Beyond the ABCs with Jeremy Topin, MD
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What does a first night on ICU call feel like for a new resident?
At the Nocturinous, we are careful to ensure that all stories comply with healthcare privacy laws. Details may have been changed to ensure patient confidentiality. All views expressed are those of the person speaking and not their employer.
This episode of The Nocturnist was made possible with the support of the California Medical Association and Vocera Communications Experience Innovation Network.
Learning medicine in the ICU is hard. The patients are sick, the hours are long, and sometimes you only have a few seconds to make a clinical decision. But what does this feel like when you're an ICU doctor in training? This is The Nocturnous Stories from the World of Medicine. I'm Emily Silverman. In this episode, ICU physician Jeremy Taupin tells a story that illustrates the highly pressurized environment of the ICU. After his story, Jeremy and I talk about developing the so-called clinical hunch.
I have learned to trust that a bit more, but what what gets me more concerning is when that fails me.
Here's Jeremy.
So I've been up all night thinking about cinnamon rolls. More specifically, how to get to the bakery right at five AM when they open to buy cinnamon rolls. I don't want to get there early 'cause that would mean I'd be losing out on some sleep. I don't want to get there late 'cause I'm already gonna struggle to get to the ICU in time this morning. So my brain has been wired all night trying to back calculate how early to get up to be there right at five AM. It's got all these obstacles it has to overcome. I have to find a clean pair of scrubs. I need to find several layers of clothes, because it's December in Chicago. I have to do this without turning on a light or making a sound because my wife and one year old son are in the bed.
I absolutely cannot wake them up. I then have to go find my car, scrape, shovel, whatever ice has accumulated overnight, then hopefully find a parking spot close to Ann Sathers. That's the restaurant where they make these fantastic cinnamon rolls. I navigate this pretty well. I'm there right at about five. I buy a couple of boxes of these cinnamon rolls right out of the oven. They're piping hot. The glaze is melting. I I'm watching them kind of in my car on Lakeshore Drive. It's everything I can do not to eat one. But now that mission's accomplished, I have the roles, my brain can now focus on what it's been avoiding. Um that is tonight is uh to the day is going to be my very first day. as the senior resident on call in the ICU.
So A little more context here. I'm a MedPeds resident, and so we do three years of pediatrics and three years of medicine and we squish it all into four. We rotate every three months between PEADs to medicine, PEADS to medicine. So I'm always several months behind my categorical medicine colleagues. And they just always seem quicker, smarter, definitely more clinically confident than me. And nowhere does this imposter syndrome rage more than in the ICU, my inter year. There things are so much faster. There's just volumes of information to try to deal with. The stakes are higher, uh organ systems that are failing.
How do early‑morning cravings for cinnamon rolls illustrate resident life and stress?
And I'm just in awe of those that seem to be able to navigate this space with ease. They can absorb and synthesize this information. They seem to recognize complex patterns of illness quicker than others. And those that do it well, they seem to be able to communicate and connect to these families, patients, during these really intense, often intimate times when they're discussing issues of end of life and death. And I realize this is what I want to do. There's this marriage of complex physiology. And humanity. And it's drawing me to this profession. Yet I'm terrified of it, and I don't know whether to lean into the ICU or to run. So I've been really over the last several months trying to figure this out.
I've been talking to my program director, I've been talking to the head of medicine, and they've given me the green light to do the ICU early in my second year instead of later in my third, which really feels like a questionable choice at this moment.
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Chapters
8 chapters
1
What does a first night on ICU call feel like for a new resident?
0:00–3:27
2
How do early‑morning cravings for cinnamon rolls illustrate resident life and stress?
3:27–6:50
3
What triggered the first critical patient emergency on Jeremy’s debut shift?
6:50–9:09
4
How did the team manage the rapid decline and intubation of the deteriorating patient?
9:09–12:05
5
Why did the ventilator settings cause right‑heart failure and how was it recognized?
12:05–15:50
6
What role does clinical intuition—or the ‘hunch’—play when checklists fall short?
15:50–19:28
7
How does the culture of medicine affect admitting uncertainty and asking for help?
19:28–23:15
8
What key lessons did Jeremy take away from his first ICU call night?
23:15–27:45