consults--Siamese twins! With necrotic livers!--and giggle wildly at references to poop.
Death is all around them; they're coping, of course. And the coping is fun.
When none of my patients can really talk--and most of them in the ICU cannot--I forget that sick people need to cope, too, and that some of them want to laugh as much as I do. Apparently, some of them even want to make me laugh.
I'm happy to oblige.