Week 4-Marsha

This week I ventured outside of plastic surgery for the first time and did clinical rotations in the Pediatric Intensive Care Unit (PICU) and Obstetrics (OB).  I have really enjoyed my time spent with Dr. Spector and especially the continuity of seeing patients during surgery and then multiple weeks of follow-up monitoring their progress. However, surgery is only a small part of the much larger hospital system and it is important to appreciate the breadth of services offered.

The first thing that struck me in PICU was the size of the patients. With one exception, all the patients I have seen in surgery have been adults. To see a 3 or 7 year old on a giant hospital bed was a shock. Their tiny bodies only occupied the smallest area on the bed. It was hard to see people so young so sick, but the doctors were very empathetic. The atmosphere within the PICU was much different than surgery in the sense that there was a large team of residents, a medical assistant, and an attending that rounded on each patient, each of whom was critically ill. At the bedside of each patient, the case would be discussed in detail and then a plan of action would be developed. The collaboration among the team was something that I found to be unique to the PICU. Anther interesting aspect of the PICU is the patient-doctor dynamic. The patient is obviously the child, but in most cases the doctors are actually devising treatment plans with and must report to the caretakers (parents). At the end of the PICU rounds the attending told me that there is often a fine line between medical intervention prolonging life in a positive way and prolonging life in a negative way. Ultimately this decision is given to the families and it is the doctors’ responsibility to educate and provide the best care possible given the decisions that are made.

OB was also quite different than either PICU or surgery. I was on the labor and delivery floor which, as the name suggests, is where the babies are born. During a typical surgery day, surgeries are scheduled back to back beginning at 7:30 am until the end of the day often with multiple rooms going at the same time. OB is different because you can’t put labor on a schedule. The majority of the day was spent waiting and learning from the PAs and nurses since none of the women were close to giving birth. Then, all of the sudden at 3 pm a rush of births started.

I think one of the moments from summer immersion that will stick with me the most is an emergency c-section. Up to this point, everything I had observed within the hospital had occurred in a scheduled manner. The hectic-ness, anxiety, and then relief following the operation were unmatched to anything I had seen thus far. My heart really went out to the mother when she kept asking if her baby was going to be okay. The doctors could only answer that they didn’t know but would do everything possible. I actually didn’t find out until the next day that the baby was doing just fine in the NICU.

Of course, I still had my regular office visits and surgery time with Dr. Spector this week but spending time in the PICU and OB units was very insightful. Next week is the last bit of summer immersion so I’m excited for at least two more clinicals in the emergency room and a cardiothoracic surgery.