It’s 1:30 a.m. and the alarm is blaring. Time to get up and go to the hospital to prepare for 6:30 a.m. interdisciplinary rounds in the burn ICU.

Despite having rotated through six other ICUs as a student and resident, I have found that nothing compares to the complexity of burn patients. Patients who have been severely burned have lost the protection of their skin, have been through a painful trauma, will likely undergo multiple surgeries, and will likely spend a long time in the hospital.

To provide the best possible care to these patients, each member of the team must be focused and collaborative. I am expected to know every detail of the patient’s medications so that I am well prepared to answer any questions that may come up about their treatment during rounds.

I get to my office to begin reviewing patient charts by 3 a.m., and I arrive on the unit to touch base with the on-call team at 4:30 a.m.

As I sit down, the overnight medical resident informs me that one of our patients had a rough night with some worrisome new symptoms.

This patient is young with a large percentage of his skin burned, and he’s been in the hospital for many months at this point. His list of surgeries and complications is pages long.

As members of the team filter into the unit to prepare for rounds, everyone is worried about our patient.

“How can we best manage these new symptoms? Is he getting sick again? What can we do?”

The day becomes a whirlwind of activity. Every member of the team contributes to his care in an essential way to ensure that he makes it through the day.

Our team in the burn center includes respiratory therapists, nurses, physical therapists, occupational therapists, pharmacists, dietitians, social workers, case managers, researchers, chaplains, psychiatrists, medical residents, and surgeons – not to mention the various specialties that we consult when a patient needs additional care.

Patients with severe burns are very complex for a variety of reasons; pharmacists and dietitians have to consider the hypermetabolic state associated with burns, physical and occupational therapists have to prevent complications as new skin heals, nurses have to become experts at wound care, and we all work to treat and avoid the complications that accompany a body that is desperately trying to heal. No one person, regardless of his or her degree or training, can treat these critically ill burn patients without help from other disciplines.

A nurse comes up to the resident and tells him about a new development with one of our patients. He turns to me and says, “What do you want to do?”

Internally, I panic a little. What if I’m wrong? What if I make it worse?

Then I remind myself that I’ve seen this before and that not only do I know what I’m doing, but my preceptor has also helped me build the tools and knowledge to use my training to make informed decisions about this complex patient’s drug therapy. The patient needs me. I make my suggestion and answer questions as they come up, and we implement it as a team.

As a new practitioner in my second year of residency, I find it daunting to take on the responsibility when the medical resident asks me what I want to do with a patient’s pharmacotherapy because we’ve gone beyond the resident’s experience or comfort level.

It’s equally daunting to question a resident’s decision that has already been made. If I am certain of what is best for the patient, I can approach the scenario with evidence and confidence, but what about all the gray areas? Sometimes, my best approach is being present and available. Not every decision and order requires discussion with the entire team, but asking the right questions and making myself available for discussion allows the team to depend on me as the drug therapy expert.

I can easily say that rotating through the burn ICU has provided me with more opportunities for learning and growth than many other rotations. The complexity of the patients’ conditions brings out the best version of a multidisciplinary health care team, and it’s very rewarding to know that I am a valuable member of that team.

About the Author: Louisa Sullivan is a PGY2 emergency medicine pharmacy resident at Valleywise Health Medical Center in Phoenix, Arizona. She is passionate about emergency medicine, critical care, teaching, and advancing the role of pharmacists. When she’s not nerding out about pharmacy, you’ll likely find her with her nose in a book or traveling somewhere exotic.