The 4th week I attempted initially to stay out of the OR, but alas, this didn't happen. However, it was an exciting week in many other ways. Last week in the M&M meeting some of the physicians were discussing issues with spinal cord perfusion and tracking that during various thorasic and cardiac operations (especially aortic aneurysm cases). This week, I found the main physician who brought up the point and am setting up a meeting with him for next week to discuss potential engineering strategies to this problem. I think I will make this my research project. I began doing some initial research on Monday.
Other than that, I spent the day in the ER on Friday. This was particularly interesting because you really get a feeling for how a diagnosis is made, and quickly! What struck me the most here was the inefficiency of the whole process. First an intern would go see a patient and give an initial diagnosis and come up with a treatment plan. Then, they would present their observations and plan to the senior resident who signs off the the plan. The senior resident would then go see the patient, often asking the same questions, and deliver the plan to the patient (sometimes for the second time). Then, the senior resident presents the case to the attending, who also goes and sees the patient. I know it's important to make sure that all bases are covered and that important points aren't being missed or overlooked, but this was just crazy. This left no one with the amount of time they needed to either see patients or to document patient care. And many patients were at least rather open with me about how they were tired of answering the same questions over and over again. Granted, I was in the ER on a busy day - but still. it seems like it just made it more difficult to turn around care.
There were numerous "stroke" cases that came in. They can call a stroke case in the triage area and the person then gets rushed back and examined. Many of these cases though, the moment they came back were determined not to be strokes. This was another inefficiency. The neuro residents are responsible for conducting the neurological exam. They primarily look for patient orientation to person, place, and time and then look for basic cognitive function and symmetric motor skills. Any of these things lacking is a potential sign of stroke. There were also some cases that were less clear cut. One lady came in one year post-op for an aneurysm at the base of her skull with normal cognitive function but some kind of different bilateral sensation but primarily numbness and pain radiating down her right neck and arm. She had worsening headaches, but these headaches had been constant for a year. She presented as more of a muskuloskeletal case, but there were so many other factors going on that it was difficult to tell if some kind of stroke was also happening in addition to the easily identifiable muscle spasms. I unfortunately had to leave before they got all of her tests back.
The other thing I did this week was visit the cath and ep labs. Everyone up there was really really nice and one doctor got us scrubs and let us watch a pacemaker procedure! The doctor was really great about explaining what was going on and letting us get close to the field so we could see. In terms of the cath lab, it was cool to see how they actually did the procedure and to see a stent placed especially after having seen so many of these images in the pre-op stage down stairs. I'm hoping to come back to see other procedures such as oblation therapy as well as to hopefully get more clinical, pre-procedure, exposure.
That's all for this week since it's 4th of July and I'm going on vacation with my family for the weekend. But, looking forward to getting going on research and seeing other areas of cardiac health care when I get back next week!
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