Chapter 161: Trials in the Intensive Care Unit

Zhou Can bowed his head in deep thought.

After working at the hospital for so long, whether it was during his internship or the eight-month trainee program, his understanding of the ICU was actually very limited. To most doctors at Tuyu, the Critical Care Medicine Department seemed like a mysterious realm.

Deputy Director Ye personally arranged for him to train in Critical Care Medicine for three months—a decision brimming with hidden significance.

“Perhaps many of you are still unfamiliar with Critical Care Medicine. Let me begin with a brief introduction,” the speaker explained.

The speaker did not urge Zhou Can.

“At present, the only fully established unit is at Tuyu Main Hospital’s Critical Care Medicine Department. The Respiratory and Critical Care Medicine unit is merely a branch, not very different from the specialized ICUs in General Surgery, Cardiology, or Obstetrics. Many of you may have visited a specialty ICU during your internships or training. But let me tell you, true Critical Care Medicine is vastly different from those specialized ICUs.”

Everyone listened intently.

Tuyu Hospital was like a complex metropolis with numerous and varied departments.

Even as doctors here, without sufficient seniority, one might know very little about the hospital’s other departments.

“What you see in specialty ICUs is essentially just a monitoring ward. There is a considerable difference compared to the comprehensive wards of true Critical Care Medicine. The construction of specialty ICUs is based on departmental needs. When it comes to technology, management, and equipment, they can only be described as ‘inexperienced’. Their main purpose is for patients to receive ECG and oxygen monitoring, with very limited rescue measures.”

The speaker was rather vague in his wording.

In other words, he was telling everyone that the specialty ICU is an amateur level facility, while only the Critical Care Medicine Department is truly professional.

Zhou Can couldn’t help but recall the ambition Qiao Yu had mentioned.

She had said that after working for a while, she would strive to pass the Critical Care Medicine assessment and gain some experience there.

It seemed she had long studied Tuyu’s Critical Care Medicine Department in depth.

Back then, Zhou Can had wondered why it was said to be so difficult to work in the ICU when the Emergency Department had one too!

Now he realized that what she intended to join was this true Critical Care Medicine Department.

“In principle, each trainee only gets one chance to apply for a three-month stint in Critical Care Medicine. Once you become an elite in your specialty, there might be an opportunity to further your training here, or even be transferred directly into the department. But such chances are very slim. So cherish this one month and learn as much as you can about Critical Care Nursing and resuscitation techniques.”

Hearing this, regular trainees only had a one-month stint in Critical Care Medicine, but Zhou Can was given an extra two months—a special privilege.

One should never pass up a bargain.

Zhou Can already began to calculate the benefits in his mind.

A little more pressure and a bit more work for three months meant mastering resuscitation and critical care—which would be immensely beneficial for his future practice.

He could faintly sense the fierce competition among the hospital’s departments.

Specialty departments didn’t want the Emergency Department to grow stronger; they hoped it would remain merely a triage station.

Similarly, the Critical Care Medicine Department was in competition with the specialty ICUs.

Every department was striving to prove its unique worth.

Otherwise, they would soon be replaced and eliminated.

The harsh rules of the professional world were omnipresent, forcing every individual, department, and institution to enhance its competitiveness.

In a way, this was the mark of societal progress.

“Zhou Can, what do you think?”

After outlining the differences between the Critical Care Medicine Department and the specialty ICUs, the speaker’s gaze returned to Zhou Can’s face.

Wasn’t it obvious that the whole introduction was a subtle persuasion meant for him?

“I am willing to train in Critical Care Medicine for three months. I am grateful to Deputy Director Ye and all the leaders for their support.”

Once he understood everything, Zhou Can agreed without hesitation.

Extending his training in Critical Care Medicine by two months meant that his time in other departments would be reduced.

For an ordinary trainee, this wouldn’t make much of a difference.

But not for him—he had to rotate through multiple surgical departments and also Internal Medicine.

So far, he had already spent eight months of his 36-month training, and adding the three months in Critical Care would consume nearly a third of his time.

“Excellent, excellent! One day, you will realize that the choice you make today was extremely wise,”

The speaker beamed with relief as he saw Zhou Can agree.

After a moment’s reflection, Zhou Can understood the hidden agenda.

If the task assigned by Deputy Director Ye wasn’t accomplished, the speaker would surely lose points in Ye’s eyes.

“Next, let me introduce the sources of patients for Critical Care Medicine. They can be roughly divided into four categories: The first category is patients with acute reversible diseases—such as various types of shock, post-major surgery cases, severe trauma, serious infections, acute poisoning, and post-cardiopulmonary resuscitation. For these patients to be admitted to the ICU, a key requirement is that effective intervention clearly reduces mortality.”

