By VIPAN NIKORE, MD
Six months down. Six to go. I am officially halfway through what people have told me will be one of the most challenging years of my life. I’ve rotated through Cardiology, Primary Care, Gastroenterology, General Medicine, Psychiatry, Palliative Medicine, the Medical Intensive Care Unit (MICU), and Rheumatology. Finally I have reached every resident’s favorite rotation – vacation.
Intern year has been hard work, but I’ve enjoyed it and am extremely pleased with the experience my Internal Medicine program has provided. Each rotation has taught me a tremendous amount and helped me grow as a physician, but the most profound impact occurred during my back-to-back rotation in Palliative Medicine and the MICU. Last August, Atul Gawande wrote an insightful essay titled “Letting Go” in The New Yorker. He vividly illustrates the different mindsets for treating patients in palliative medicine compared with doing so in the ICU. He discusses the lost art of dying and how palliative medicine can help us regain that art. I was fortunate to have witnessed this sharp contrast by working in palliative medicine immediately followed by working in the MICU for a month.
The sights and sounds while walking through the halls of our Palliative Medicine floor are unique. One moment, I might walk past the “Caring K-9” dog, and the next moment I might hear peaceful sounds from a talented violinist as I walk by a patient’s room. As Gawande mentioned, the goal in palliative medicine is comfort, and any measure that may enhance comfort is fair game. Contrast that experience to the ICU, where I might arrive to work at 5 a.m. and by 5:01 a.m. might be doing compressions in attempt to restart a stopped heart. No morning coffee to settle in, no dogs roaming the hall, no violinists. It is intense and unpredictable in the ICU. Generally the goal is the keep the patient alive at all costs.
