The initial shock of medical terms and patients has started
to wear off, and week 2 has made me much more comfortable blending into the
hospital environment (possibly aided by the white coat given to me by my mentor).
At the beginning of the week, I was able to observe clinics with another
doctor, and found it very interesting to see the similarities and differences
in styles and practices between doctors (although no doubt that both provide a
truly impressive level of care to their patients). I observed a stress
echocardiograph and learned to read nuclear stress tests, and have gained a lot
of insight into how heart abnormalities and failure are diagnosed. In the
Catheter (Cath) Lab, I got to see another angiograph to diagnose coronary artery
blockage and plugging a hole in the septum caused by another procedure. And finally,
I was able to sit in on rounds in the Cardiac Inpatient Ward of the hospital to
see how new patients are presented and how each patient is check on every morning.
The highlight of Immersion so far has definitely been the
Transcatheter Aortic Valve Replacement (TAVR – see image below) that I was able
to observe this week. The slew (>15) of OR and Cath Lab doctors, nurses, and
technicians working together on this case was beautifully coordinated, with each
person executing his/her tasks to go from prepping the patient to rolling the
patient out the door after the procedure. It was very impressive to watch! The
surgery itself saw three attendings working together to coordinate catheters
through both of the patient’s femoral arteries to efficiently place a
pacemaker, place baskets over the arteries exiting the aorta (to protect from
debris that could travel to the brain), loosen the aortic valve with a balloon
catheter, and place and inflate the graft using another balloon catheter. On
top of the complexity of the procedure, it was by far the most intense and
stressful situation that I’ve observed so far:
a patient that won’t stop moving around (each time answered by a chorus
of “DON’T MOVE!”), the patient losing their heart rhythm from the placement of
the device, and the critical moment in which the device is expanded and the
patient loses the pressure to pump blood through their body.
A bioprosthetic aortic valve, placed during the TAVR procedure.
Overall, I am very surprised by the inner-workings of the
hospital: the complex coordination
between the different departments and doctors, how sudden, urgent, and
stressful situations arise and are handled, and how much knowledge and
experience it takes for each staff member to carry out his or her task
correctly and efficiently to deliver the best health care possible. With this
much insight after only two weeks, I am excited to see how my thoughts and
understanding of it develop after 5 more weeks of immersion.
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