Monday, August 8, 2011

Week 7 - Natalie

As promised, this week was packed full of clinical experiences at New York Presbyterian! I’ll give the day-by-day rundown:

Monday – I spent the afternoon in the emergency department and shadowed a resident. We saw approximately six patients, with varied complaints. Nothing was that earth-shattering: we saw a lot of fevers, abdominal pain, chest pain, one woman with continued pain after a C-section who wanted further pain medication, one woman who had fell down stairs and was cleared of any neck/back fractures. One patient that sounded very interesting but that I did not see personally was a Con Edison worker who was electrocuted. His co-workers performed CPR and defibrillated him in the field and that was the only reason he survived. I’ll come back to him when I visit the burn unit on Wednesday. Overall, my experience did not match the TV show “ER” – things were pretty laid back, and there wasn’t as much rushing around and saving lives as the show leads you to believe. That being said, I can see where it would be one of the more interesting places to work in the hospital, since you see such a variety of ailments.

Tuesday – I spent the day in the medical intensive care unit, starting with rounds in the morning with the medical team. I asked one of the residents what exactly the MICU specialized in, or which patients would come here specifically, and he explained that the main difference with the MICU was that the nursing staff to patient ratio was much higher, since these patients require such intensive care. The patients in general were not responsive, and were almost universally on assisted breathing devices. One patient became agitated during the day and began trying to get up and rip out his IVs and breathing device, and had to be restrained.

Wednesday – Burn unit. I was able to see several central lines be replaced, which is when there is a catheter placed into a large vein in the neck. These have to be replaced every 3 days to minimize infection at the site. The basic procedure involves advancing a wire down the existing catheter, removing the old one, sliding the new one over the wire, removing the wire, and suturing the new line into place. I also learned a bit more about the Con Edison worker, although I did not get a chance to see the extent of his burns in person. They were very concerned about his brain after the electrocution, so they chose to perform a cooling regimen, where his body temperature was reduced to 34C over 24 hours and then rewarmed to 37C over another 24 hours. They were just about to begin the rewarming process while I was on the unit, and he had handled the cooling process adequately. The extent of his burns had not really been assessed yet, due to this process. Unfortunately, there was another patient on the unit who was very sick, and the doctor met with the family to try and convince them to agree that the hospital would not take any extraordinary measures if the patient worsened. It was interesting that the family refused, saying that he was a fighter and that he would make it through and that they wanted everything possible to be done. The doctors had to accept this request, but were clearly frustrated by the family’s decision. This was an interesting aspect of medicine to see, as I can understand both sides of the argument. It must be incredibly difficult to basically “give up” on a family member, yet as a doctor who has seen this situation many times, it is probably frustrating to not be able to convince the family that there is very little chance the patient will recover.

Thursday – Neonatal intensive care unit. The highlight of this experience was assisting the fellow with a spinal tap on an infant. I was allowed to hold the baby in position, with the help of the nurse, and kept the infant preoccupied with its pacifier to try and distract it. I also saw a baby with a rare disease called “ichthyosis”, where the infant’s skin is scaly, like a fish (the ancient greek word “ichthys” means fish). The baby was doing much better, but apparently will eventually slough off the entire skin layer, almost like a snake. I was told the baby will always have strange skin, and some scarring, but should be otherwise healthy.

Friday – Labor and Delivery. I was able to see a natural birth, and I held the mother’s leg to assist her delivery. It was pretty powerful to see this very natural human experience in person, especially when I could be removed emotionally from it in a way, since it was neither my own labor nor anyone I know! At the same time I became part of the team as I encouraged the mother and put my own effort into the birth! The whole process was very rapid for this particular patient, she came in fully dilated and from start to end it was probably only 30-45 minutes. Although she requested an epidural, she was too far along for them to place it, so this was a truly natural birth. The result was a healthy baby boy who weighed 8lbs 3oz! After the birth, the fellow showed me the placenta, which was a lot larger than I realized. Seeing a baby born was quite the way to end a really incredible summer of clinical experiences!

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