University of Illinois at Chicago
The past 3 weeks in IR went by just as fast as the weeks spent in GI. The last day in IR was very enjoyable because we were able to observe a procedure in the OR, and Dr. Bui showed us how an ultrasound works. It was really helpful to see how the ultrasound works, I was always confused looking at ultrasound images. Overall my time at IR was great! The physicians were very eager to teach us and very welcoming. I was not too familiar with IR before this program, so it was amazing to get exposure to the field. After going through this rotation I’m very excited for my Biomedical Imaging course in the fall semester.
Overall, this program was great! I came into the program with the goal of become a physician, which this is still my goal. I am very passionate about engineering, but I have a deeper passion for patient care. Innovation in medicine is truly a growing field, which is is very exciting. However after completing this program something I became much more interested in is innovation in rural medicine. Coming from a smaller town, I can imagine the huge limitations in rural medicine, technology wise, since resources can be sparse. I think it should be interesting to see how innovation in medicine grows, and I really hope this grows and even focuses on innovation in rural medicine. I will be applying to medical school a year from now. After this program I’m heavily considering applying for a rural medicine program, just because I see the huge potential in innovating in rural areas. Even though rural medicine may not be as diverse as urban medicine, physicians ultimately need to maximize care with limited resources. Granted rural areas are not as limited as austere environments, but limited in comparison to urban medicine. Typically when someone from my hometown area gets very sick, or critically injured they initially go to our hospital in Kankakee. However on a couple occasions patients need to be transferred to Chicago land hospitals, sometimes this happens in an urgent life/death situation. After completing this program I’m becoming more interested in what protocol is taken for this transfer, because I never really questioned in before. There have been occasions in which people get into car accidents on country roads and they are air lifted immediately from the crash site; whereas other times patients are brought to Kankakee hospitals first and accessed. Another problem dealing with car accidents, is sometimes the ambulance drivers cannot find the exact location of the crash scene because there are not landmarks or intersections the caller can describe to the responder. Time is so valuable during these times, and wasted time finding the crash site is just added time that could ultimately be the deciding factor if this patient lives or dies. I personally believe a lot of innovation can happen in rural medicine, and I think after completing this program this is something I would like to look more into moving forward. Someone should not receive lower quality in health care because the area is smaller in numbers.
After Dr. Bui collected a biopsy, he let us look at the devices. During this particular procedure, the first biopsy needle being used had problems collecting tissue. They switched to a different needle which worked much better. After seeing both needles, I think the second needle that was used is much easier to use. The second needle used is very similar to the featured image for this blog post. The two grey buttons are pushed down, and either the yellow switch on the side or the button on the very bottom can be used to collect the sample. However the reason why I thought the first needle used was harder to manipulate was because there was a safety piece you had to pull out and lock and push back in. It was really cool to see the mechanism behind collecting the tissue and deploying the sample into the dish.
There was an in-service for a new stent that was going to be used for a biliary duct. The company representative considered this to be a closed stent. However this did not look like a typical closed stent, but it was more of a material coating. This type of coating would make it easier to deploy the stent. Currently some stents want to spring forward and tend to be misplaced, but the coating prevents this. This was cool to see, because during one of the procedures our team observed stents being misplaced due to the deploying mechanism.
During my time at IR, the team prepped a patient in their lab before they went to the OR. In this case this patient was getting a large kidney stone removed. IR had to insert a tube to serve as a guide for the urology team to use in the OR. The IR team had some problems placing the tube properly because they were trying to place it in a specific orientation around the stone. This portion only took about 15 mins. After the IR team was done, the patient was going up to the OR. Dr. Bui suggested we go to the OR to see the urology end of the care because he said their work is really cool. Dr. Bui suggested we go check the OR an hour after he placed the tube. An hour went by and we checked the OR board and the patient was not in the room, so we decided to wait a bit. After some time the patient was finally in the room, and the operation started about an hour after the scheduled time.
