Two Weeks Later: Reflections After the ICU

My wife was right: it wasn’t so bad. 😅

The first day was rough.

I showed up without a clue what to do and was completely unprepared for rounds. When my attending asked about my plans for each patient, I said, “I don’t have one.” I hadn’t even had time to pre-round or do physical exams.

But my attending was kind and understanding. He told me it was okay not to have everything together on day one—but tomorrow, I needed to see my patients and come prepared with a plan. My job as the intern, he said, was to gather information, write the notes, and know my patients.

Roger that.

The next day, I came ready. I saw all my patients, had plans prepared, and although my presentations were still shaky, I had most of the information I needed when asked.

What I quickly realized is that while the ICU is intimidating, the culture at my program is incredibly supportive. As long as I made an honest effort and kept improving each day, I was met with patience and respect.

By the end of the rotation, I received positive feedback. The bar for Transitional Year interns is understandably low, especially early on—and I had cleared that first hurdle. Now, I feel much more confident in myself and ready to take on the rest of intern year.

But this rotation did more than just teach me how to be an intern.

Spending long days caring for critically ill patients made me painfully aware of how fragile—and valuable—good health is.

Most nights, I’d make it home just in time to read my daughter a few books before bed. I just wanted to hug her, kiss her, and hold her tight. I’m so grateful she’s healthy.

Then came dinner with my wife, cleaning up, and getting ready for bed.

Rinse and repeat—13 hours a day, 6 days a week.

But even when the lights were off, I wasn’t sleeping well. My mind kept replaying the day—thinking about my patients, what I learned, and how I could be better tomorrow. It was hard to turn it off.

Most patients recovered and transferred out of the ICU after a few days. But not all.

One patient—a relatively young man with end-stage COPD—was no longer a surgical candidate because of how badly smoking had damaged his lungs. Palliative care recommended hospice. I watched him gasp for air, suffocating in front of my eyes during an exacerbation. He simply didn’t have enough lung function left to breathe.

Another patient had suffered a hemispheric stroke and developed meningitis. After several days on the ventilator, his wife made the decision to withdraw life support. I was in the room when he was extubated. I’m not usually an emotional person, but I had to step out of the hospital and cry on the phone to my wife.

One young man with cerebral palsy and seizures reminded me of my nephew, Jack. His condition was so severe that it made me grateful for Jack’s relative health.

And then there was the patient whose systolic blood pressure suddenly spiked to 290 mmHg. He was paralyzed by the chest pain. We all watched anxiously as our attending brought it under control with a Cardene drip.

And of course there was the frail and very elderly woman with an active GI bleed, a poor candidate for intervention, who was full code.

As I progress through intern year, I know I’ll continue to meet patients who leave a lasting impression on me.

The ICU was challenging, but it helped me grow—not just as a doctor, but as a person.

Looking back, my fear stemmed mostly from the unknown. I had written, “It feels like one wrong move could lead to someone’s premature death.” But in reality, I was never placed in a situation where I was alone with that kind of responsibility. When a patient decompensated in front of me, I didn’t have to manage it on my own—I had seniors and attendings to call on for help.

Once I showed up and completed that first day, I realized it wasn’t nearly as bad as I had built it up to be in my head.

In fact, by the end of the first few days, I was enjoying the work. I was learning, growing, and even laughing with my co-residents between moments of intensity.

This rotation reminded me that fear often comes from not knowing—not from actual danger.

And that showing up, even when you're afraid, is often the hardest part.