MICU part 2

I have learned a lot on this subinternship. I thought I would learn a lot about the administrative stuff, writing orders, all that crap. I have, but I've also learned a lot about thinking about disease. Consider the following comparison: treatment of disease is like hiking through the forest. At the beginnig of my third year, I was barely able to recognize anything abnormal, to notice that there were trees in this forest as 'twere. I was too focussed on walking along the path and getting the motions of a physical down. By the end of third year and where I am now, I can see trees, and occaisionally discern between types of trees. I can now recognize when something is abnormal and know what to do about it. But I still see a lot of individual trees. What my attending does which I cannot, is to stand back, and say "this is a 3rd generation mixed forest of deciduous and coniferous trees, typical of the pacific northwest, most specifically the costal region between latitude 35 and 50 degrees north. I can say "this guy is hypotensive, hyponatremic, hyperkalemic, is covered in non-blanching livedo, and has 2+ pitting edema of his lower extremities. He is also anuric." This pt does not immediately scream SEPSIS to me, although he does more now than he did 2 weeks ago. It's really hard to put all the pieces together and parse between the important,the urgent, and the less-important, and identify a unifying diagnosis and come up with an appropriate treatment plan. I guess that's why I'm still a student, huh? At least watching my brand new interns, I can see myself doing what they do and being able to at least function at that level.
SS