Q&A with Mark Nunnally, M.D.




Mark NunallyMark Nunnally, M.D., Anesthesiologist
University of Chicago Medical Center, CCU

Q: Why did you choose a career in medicine?

A: No one in my family was in medicine, but I was very sick as a child with severe asthma. I was able to see first hand – at a very young age – how medicine could
make a big difference in normalizing someone’s life and their ability to function in
the world. This experience exposed me to a wonderful collection of physicians and
caregivers who helped me a great deal. I remember one physician gave me a quarter when I learned to swallow a pill. These people left an impression on me. Beyond that experience, I always enjoyed the biological sciences and it just seemed that my natural abilities lent themselves well to medicine.

Q: Why did you choose to specialize in critical care?

A: I thoroughly enjoyed all of my clinical rotations, but at one point during my medicine rotation I was given an ICU patient and helped her through a very long and protracted course. It was an inspiring experience and that helped make the decision for me. I was also drawn to the pace of the ICU, the attention to detail and seeing good outcomes. It’s the perfect match for my skills and temperament.

Q: What is the anesthesiologist’s role in the ICU?

A: Anesthesiologist intensivists are the managers of the ICU. We bring all the people together. There are surgeons, ancillary service providers, nurses, physical and occupational therapists, social workers, nutritionists, pastoral services and on and on. Each person has a specific role and function, but the anesthesiologist intensivist is in charge of seeing the patient as a whole. We look out for conflicts and reconcile them across services.

Q: What is a typical day like?

A: I come in early – about 6:00 – so I can get work done in my office. I then go to the ICU and the entire team gets together to go room to room and discuss each patient. A tentative plan is set for the day. This whole process lasts between one to three hours, depending on the day and the number of patients under our charge. The next part of the day is attending to each of the plans we set forth. No two days are alike. I’ll break off and talk to surgeons, patients, families, nurses and others about a particular patient or some other issue that we must manage. I carry a pager so that I can respond to a need somewhere else in the hospital, such as an intubation. In the afternoon we have card flips. We go over every patient again to see what has changed and what hasn’t. Throughout the day, new patients come in and others leave. Lastly, we compose a plan for the night. I leave the hospital in the early evening. My day is about 12 to 13 hours long but it’s very stimulating so it goes by fast.

Q: What is the most challenging part of your work?

A: ICU medicine can be very political with a great number of very bright people who have specific views of the world. I have to reconcile perspectives and viewpoints – sometimes that may not even have an easy resolution. Finding solutions that satisfy everyone’s concerns and sensibilities may be the most exhausting part of what I do – but it’s also a very important part of my job as well.

Q; What is the most gratifying part of this work?

A: I have a pathologic fear of boredom, of being stuck in a situation where nothing changes and nothing is new. So this work is perfect for me in that regard. Every day I learn something new – a new wrinkle – a nuance to consider and learn from. I find that very refreshing. I also get to interact with a lot of extremely bright people who are joined by a common purpose and mission. That’s very gratifying. Interaction with families is also a great part of the job. There are extreme highs and lows for the patients and their families. We bring very good news and very bad news. Watching how families cope and the amazing resiliency and strength so many people summon in a difficult time is inspiring. The human spirit is amazingly strong.

Q: How is the critical care unit evolving?

A: The extraordinary advancements in medicine are always creating new kinds of patients that we’ve never seen before. We can now sustain vital signs for a patient that we couldn’t have dreamt about a generation ago. This creates a whole new set of variables and challenges, which makes the work stimulating. There are still untapped opportunities for clinical advancements so it’s not a stretch to say that the ICU thirty years from now will look as different as today’s ICU looks from thirty years ago. Yet, while the technologies and therapies will always evolve, the essential work remains constant. It’s about people, families, teamwork and a dedication to patient care.

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