This type of patient should form the majority.

While training in General Surgery, Zhou Can had observed that many post-operative patients were specifically instructed by the chief surgeon to be admitted to the ICU for close monitoring.

On the other hand, patients with conditions like acute cardiac poisoning or severe infections were rarely seen in General Surgery.

“The second category is high-risk patients. These patients, with underlying conditions, might be about to undergo high-risk invasive surgeries—such as severe pancreatitis, critical asthma, organ failure, or obstetric crises. Admitting these patients helps to prevent complications, cut medical costs, and shorten hospital stays.”

Many patients, when awaiting surgery, might never meet the strict criteria for operating unless they are admitted to the ICU.

In such cases, opting for ICU admission to stabilize life before scheduling surgery is a sound choice.

Many believe that an ICU stay is just a money pit, but the opposite can sometimes be true.

Occasionally, it might actually save on medical expenses.

Imagine the staggering costs incurred when multiple complications erupt.

Moreover, these complications can severely prolong hospital stays.

“The third category includes patients with chronic diseases during an acute exacerbation. The ICU can help them navigate the crisis and, ideally, return to their baseline chronic state—for instance, patients with a worsening of chronic respiratory diseases.”

These patients are very common.

The saying ‘money can buy life’ often refers to this group.

For them, an ICU admission can indeed stave off the grim reaper.

Once they pull through, they have a real chance at a normal life.

“The fourth category comprises patients with irreversible, malignant deterioration—for instance, those with massive bleeding that defies hemostasis, terminal cancer, or elderly patients awaiting natural death. The primary purpose of treating these patients is to honor and respect life.”

These cases are usually seen in wealthy families, where money is no object.

Typically, as long as the family refuses to remove life support, these patients can remain in the ICU for a very long time.

Basically, unless brain death occurs, they can continue to be kept alive.

It is worth noting that almost no one survives upon leaving the ICU in the fourth category.

They are well aware of their fate even before entering the ICU.

It is purely to prolong their lives, nothing more.

Of course, one must also realize that the willingness of these patients’ relatives to pay exorbitant fees speaks to their deep emotional bonds.

For instance, children unwilling to watch their nurturing parents pass away would spare no expense—even if it only meant a few extra seconds of life.

“The patient sources for Critical Care Medicine broadly fall into these four categories. I provide such detailed explanations so that once you begin working here, you’ll have a clear understanding of the treatment directions and objectives for each category,”

the speaker announced in a loud, clear voice.

Each category demands a different treatment focus.

For surgery preparation, one must strive to minimize complications and provide the best nutritional support possible.

To extend life, every effort must be made to prevent death.

After listening, Zhou Can could already feel the intense atmosphere of the Critical Care Department.

“When admitting patients to the ICU, aside from the four standards I mentioned, there is one very important metric—the mortality scoring system. Take, for example, the Acute Physiology and Chronic Health Evaluation system. Based on various physiological parameters, patients are scored to predict mortality. Scores between 15 and 35, indicating a mortality rate above 15% but below 85%, are ideal for ICU admission.”

This scoring system is currently the golden rule for ICU admissions.

Patients with a score predicting a mortality rate below 15% are generally admitted to specialty ICUs or regular wards.

For those scoring above 85%, unless the family is extremely wealthy, doctors, out of conscience, suggest spending their final moments in the resuscitation room.

Of course, this standard should not be applied dogmatically.

Some patients may have a predicted mortality rate above 85%, but if the attending physician believes that surviving the most critical period is possible, they will be admitted.

Lowering the hospital’s overall mortality rate is the fundamental goal of the Critical Care Medicine Department.

“Now, let me explain the team divisions. The clinical medical team is divided into three groups, working in eight-hour shifts around the clock. The nursing team comprises five groups working twelve-hour shifts. Remember, working in Critical Care is extremely demanding—so brace yourselves,”

The doctor-to-nurse ratio is about one to three.

One doctor is responsible for three nurses.

Every patient receives one-on-one care.

A doctor can manage at most three beds.

It’s like a battlefield—wherever there’s a need, you charge in without hesitation.

“Alright, that concludes the basic introduction. If you have any questions, approach your senior doctors. But I must stress that while working in the critical ward, you should speak less and do more. Your superiors need to focus on handling emergencies. Interruptions, even with questions, can cost you—if not a scolding, then a trip to me, so that I can set you straight.”

The speaker first laid down the rules for the thirty-two trainees.

It was a whole different system compared to regular departments.

In specialty wards, doctors take a more relaxed approach; casual chatter is common even more than questions.

“Now, let’s assign your supervising doctors. For now, only resident physicians can accompany you. Those who perform exceptionally may earn the opportunity to be directly mentored by an attending physician.”