The urology team started the procedure and they came to a point when they had to use a scope. Turns out the scope’s lens was broken and only ¼ of image was displayed. The physician asked the company representative to find out where the other scope was. The other scope could not be used immediately since it was not sterilized. The physician asked if it would take 2 hours for it to be sterilized, and the company representative said it would probably take that long. The physician asked the rep if they checked the scope beforehand, which they did not. This seemed absolutely absurd that no one would check the scope before starting the procedure, instead of realizing in the middle of the procedure it was not working. The representative was going to call Rush to see if they could borrow a scope from them, but I feel like this would affect the sterility process negatively. It seemed that was the game plan the team decided on, my partner and I ended up leaving the room since tensions started to rise. We went to get lunch and went back to IR. We saw Dr. Bui and he asked if they were still missing stuff and we explained everything. He said it was probably best to stay in the IR lab since that OR would be very tense. This makes me curious what would’ve happened if this circumstance occurred in a rural hospital where they wouldn’t have a neighboring hospital nearby to borrow one. There was plenty of time for the scope to be checked anyways since there was a large chunk of time between when the patient initially got into the room to when the procedure started.
By the second week in the IR lab, we were able to observed majority of the procedures. Since our group already saw some problems and took note of a lot of observations, we asked Dr. Bui if we would be able to observe general diagnostic radiology for a day. We all agreed it would be beneficial to get some exposure of the field. We’ll be with diagnostic radiology for the day tomorrow.
This week we actually got to go into the OR for a procedure. This was actually my first time in the OR, since GI had procedures in their own lab. Dr. Bui had to insert a tube into the patient before the surgery team started operating. This was interesting to see the change in pace and work flow between the two different operating settings. The IR team brought all the supplies that were going to be used during the procedure to the OR. However, they did not bring a proper sized balloon catheter, and the technician had to run back down the IR lab. This was the only time I observed miscommunication between the IR team.
Another interesting case we saw was a kidney biopsy for a patient with an intraperitoneal, transplant kidney. Dr. Bui called the transplant surgery team to communicate with them he was preparing for a biopsy and there would be a chance the patient would start bleeding. If this was the case, the patient would need to be brought to the OR immediately. However, this biopsy went fine. The device used to take the biopsy had an inner needle that is deployed when the outer needle is in place, working like a spring. However when the inner needle is deployed it makes a large click noise. Dr. Bui actually notified the patient the device would click and showed them before the biopsy was collected. Even though this click noise may not hurt the patient much, the noise makes it sound a lot worse than it is. Even though the patient heard the sound before, they did flinch when Dr. Bui collected the biopsy. Another procedure we got to watch was an inferior vena cava filter (IVC) filter being placed. I mentioned this filter in my last blog post. This procedure was very elegant and swift. The deploying device was placed properly, and it only took a few seconds for the filter to deploy.
An interesting point Dr. Bui made was only 40% of de-clots have a success rate after 3 months, which this seems very low. It would be interesting to look into what happens with the other 60%, what exactly goes wrong, and if there’s a common problem. Another interesting point Dr. Bui made was about the transjugular liver biopsy. He stated that there is progression being made on the engineering side of the procedure. He stated that they are working on getting a hand-held spectrometer to scan the biopsy and be able to read the diagnosis instantly. I feel that this would be very beneficial and interesting to observe.
By the middle of the week I felt pretty comfortable around the IR lab and was finally getting the hang of things. The first few days were a little overwhelming because it was a lot! IR does some pretty amazing things. On Wednesday, the department had an in service in which a company representative came in to discuss a product and how to use it. The particular product was a laser that helps treat varicose veins. The beginning of the in service was a little boring since the representative mainly discussed how the nurses and technicians should operate the product. However once the nurses left we got to ask a few questions and see some other products. The most interesting product we saw was the AngioVac, which is the featured image of this post. This device basically acts as a vacuum to suck out large blood clots. Dr. Bui actually showed us a case that he used the device. The patient had a huge clot, and we were able to visualize some of the suction from the radiation pictures that were saved. Dr. Bui expressed how he would find it beneficial for the device to be made a little smaller. There is a device similar to the AngioVac however the suction technique is much weaker. Dr. Bui explained how the device can be difficult to maneuver since it is quite large. Additionally Dr. Bui stated it would be beneficial to have a smaller device so it can help with smaller clots.
