“Make friends with those critical care nurses in the ICU,” my friend from high school and general floor nurse whispered in my ear before the start of my MICU rotation. “They can really save your butt.” This was one of my many goals I set out to achieve during my first month in the intensive care unit as an intern. I wanted to become more comfortable managing very sick patients, get some procedures under my belt, and mostly “survive” the emotionally and physically taxing weeks that were sure to come.

The sign out I received on my 3-patient load suddenly did not feel at all detailed enough on that first morning. Where can I find the ventilator settings? What happened during the spontaneous breathing trial? How is one supposed to do a neurological exam on a heavily sedated patient? This was before I pre-rounded on my final patient that morning, Ms. C. Weighing in at 675 pounds, Mrs. C was a transfer from another hospital for further management of respiratory failure and fever of unknown origin. She was also the largest person I had ever seen.