The term ‘flipping the card’ is akin to the emperor choosing which consort to spend the night with.

In other words, earn the favor of an attending physician, and you might get personal mentorship.

Following an attending surely means absorbing more advanced knowledge.

“Zhou Can, your supervising doctor is Attending Hu Yi Ba.”

Zhou Can was the first to be announced.

Everyone could tell that this trainee, Zhou Can, was receiving special attention—completely in a class of his own compared to the others.

A few of the trainees from General Surgery who came along with him knew that his talent far exceeded that of the average trainee, so this special treatment was no surprise.

Those who didn’t know him were already grumbling quietly among themselves.

Damn it—what well-connected person is wasting their influence here to put others down?

Under normal circumstances, how could a trainee possibly receive such special treatment from the Deputy Director? For many trainees, they hadn’t even seen the Deputy Director in person to know if he was fat or thin, male or female.

“Jin Mingxi, your supervising doctor is Yuan Kun. Chen Hao, your supervising doctor is Luo San Zhang…”

Unlike training in other departments, here the mentorship appeared to be on a one-to-one basis.

This arrangement put everyone at ease.

Having one-on-one guidance from a resident physician was already a considerable perk.

Only Zhou Can’s treatment was one level higher.

Soon, all the supervising doctors were assigned. Except for Zhou Can—who was to be directly mentored by an attending physician—everyone else was paired with resident physicians.

“Do you see this schedule? It shows your supervising doctor’s duty roster. If your supervisor isn’t on duty, you can familiarize yourself with the protocols in the office or even go home and adjust your schedule to match theirs.”

Without a mentor, you probably won’t even get through the door of the ICU.

Zhou Can checked Attending Hu Yi Ba’s schedule: a morning shift from eight in the morning to four in the afternoon.

This schedule was very similar to that of the Emergency Department.

It was a 24-hour rotation.

“Alright everyone, listen up. Those on the morning shift—I’ll take you into the ICU. Remember, once inside, wash your hands and change into your isolation gowns. The area is under strict sterile management; you are not permitted to go in and out casually. If you need to use the restroom or get water, sort it out before entering. Those on the afternoon or night shifts can go home and rest until it’s their turn.”

Many of those on the morning shift quickly dashed off to use the restroom or grab water.

Zhou Can noted that there were nine people on the morning shift, including himself.

By the time he returned from the restroom, some of the trainees had already left.

But the person in charge, overseeing these trainees, was still patiently waiting for everyone.

“Is everyone here? Follow me!”

At his command, everyone followed him out of the doctors’ office.

“Inside, the area is divided into several wards. If a senior doctor calls you to assist with a code on a particular bed, jump into action immediately—even if it means cleaning up after a patient’s mess. Once you’re in, you must put aside your sensibilities. Here, you’ll witness death every day, so you must learn to control your emotions. No crying allowed inside, no matter how upset you might be.”

This was clearly directed at the two female doctors.

Male doctors, when faced with a patient’s death, might retch or show minimal sadness, but rarely shed tears.

Women, with their sensitive natures, might burst into tears at the slightest sorrow.

The speaker led them to a corridor where dark golden tiles adorned a wall displaying the five bold black characters for Critical Care Medicine.

Below, a sign for the Nutritional Infusion Demonstration Ward hung.

A spacious automatic metal door stood firmly closed, with an eye-catching reminder sign on the adjacent wall.

“If we do not answer your doorbell promptly, please understand that we are in the middle of an emergency. Kindly use the side door designated for accompanying visitors!”

It had long been said that there were several entry and exit points in the ICU.

Medical staff generally used the main entrance, while family members had to apply to enter through the side door.

That door was not manned 24/7.

If family members had items to give to the patient or had prepared a nutritional meal to be fed by the nurses, they could hand it over to the nurse on duty.

However, it should be noted that if family members wanted the patient to receive better nourishment and recover faster, their feelings would be understood.

In reality, many of the foods given would not necessarily be fed to the patient by the nurses.

They accepted the food merely to avoid disputes between doctors and patients.

Sometimes, patients simply could not eat.

For example, patients scheduled for surgery, those with tracheostomies, or others who must remain fasted cannot consume anything.

Where the accepted food ends up is hardly worth questioning.

If asked, it was either discarded or fed to the patient.

It should be noted that the ICU does not require family members for bedside care—all tasks are handled by doctors, nurses, or professional caregivers.

Besides the main door, there is a well-known side door for accompanying visitors, and another door infamously known as the mortuary door.

Deceased patients are not taken out through the main entrance.

This is because it not only creates a bad image, but also increases the risk of spreading infections.

There is a special back door designated solely for the removal of bodies.