We got to see other devices used, mainly stents and filters. The picture I had for the filter did not insert properly. But the design creates laminar flow and there is a hook at the top so the filter can be easily removed. I thought this design for the filter was interesting, I saw a similar design for an object in GI however it was used to trap foreign bodies. Some stents were saw are pictured here
The stents with the white covering are considered closed. The more interesting stent we saw was the stent used during Transjugular Intrahepatic Portosystemic Shunt (TIPS). This stent serves as connection between the hepatic vein and the portal vein in the liver. A picture of the stent is here:
The image for some reason is inverted. But the open part of the stent is released first and it expands. Once the open part of the stent is deployed, they will pull back and feel the stent get caught on the liver. Then they can deploy the rest of the stent. This design is very interesting since the open part allows blood to flow in and out, but the closed part prevents bile from entering the blood. Despite this great design, this particular stent comes only in one size. This can be difficult because not everyone is the same and too big of a stent may have too much flow; whereas too small of a stent may not have enough flow.
Overall, it was very interesting to see the stents, filters, and other devices used during procedure. My first week at interventional radiology was amazing, and I’m very excited for these next two weeks.
Week 4, means starting my new rotation at Radiology. I was very excited for Radiology because imaging is very fascinating to me, and I’m also taking a biomedical imaging class in the fall semester. The physician that is the primary contact for this program, Dr. Bui is very interested in interventional radiology. Our first day in the department, he gave us a quick lecture on interventional radiology, some examples of procedures done, and the techniques used. He asked us what we wanted to observe; he thought interventional radiology would be more beneficial to us. Our group decided we would start in interventional radiology and decide if we want to observe the diagnostic end of radiology. Interventional radiology (IR) is using imaging techniques to help visualize during a procedure. IR is really cool because it is very minimally invasive, but the procedure has such a high impact for the patient’s health. This rotation is a lot different from my past rotation in GI, since they were always dealing with the same track and usually similar problems. However, one common denominator was I did see ERCP’s in GI in which radiation is used to help the physician obtain the bile and pancreatic ducts, which is a similar set up to IR.
One of the first procedures we watched was a chest port placement. This is a catheter connected to a plastic reservoir. The port is inserted under the skin. For this particular port placement it was to be used to administer chemotherapy. Another procedure we observed was a transcatheter arterial chemoembolization (TACE). This was really interesting for me because during my GI rotation some physicians were discussing a patient could receive TACE for a treatment of their liver tumor. It was very interesting to see this applied. This procedure restricts the tumor’s blood supply. It is localized way of administering chemotherapeutic drugs. However the tumor will not disappear, but it will decrease in size. This is a very cool way to deliver chemotherapy and treat a tumor since it is minimally invasive. This area seems to growing, since this technique is mainly used on liver tumors. It should be interesting to see in the next few years if this procedure treats multiple types of tumors.
Cannot believe my time at the GI department has come to an end. The past three weeks went by way to fast. I learned so much from this rotation, mainly the anatomy of the GI tract. The last day was very interesting. We did our presentation in front of most of the GI fellows and our supervisor, Dr. Carroll. After the presentation, the fellows had to attend a workshop on foreign body objects. This workshop consisted how to get random objects out of the body if a person swallowed it. A problem that they run into at UIC is some prisoners swallow whatever they can find so they can spend time in the hospital. Some of the fellows actually mentioned some prisoner kept swallowing whatever they could find and racked up $1 million in medical bills. There was an article on him in the Chicago Tribune. Some examples of foreign bodies that were discussed were toothbrushes, batteries, and buttons. The person that led the workshop actually said that toothbrushes are commonly swallowed by people who suffer from bulimia, since they usually lose their gag reflex. The objects that they used to grab these objects were very interesting. There was a lot of choices for the physician to use. However some of the physicians were a little nervous to use was a claw similar to one used in a claw crane. Some felt if this claw was used, the object could possibly fall out as it is being pulled up out of the body.
