Thread by @gradydoctor

1/
#InternReflections, Day 5

ICU, 1997

Them: "You need to steer clear of Ida."
Me: "Which one is Ida?"
Them: *head gesture* "The one talking to our attending. She's legendary for going off on interns."
Me: *swallows hard*
Them: "Look. She even checks attendings."

I looked.

2/
Ida's hands were animated as she talked. I noticed the way her biceps bulged at the meeting of her scrub sleeve when she moved her arms. Her head was up and eye contact deliberate.

Ida: *hand gestures*
Attending: *listening*
Ida: *explaining something*
Attending: *nodding*

3/
It startled me when they both erupted into laughter. It was warm and respectful. The attending said something else and she said something back. Both gave knowing nods.

And that was it.

Them: "Most of the nurses here are cool. Not her, though."

I gave a tiny nod.

4/
Somehow I managed to avoid crossing Ida's path much. Because she was so experienced, she always had the sickest patients in our ICU. As a fresh new intern, those never seemed to be under my care.

I was glad.

The words fed forward to me about her shaped how I saw her.

Yup.

5/
I recall seeing her jump onto a gurney to deliver chest compressions to a patient who'd suddenly gone pulseless en route to a procedure. She gave clear, urgent orders to the nurses around her.

And they saved that man's life--before the doctors could even do anything.

Damn.

6/
I barely looked in her direction on rounds most days. My goal was to stay under her radar and learn as much as I could.

My resident would always mumble things about her to the rest of us--calling her "Cujo" -- like the murderous '80's canine from a Stephen King flick.

Eek.

7/
But then came that night on call. Ida, who was usually a day nurse, had agreed to cover an extra shift for a colleague. That meant I'd be there with her overnight.

*insert palpitations*

We'd be admitting. Which meant someone sick-sick might come in.

Damn, I was scared.

8/
Mostly things were busy but manageable. Finally, the admissions slowed down. I was glad. as afraid of Ida as everyone else. That helped a little.

A little.

Mostly things were busy but manageable. Finally, the admissions slowed down. I was glad.

9/
My senior went to check on an unstable patient on the floor. Though she suggested I go to the call room, I decided to lay my head down at the nurses' station instead.

Just in case.

No sooner than I dozed off, I heard Ida call for me. I didn't even know she knew my name.

10/
Ida: "Hey Kimberly? Can you look at Mr. Evans? He's not looking so well to me."
Me: "Me? Uh.. .okay." *looking for my senior*

Mr. Evans, who'd been admitted to stepdown for rapid atrial fibrillation, was now clutching his abdomen.

Ida was right. He didn't look so good.

11/
Me: "Mr. Evans? What's going on?"
Mr. Evans: *between breaths* "I . . I. . .don't know. I just. . .my. . .stomach feels like. . ." *closing his eyes*
Me: *raising voice* "Mr. Evans. . .sir! Talk to me, sir!"

But that was it. He slumped over and stopped talking.

Shit.

12/
Before I could, Ida checked his pulse--which was absent. And the rest was a gigantic tsunami of night nurses rushing to assist.

One nurse on compressions. Another RN with the crash cart. And Ida moving faster than anyone I'd ever seen in any hospital.

She looked at me.

13/
At this point, I'd seen many, many codes. But never had I personally run one on my own.

Shit. Shit. Shit.

Ida could see me craning my neck for my senior--or any senior--responding to the code alarm. She placed a hand on my shoulder.

Ida: *low growl* "C'mon little sis!"

14/
Ida: "Just focus on the patient. You know what to do."

I took a deep breath and thought through the ACLS algorithm. I tried hard to think of why this could be happening. Then I looked back at Ida.

Ida: "You got this. Let's check this rhythm."

And we did.

15/
Ida stood right beside me the entire time coaching me in that low, throaty growl through every instruction I called out.

Me: "Hold compressions. . ."
Ida: "That's it. There you go. . . ."

She also tenderly spoke to Mr. Evans--urging him to fight and saying we were here.

16/
When we couldn't get a return of spontaneous circulation, I saw Ida's teeth gritting.

Ida: *to Mr. Evans* "Come on, baby! Fight with us!" *swinging her head around* "Shoot! We need this airway!"

The respiratory therapist continued squeezing the ambu bag and nodded.

17/
Just then, the anesthesia resident came in and quickly intubated Mr. Evans--and moments after that, he regained his pulse.

Ida: "We've got a pulse!"
RT: "ET tube secure."

My senior and two other residents came running in. She looked at Mr. Evans and back at me.

18/
Her: "Holy cow! Wasn't he on stepdown? What happened?"
Me: "He had a stomach ache and then became unresponsive. I don't know!"

We spent the rest of the night caring for Mr. Evans. Turns out he had embolic mesenteric ischemia secondary to atrial fibrillation.

Whew.

19/
I'd only read about this happening. But it turns out that his chief complaint to EMS was belly pain--which quickly got swallowed up by his rapid ventricular rate as the focus.

Yup.

He'd ultimately go to the OR and survive. But damn, was that a scary night.

20/
It's funny. When I look back on that time, what stands out the most for me is how I let someone's negative interpretation shape my interaction with a member of our health care team.

Ida was passionate.
Ida was competent.
Ida was patient-centered.
Ida was DOPE.

21/
She also helped me to trust myself enough to step into the line of fire. She sure did.

I've encountered many Idas over the years. I'm careful about feeding forward slanderous opinions of people.

Especially those over whom I have influence.

Yup.

22/
I've no idea where Ida is now. But if I saw her, I'd thank her. I'd also apologize for laughing when my resident called her Cujo.

Lessons:
Form your own opinions.
Watch what you say.
For real.

I'm glad ICU fellows are in-house overnight now. I'm glad the Idas are, too.👊🏾