Week 3 - Julie

In my third week I had the chance to observe very unique departments in the hospital: the emergency department and the pediatric ICU. On my first day at the ER, I shadowed the head resident from 7:30am until 4pm. This was a good time to start with because around 11am the ER was in full swing and very busy. I attended the morning report, where the residents and interns played a matching game to learn about the top symptoms of each medication commonly prescribed in the department. Now I know not to take too much Ibuprofin. The second day I spent in the ER was from 3:30pm until 11:30pm, in which I shadowed nurses and doctors in the walk-in and ambulance triage areas. It was amazing to see them work with such alacrity during the busy 4-6pm time period, and I was even able to help organize charts with them.

The major issue in the emergency department reminded me of a key issue of the hospital in Tanzania. First, they simply do not have enough space. There were points when the number of patients in the hallway about equaled those who were in rooms. However, the patients were more varied. In Tanzania, patients and their families happily sit 2 or 3 patients per bed and quietly await the doctor’s attention. Here some family members would run around searching for a doctor or nurse in order to get their attention or ask to be discharged quicker. One patient during the night shift came in with alcohol and cocaine use, and he would not stop screaming “help” at the top of his lungs. This made the other patients nervous and the staff annoyed. It’s amazing to think of the patience and strength of the staff who not only deal with difficult medical decisions, but also have to handle the more “human” side of their patients.

What I learned in triage was the variety of afflictions that people can come in with. The doctor was able to discern not only what the patient was most likely suffering from, but how much of a stability risk they presented. But most of the cases were not as dramatic as we see on tv. There were only 2 or 3 key traumas who came in and had to be resuscitated immediately. Otherwise, the EMTs were able to stabilize the patient or they had not suffered as a dramatic injury. The psychiatric patients were sometimes difficult to handle emotionally. This is where I wish I was trained on what to say, when people were speaking of suicide or depression. There was also a man who kept yelling at me that he needed to be seen right away and we were ignoring him. We needed to get security to remove him from the building. In fact, I saw many patients escorted by security who just wanted pain medication or food and became belligerent to the staff. When I return to the ER I will try to speak to a member of social work to learn how their department fits in, since I see they could have a difficult job managing the array of patients who come in.

The pediatric ICU was interesting because while the patients were all very sick, there was a palpable positive attitude. I shadowed the blue team and red team on rounds, which allowed me to learn about the care for cardiac patients as well as other disorders. One patient has congenital heart disease, and a probable genetic disorder that causes her to develop more slowly. We spent most of our time on rounds reviewing this patient because she is a difficult case. They were unsure of possible liver failure due to electrolyte imbalances, but since her main issue was cardiac, they focused on her recovery from multiple heart valve surgeries. In a bigger picture, this patient was unique to me because I saw how a group of doctors worked together in a brainstorming session to try to determine her key problems and different methods to combat these. It was similar to how engineers are taught to brainstorm, with each person presenting ideas and no one disputing them right away. As a group they would talk through the different possibilities until they came up with the day’s treatments and noted what to keep track of during the day. I am looking forward to similar experiences in the PICU later in July.

For my lab project I began to produce the tools necessary for my research. I learned how to create fibers for my scaffolds. These fibers will be embedded in collagen with a co-culture of cells. Then the fibers will be dissolved, leaving a microchannel, representing microvasculature. Now that I have the fibers and the mold, next week I can add the collagen with the co-culture.