One of our last notes for GI was seeing a colonoscopy for someone that was bleeding in their colon. This was very interesting to see since we always heard the physicians usually described patients as a “bleeder”. I felt as if it was hard to determine if there was abnormalities in the colon since the blood covered most of the lining of the colon. A lot of blood was suctioned out of the body.
Overall, my time at GI was a blast! I’ll remember this rotation for a lifetime. The procedures I got to see were so fascinating, and the physicians I met were even better. As of now, I’m still interested into going to medical school this rotation made me realize how much I love medicine. I’m very excited to start my rotation in Radiology, but the GI team set the bar very high!
The start to week three was a complete switch in dynamics. We were shadowing one of the fellow’s on service. The fellow would need to see all the patients that would be using GI care as the consult team. This week has involved a lot of walking and talking to people. Monday was actually the first day the fellow was on service, so he was nervous since he wasn’t sure how the system worked. He also felt that the hospital was hard to maneuver around. Monday consists of seeing a few patients and the fellow would discuss with them that the GI team would be assisting in his/her care. The day was concluded with rounds. Rounds happen every day, and I felt as if they can be overwhelming because it’s a lot of information being presented very quickly. This week I’ve been able to observe rounds for the GI department and also the Hepatology department as well. A difference I noticed was Hepatology goes more in depth and more problems can arise. What I mean by it goes more in depth is because not only does the liver have issues, but they try to understand why the liver is having these issues. Sometimes these patients suffer from serve addictions to alcohol so withdraws can cause symptoms aside from being sick.
The rest of week two was spent in the endoscopy lab watching a lot of procedures. With all these procedures came a lot of acronyms. The two most common procedures were esphagogastroduodenoscopy (EGD) and colonoscopy, which I explained in the first post of week 2. Different procedures I was able to observe were endoscopic retrograde cholangiopancreatography (ERCP), endoscopic ultrasound (EUS), EGD with dilation, flexible sigmoidoscopy, double-balloon enterscopy (DBE), and capsule endoscopy preparation, a procedure for a bedside patient, called by the department as “roadshow”. It is called a roadshow since there is a cart with all the equipment on it, and the cart is taken on the road. Overall it was a very busy week. It would be very long to go into a describe all of these procedures, I discussed an EGD and a colonoscopy in my previous blog “Week 2: Introduction to Endoscopy Lab”.
The most intense procedure was the ERCP. The reason being is the physician is trying to get into the bile duct, pancreatic duct, and gallbladder, which is out of range for the scope. Radiation is used to visualize the location of a wire that is fed through the scope. Everyone in the room needed to wear a lead outfit due to the radiation. During this procedure the physician was looking for stones, removing those, and looking for other abnormalities. The reason why this is so intense compared to the others is because it is a very difficult process for the physician to do these maneuvers. The physician will know if stones are present in the gallbladder, but may not know if there are stones in the bile duct. The reason why the stones cannot be seen in the duct is due to it being overlaid by the duodenum. Usually ERCP procedures were the longest procedure. The scope used for the EGD and colonoscopy has the camera looking forward and a light that flashes, but the scope for the ERCP looks over to the side, but the light does not flash. The reason why it looks over to the side is to help the maneuver to the duct. I’m not sure why this scope does not flash though. During one ERCP I observed the catheter buckled in, I believe in the bile duct. The physician had difficulties getting this out, but after a while he was able to remove it. With this long procedure, somewhere between 1.5-2 hours, I realized how heavy this lead truly was. I was just standing in the room, I couldn’t imagine being someone active during this procedure and moving around with the weight of the lead. It would truly be a workout, and the two physicians I saw do this procedure were sweating after.
