Wednesday, July 3, 2013

Week 3 - Hannah

Week three has been a smorgasboard of shadowing experiences…resulting in further affirmation that entering a PhD program was the right choice for me.  Monday, I shadowed plastic surgeon Dr. Spector during his office hours.  It was quite the contrast to my previous clinic experience with neurosurgeon Dr. Schwartz.   MRI scans are the stars of neurosurgery clinics.   The patient and his/her entourage sit fully clothed in ordinary chairs; the obligate examination bed just an obstacle to weave around when entering the room.  Much of the conversation involves comparing various anatomies of the brain on the charts and demonstrating how they have changed.  The plastic surgery office hours are much more intimate.  Body parts are palpated and photographed.  Botox is injected, sutures are removed.  The atmosphere is a bit flashier, a bit less somber.   

Wednesday was another change of pace as I shadowed members of the pediatric intensive care unit (PICU) on their morning rounds.  Surprisingly, the PICU cares for children who are only a few months old all the way up to age 22.  This was my first time going on rounds and I wasn’t quite sure what to expect.  The attending and additional rounding personnel spoke softly in low voices when discussing patients, making it difficult to hear the discussion through the ambient white noises filling the room.  I was extremely grateful to one of the physician assistants for answering my perpetual questions and summarizing discussions for me.  One sad case demonstrated how fixing one problem can result in another being created.  A toddler with leukemia had received a bone marrow transplant.  Unfortunately, graft vs. host disease had developed and a small hole had formed in his intestine.  Fortunately, the hole had fixed itself, but not before bacteria had been released.  A healthy baby might have been able to fight it off, but he was on drugs to suppress his immune system because of the transplant.  Thus, he needed strong antibiotics.  All of the drugs then led to him having renal failure and kidney problems.  Despite these problems, the baby was in fairly stable condition when I saw him.   I want to continue to follow this case and hopefully see the baby make it out of the hospital.  As we shuffled from room to room, a large cart with a computer containing electronic medical records was dragged along as well.  While electronic records have many benefits, I witnessed the hassle they can present.  Residents scrolled through long lists of possible medical procedures, only to find the specific one they wanted to record wasn’t there.  The software seemed like it had a ways to go before it would make their lives easier.   

Thursday and Friday were ER days.  The first day I spent in the ‘A bay,’ which is where patients with the most immediate problems are triaged.  The A bay contains the A1 bed, which is where patients go when they are pulled off the ambulance and in need of intense medical assistance.   The day started off with a meeting that went over some cases and also contained a teaching component.  The topic was on acetaminophen (Tylenol) overdoses.  Once of the reasons that acetaminophen overdose is so deadly is because there is an intermediate phase where the patient feels fine, yet his/her liver is rapidly being destroyed.  One of the patients in the PICU was there due to a Tylenol OD, so it was interesting to learn more about the biochemistry behind the treatment.  I spent the remainder of the day following around a resident as he tended to several patients.  The whole ER was crammed with patients; many were without a room and lay in beds lining the hallway.   The C bay was even crazier than the A bay (partly because it was a Friday evening).  The patients in C were more elderly and tended to have chronic medical problems in addition to the acute one that brought them into the ER.  When making rounds, one of the attendings commented on how tough an elderly lady was; despite taking a bad fall in the night, the patient had waited until the next afternoon to come in.  “Tough?” the patient snorted, “Chicken is more like it—I’m scared of the ER.” Personally, I was rather inclined to agree with the patient.  Incredible as the medicine is performed in the ER is, I prefer the calmer neurosurgery clinic and operating room and am looking forward to returning there next week. 

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