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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