The least intense was the capsule endoscopy preparation. The patient had to swallow a pill and let it go through the entire GI tract and exit in body waste. The pill had a small camera on it that would show the same thing you could see from an EGD or colonoscopy. The pill remains active for 12 hours in the body, and electrodes (possibly 6) are placed throughout the GI tract. The GI department at UIC does the wired-capsule with the electrodes on the body, but a wireless capsule technique does exist. The reason why the UIC department chooses the wired technique is because it is easier to detect the location if an abnormality is present. All the preparation was done by the nurse, except one of the fellows received the patient’s consent. All these electrodes are wired and feed into a little box. The patient has to carry the box around, there is a strap for it to go over the shoulder. The box contains all the information of the pill. This box has a flashing blue light at the top that means everything is good with the pill. If the light turns off, the patient was directed to call the lab. I am not sure if there is some type of audio warning when the blue light turns off. I feel that this would be useful because the patient may not check the blue light for a while, and it could be turned off. The pill was quite large, and it seemed as if the patient had discomfort swallowing it. Also the department currently has 3 of these sets and one is currently broken. They depend on the patients returning the sets to the lab the next day. I’m not sure how common these procedures are, but I wonder how hard it is to schedule a capsule if there is a limited amount of sets.
A very interesting procedure was the double-balloon enteroscopy (DBE), the picture above is the scope used. This technique allows the physician can see more of the small intestine. During the EGD, they can only see the beginning of the small intestine.
The balloons are inflated and deflated throughout the procedure to advance the scope. This procedure required the most amount of physical maneuvers for the physician. There was a key pad the physician could control the inflating and deflating of the balloons. However the key pad had an altering sound to possibly note the tension of the second balloon was tight. The physician found it much more of an annoyance than a help. He would usually listened for the balloon inflating and could tell when the balloon was close to its maximum. At first the physician simply pushed a button to turn the sound off when it went off. As the procedure went on, things got more intense because it was very difficult for the physician to advance. From this stress, the sound did not help. It was evident he was getting much more frustrated by it. He even told us one time during this type of procedure years ago, he actually pushed the button down so hard from being so frustrated the button went completely into the pad and broke. This procedure set up was most difficult for the anesthesiology to move in and out of the room with their rotating groups. There was one time an anesthesiologist had to move the key pad to get to the door to exit, and it seemed as if the physician was annoyed by that. If I was the physician I would be annoyed too because I would want everything to be in the correct spot and to stay in place.
As much as I would love to expand on the other procedures I observed throughout the week, there just isn’t enough time to type all of them out. However I will expand more on some information one of the medical technicians gave me. She stated the biggest problems the lab has are scheduling and space. An example of a scheduling problem, one morning the nurses had a staff meeting and were not back into the lab until about 9am. One patient came at 7:30am and was not brought back into the procedure room until close to 9am. Space is a huge issue in this department. There is a lot of equipment and just enough space for the bed. The technician said she worked at another hospital that for a double scope, an EGD followed by a colonoscopy, they had enough space to turn the bed a complete 360 degrees without a problem. However in this department, it can be tricky to switch from an EGD to a colonoscopy. I asked her what she would do to change the setup they have now. She said it could be helpful for the housing unit for the scope and the cart with everything on it to be set up against the wall. This would give some more space and keep the wires more located to up against the wall. She also suggested the power coming from the ceiling, which I personally thought of too. These set ups already exist at other hospitals. Another interesting point the technician made that I found very interesting was about the gowns the physicians, nurses, and technicians wear during procedures. The gowns are very frugal because they can be washed and reused. However these gowns are yellow. She said it could be helpful for the gowns to be a different color. The reason why they should be a different color is because usually gowns used for isolation contact patients in the hospital are yellow. She stated the yellow gowns for the procedure could give a confusing message since these patients are not on isolation, but they are only getting a procedure. I really liked this point because I never thought about it before, but it really does make sense. Additionally she stated that the area they work in during procedures is very dim, to help the physician. However this dim setting is not helpful for the nurses or technicians. During the middle of the procedure the physician may say he/she wants a specific device to remove a polyp or take a biopsy. The nurses and technician have to prepare for this collection. This collection involves getting the specific device and labeling the container for what the collection is for. The technician said she has seen other set ups that use color coded glow in the dark to organize the devices and such. Not only would the glow in the dark be helpful, but the color coding would be more efficient for organization. With this increased organization it would decrease the amount of time wasted looking for things during the procedure.
Overall, week two was a success! This dynamic was much different from the clinic. It was very insightful to get a taste of the clinic and the lab. Next week our tentative schedule says we should be doing inpatient consults which will be another change in dynamic! I cannot believe my time within GI is already half way over, and I only have a week left. It’s been truly amazing and insightful. I look forward to making the best of this last week within the department.
