One week in ICU has taught me a lot. Most important thing it has shown me is the “other side of the fence”. For 9 weeks, I have spent all my efforts in trying to sell my patients to ICU consultants so that they may have HDU beds post-op. You pull out several excuses like “this patient has extensive disease and will need a prolonged anaesthesia” or “this patient has severe IHD…but has been asymptomatic since his CABG 3 years ago, BUT he has hypertension >.>” What can I say? We interns exist to please our consultants and registrars and so when they say “Daniel, book an ICU bed for this patient post proctocolectomy”, I say, “Sure, I’ll go do it now.”

Throughout this week, I have seen colorectal patients come through ICU post-op, some of which I remember making the referral for and seeing in pre-admission clinic. I’ll be honest…none of them needed ICU. However, back in my recent memories is a lady who died post-op from renal failure because she didn’t have an ICU bed and couldn’t receive haemofiltration in time after deteriorating on the ward. I can’t say that she would have definitely survived if she had gone to ICU post-op but it is probable that she would have had better vascular support than a couple of inexperienced interns on the ward. What was supposed to be a simple elective surgery ended in tragedy and who is to blame?

Of course we don’t play the blame game in medicine but it is a fact that ICU rejected our referral for an ICU bed post-op. And it is a fact that she was fluid overloaded by over-aggressive fluid resuscitation after the first MET call but was not taken to ICU. And it is a fact that she was taken to ICU the next day after we screamed for help…only for them to pour more fluid into her, hit her kidneys with high doses of frusemide, and then turf her back to the ward in the middle of the night. And it is a fact that after she returned to the ward, the medical registrar we asked to see her thought she was overloaded with a relatively normal BP and urine output so her fluids were stopped to “dry her out”. And lastly it is also a fact that as her renal function continued to deteriorate, there were no ICU beds and we weren’t confident enough to give her the aggressive fluid resuscitation she needed…so she became uraemic, narcotised, acidotic and died the next morning.

I don’t know…honestly…