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Day 7 intern year, and you already hate the MICU.

There are 22 patients on your service, you know none of them, they’re all septic, and your greatest accomplishment to date has been teaching the family in room 5 bed A to do the goals of care discussion with the 7 last patients who have been in bed B. That’s C. Diff for you.

Who is your attending? Where is your fellow? Was that RT intubating or the over-involved family member from room 12?

A shriek goes out from room 1.

The overhead PA crackles and your hair bristles for the Code, but instead a deep, seasoned voice echoes across the unit:

“DOUBLE KILL!”

You freeze and make eye contact with the charge nurse for the first time in days. Your eyes dart together as another wail goes out from the back hall, and the 1950’s circuits crackle again overhead.

“TRIPLE KILL!”

Her eyes widen, and with tears starting down her cheek she whispers ferociously, “… I think we’re tied with surgery!”

Suddenly, the floor is alive with energy, and fresh coffee is being brewed. The fellow bursts from her call room eyes glued to the trackboard and crying “Palliative consult, STAT. Rooms 2, 23, and 52. This is our chance, people!

“LOST THE LEAD” scolds the mysterious voice. The OR board shows three Whipple procedures complete in the last 15 minutes. Combined EBL? 5mL.

Clawing at the padlock you used to keep the oncology team in the staff bathroom, suddenly a greased hand in overalls falls on your wrist. The janitor smiles at you with a giant bolt cutter in hand and PT flexes to snap them free.

“KILLING SPREE!” goads the new announcer.

5A’s family has 4 rooms on comfort care, and nursing is running after them with a daisy chain of morphine IV tubing. Surgery schedules a sports hernia for open mesh repair.

“RUNNING RIOT!” screams the overhead.

Administration arrives tie askew bearing three boxes of donuts and a bottle of champagne for “whoever nailed the Sepsis bundle on that kidney guy.” In between replacing “daily” with “qd” on all your patient’s charts you look up and see like you never had seen before. Dr. M, handsomely performing a complete echo including bubble study between chest compressions. Room 3’s NA Brian (how could you have ever forgotten Brian?) discharging room 9 directly to home ECMO. No egos, no rudeness, only teamwork.

Then the call comes you’ll never forget the rest of your career:

“KILLIMANJARO!”

The entire unit is put on inspiratory hold. An errant LVAD alarm is smothered.

A gentle cough heralds the announcement. Beaming with pride, mother of 5 and winner of her church’s Mary Magdalene award Susan Maccabees softly whispers into her microphone:

“GAINED THE LEAD.”

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