For week two I have been in the endoscopy lab observing different procedures and learning about the equipment used. However when the clinic was slow during week 1, we did have the chance to watch some procedures. The first procedure I saw in the lab was an esophagogastroduodenoscopy, commonly called EGD. This procedure consists of using a scope, the knob is in the featured image of this entry. The other end of the scope contains a flexible end with a light and camera, which is controlled by the knob. The picture from the scope’s camera is projected onto a monitor for the physician to examine, this image is inverted. The knobs are used to move the scope up, down, left, or right. For this patient, she was only partially sedated with drugs administered by the nurse. These drugs help with pain, and actually the patient will not remember the procedure. Benadryl was also available to help the patient feel sleepy. Before the scope is interested into the mouth, a mouth guard was placed to protect teeth and the scope. The patient was then laid on her left side, and a cushion was placed behind her back back to help her stay in that position. Once the patient seemed to be sleepy, the scope was inserted into the mouth and went through the esophagus, stomach, and duodenum. While doing this procedure the physician was looking for any abnormalities and taking pictures with the scope that were saved onto a software. However in the middle of the procedure it seemed as if the patient started to have discomfort. She started to move around and attempted to raise her hand to grab the scope. Overall, I thought the procedure was amazing. I have never seen an endoscopy procedure before so I was not sure what to expect. I was surprised that she was just partially sedated and that worked fine; I expected an anesthesiologist to sedate the patient. However during a different procedure I observed later, a physician explained more of the sedation process. Patients are sedated for comfort and prevent the gag reflex. Apparently back in the day EDG were done without sedation. Some countries today still perform EDG without sedation, which I’m glad I won’t be getting an EDG there any time soon!
The second EDG I observed the patient was fully sedated with help of the anesthesiology team. For this procedure an attendee and fellow were in the room, the fellow mainly performed the procedure. The attendee said this procedure was a better teaching environment with the anesthesiology team there. She could focus on teaching the fellow opposed to making sure the patient did not move too much due to pain. However there was a problem trying to make a turn during the procedure. The fellow was having problems and the attendee was not able to describe the procedure to get around the turn in words. The attendee then tried making the maneuver and succeed. However I felt that this movement was quite difficult, the physician had to move both knobs in opposite directions and physically turn the body to the right. I was truly surprised that physicians have to sometimes turn their entire body to move the scope. During this procedure some biopsies were taken which was quite interesting to watch. A wire with a clamp at the end was fed through the scope. The physician had to keep feeding the wire in blindly until the clamp showed up on the monitor. Then the physician had to direct the technician or nurse to open and close the clamp as needed. Once the clamp was closed and part of the tissue was in the clamp, it was raised to remove it from the wall. This would usually cause some bleeding, but the patient would not feel this at all. When the scope was being taken up, the patient had some problems. The anesthesiologist mentioned she had an asthma attack, I wondered if this is usually common people getting EDG with asthma, and if so why did the attack happen.
Both of the above EDG procedures, I observed the first week so I was not familiar with how the lab actually worked. During the first two EDG, I just went back into the procedure room without observing the lab. The start of the second week was observing how the lab worked. A nurse showed us how she would prepare for a patient. A drug bank is used to retrieve the sedation medication in which the nurses have finger print access. However the nurse had problems with the finger print so she entered her ID. I thought the finger print for the system was nice because it could potentially save time. However, in our case it probably added on time since it took a few tries, but she ended up entering in her ID. The nurse then selects the patient from a database. The nurse would then select the drug and the amount on the computer. Once this is entered a drawer opens with the drugs. During this time, the patient has a magnet on a white board behind the desk placed at the waiting room they are currently in. So if this patient was waiting in room A, their magnet would be right next to the magnet letter A. Once they are moved into the procedure room, this magnet is moved to indicate what procedure room they are in. As we were describing to the nurse we were bioengineering students looking for problems within the clinical environment, she immediately mentioned the wires being on the floor. This seems to be a common problem in all departments. I noticed some wires were zip-tied together to keep them localized. Even though I noticed wires being on the ground was a problem in most procedure rooms, I did notice one room had a cable cover. But the cable cover wasn’t covering any of the cables so it was a waste. This particular patient was getting both the EDG and the colonoscopy. The physician examines the large intestine during the colonoscopy. The EDG is performed first, and once this is complete the scope is unplugged and the patient’s bed is turned completely around. While turning the bed a complete 180 degrees, you can really see how small the procedure room is. During this colonoscopy a polyp was taken out. Since this polyp was bigger, a bigger trap was used. Smaller ones are taken out by the same type of clamp used for the biopsy I described earlier. However this bigger trap looked like a diamond that the physician would adjust so the polyp was in the middle of the diamond. Once polyp was in the diamond, the physician would instruct the nurse to close the clamp and retrieve the polyp.
Another EDG I observed the patient was not responding well to the sedation medication. The physician asked if the patient takes any pain medications or drinks alcohol frequently. I thought this question odd since it seems more like a screening question on overall health of a person. This particular patient had drank recently. The physician then told us that drinking alcohol and in taking pain medications can actually make the patient more tolerant to the sedation medications. Also, this patient had a higher blood pressure so this was monitored very closely while administrating the sedation medication. The physician said he would attempt the procedure, but he was not sure how the patient would be during it due to the tolerance to the medication. However this scope did not last long since this patient had his stomach taken out, which the physician was not expecting this. The patient had a small section of the stomach connected to the side of the small intestine. The physician said it is better to connect things from side to end opposed to end to end, meaning it was better to have the side of the small intestine connected to the end of the stomach.
Overall the start of week 2 was fantastic! This was a completely different environment opposed to the clinic. It was interesting to see how even in the same department can contain such different routines. I’m very excited to see where the rest of the week takes me!
For the rest of week 1, we were in the clinic for a most of the time, except for the few times we got to observe procedures. The clinic had different paces with different dynamics between the physicians. During faster paced days, efficiency was truly key. One morning we were shadowing the attendee, Dr. Nannegari, which this pace was much faster than shadowing the fellows. Dr. Nannegari was going from patient to patient quickly, I was amazed how she kept everything straight. Another day I was shadowing a fellow, Dr. Skef, but the pace within the clinic was faster than other days. The patients kept coming in constantly. Dr. Skef understood how important efficiency was in these times. Typically the fellow would consult with the patient, discuss the care plan with the attendee, and both the physicians would go in to talk to the patient to discuss the plan. However during the faster paced times, Dr. Skef would double check his care plan with Dr. Nannegari. Once the plan was agreed upon, Dr. Skef would go into the room alone to speak with the patients one last time, so Dr. Nannegari could see other patients to maximize productivity.
One problem I noticed while shadowing Dr. Skef in terms of efficiency was the interpreting phone service they use in the clinic. It was Dr. Skef’s first time using the service, but he didn’t have problems figuring it out. However the service disconnected mid-conversation. Once this happened, Dr. Skef had to follow through with the entire process again. The process consisted of dialing the number, selecting the language from the menu, and once an interpreter answered they listed their name and their ID number. The interpreter asked for the department, physician name, and patient identification number. With Dr. Skef’s name, the interpreter had to ask how to spell it which took even more time. This time is not only inefficient, but could potentially make the patient feel uncomfortable since there’s added time to build up anticipation. Even though efficiency is key in a clinic environment, the patient should be comfortable as well. One thing I noticed was that you select the language you need for interpretation by selecting from a typical phone menu, #1 was for Spanish. I thought it was convenient for #1 to be Spanish since it seems that it is the most popular language in the area. The #2 option was Mandarin. I’m not sure if the demographics of the patients that come to UI Health were used while making the menu, but that would be very beneficial. For example, if the second most popular language is Polish, that should be #2 on the menu instead of the last option. That way the physician doesn’t have to listen to all the selections before getting to Polish. Another way for helping the efficiency is the interpreting service should have a list of phone numbers that they can recognize what departments the calls are coming in from. I’m not sure if these calls come in as a caller ID or not, but it would help if the interpreting service could see the department that the physician is calling from instead of asking for during the conversation. If it is critical for the interpreting service to have the physician’s name, then each physician could have a four digit code which could be entered during the process. Entering four digits would take less time than spelling out names.
Besides efficiency, communication between the physician and the patient is important. Sometimes it can be difficult to explain pain to others and give specific details. Sometimes pain can be described very well, other times pain may be indescribable. Especially with GI describing symptoms may be uncomfortable, since it is very personal. The appointment starts as a usual appointment would, the physician asks how the patient is doing and why they came to the clinic. After this, things get a little bit more personal. Even though these questions may make the patient uncomfortable, it is essential for their care that they open up to the physician. Even though efficiency is important for a clinic to run smoothly as a whole, the interactions between the patients and physicians are important more for the individual getting the best care possible. Physicians must work efficiency in the clinic, but they must also take time with the patients to understand what is truly going on within their body.
Just with any new beginning there are several emotions involved. I was basically split 50/50 between excited and nervous. Excited for the opportunity and journey I was about to embark on, nervous because I wasn’t sure what to expect since this program is so open ended.
Based off the information given for the GI/Hepatology rotation, we were to report to the clinic. Ideally, someone at the clinic would know we were coming and be familiar with the program. However the information we received was from the previous year. However, a registered nurse gave us a suggestion to go to the new fellow’s office in the hospital. Once we met the fellow, Dr. Khan, things quickly turned around, emotions turned form nerves to pure excitement. The fellow was truly our saving grace to the rough start of the day. He wasn’t aware of the program, but once we described what we were doing, he seemed just as excited to have us in the department. He mentioned he had a few suggestions of some clinical problems he had noticed from his own experience.
Once the introductions ended, we talked more about GI in a general sense. I took a physiology course last semester, and it was amazing to see these concepts I became familiar in class discussed in real life. During the afternoon we became more familiar with how the hospital works with the dynamic between the primary care team and a consult team. The primary care team is just as it sounds, they deal with all the primary care and make the final decision for the care. Whereas, the consult team deals more with checking in and analyzing the situation and decide what care plans they would enroll and communicate this with the primary care. I felt that this system was very efficient since there are two separate teams working on the same patient so the care can be maximized with this collaboration. We consulted with a few patients in the hospital, one of them being a native Spanish speaker. Even though an interpreter was easily accessible, the fellow did a fantastic job speaking with the patient when he, himself was not a native speaker. I feel that it is important in medicine for the physician to connect with the patient on a personal level. There must be a trust present, despite not knowing each other for more than possibly a few minutes. Currently I want to go into medicine because the overall fields of medicine and technology interest me, but I want to be interacting directly with the patients opposed to indirectly like a bioengineer could.
Since Dr. Khan mentioned he had a slower day, he didn’t have much after consulting with patients. We made our way back to the clinic hoping for better luck than earlier in the day. Sure enough we had great luck! A physician in the clinic that wasn’t around when we checked in earlier was now there, and she knew who we were and what to do with us. We shadowed a few physicians in the clinic for the rest of the afternoon. This process was pretty routine, just seemed as if times it picked up and others it slowed down. With it being a teaching university I thought the dynamic between the fellows and attendees was interesting. The fellow would consult with the patient first and discuss the case with the attendee. They would then suggest what they would like to do with the care plan. From what I saw there usually agreement between the fellow and attendee, except for specifics. However the one thing that made this part of the day memorable was seeing patients with Nonalcoholic Steatohepatisis (NASH). Currently at research my main project deals with liver biopsies from patients suffering from NASH. I only deal with the disease on a very small scale, but I was actually able to see it in live action. I was able to see what problems these patients run into and why these symptoms occur. One of the reasons why I chose this rotation was because I’ve dealt with colon and liver samples and wanted to see it more in real life and make personal connections.
Overall from the beginning of the day was a little rough since we had the wrong information, but we received the new updated information! It turned out to be an awesome first day! Now it can be a little funny how lost we were the first day, but we somehow made the day a success. Since the first day was finally out of the way, I was extremely excited to see how the rest of the week would unfold.