Elise Debryn

University of Illinois at Chicago
Bioengineering


Rounds

Yesterday, we didn’t have much to do or see in the west wing of the seventh floor of the hospital. The attending, nurse practitioners, residents, and other staff members reviewed patient progress around an oval table while projecting patient info on a large monitor. One of the attendings expressed concern with administering tap water to a patient with kidney problems because he/she could potentially develop phosphate edemas. Another attending was concerned that a high BMI patient received a kidney from a very low BMI patient because a small kidney may not function as well. For their final patient, the attendings were uncertain  as to whether or not the hospital has a protocol for an HIV positive patient donating an organ to an HIV positive recipient. This is one aspect of the transplant surgery process that seemed to have “fallen through the cracks”. An attending vocalized her confusion as to why an HIV positive patient should receive an organ from an HIV positive recipient. 

Additionally, Dr. Tsvetkova took us along with him on rounds around the transplant and ICU wings. He talked to us about how it is sometimes difficult to access the pancreas in a recipient, so the pancreas is often attached in a more accessible location, such as near the kidney. Dr. Tsvetkova also went on to talk about an objective means of prioritizing which patients get a new liver. There are approximately 5,00 – 6,000 liver transplant annually. Patients are rated on a scale from 6 to 40, where 40 is the worst possible condition. Patients are rated based on certain characteristics of their blood work, such as bilirubin, creatinine, and iron coagulation levels. This method makes the transplant process more quantitative and less biased. 

Fire Hazard

Today was an exciting day in the OR! In the morning we got to see the removal of a graft. A graft is placed in hemodialysis patients and it functions to connect an artery to a vein. Blood flowing through the artery ultimately flows directly into the vein, causing the vein to bulge over time, and provides easy access to a high pressure blood source for hemodialysis. Grafts can also act like stents because they contain a wire mesh inside that keeps the vessel open. One patient’s graft had the wire slightly sticking out and was in danger of contracting an infection, so it had to be removed. I wondered if damaged is caused to the vein because of the sudden increase and decrease in high blood flow after the graft is inserted and removed. Veins naturally carry low blood flow because they are more compliant than arteries and can handle higher pressures better (they work against gravity to return blood to the heart).

Later on that day we got to see a tracheotomy whilst waiting for another transplant-related surgery. My friend Dr. Andrew Gonzalez allowed us to shadow the surgery. Another resident talked with me about the potential fire hazard of inserting a tracheostomy tube. I didn’t expect such a hazard to exist for this procedure, but he explained that there are three things to start a fire: air, fuel, and heat. This reminded of the article we were handed in one of our Monday workshops about the firefighter who saved his life in a wildfire by igniting embers to create a thin layer of oxygen around him. Anyway, a cauterizer is used to cut through the neck tissue to reduce bleeding and to make a clean cut. Meanwhile, the endotracheal tube has high pressure oxygen flowing through it. A combination of the sparks from the cauterizer and oxygen in the endotracheal tube is combustable and can cause a fire, which has happened before but not at UIC. It was scary to think that this could be a possibility during the procedure. The resident explained they can reduce fire hazard by temporarily stopping respiration or by reducing oxygen flow through the endotracheal tube. In these kinds of situations, it is very important the surgeons communicate with anesthesia. 

This surgery had to be performed in the first place because patients can only have an endotracheal tube for up to two weeks before it starts causing major damage to the trachea. The endotracheal tube pushes against the trachea’s lumen, causing micro-movements that can create ischemia in surrounding tissue. 

It was interesting to see the drawbacks of some of the medical equipment used in the OR. I was surprised something hasn’t already been implemented to reduce the potential for fire hazard in some of these surgeries. 

Da Vinci

Yesterday, we had the opportunity to shadow another living-donor kidney transplant, this time performed by Dr. Oberholzer. When we first got into the OR, there were some technical difficulties with the automatic ventilator, and the anesthesiologist had to vent the patient manually. The anesthesiologist said it was difficult to initially figure out if there was something wrong with the ventilator or with the patient because the machine did not specify. The ventilator started to work three people and half an hour later.

Dr. Oberholzer complained that the organ flusher machine did not work on a negative feedback loop. The flusher functions to keep the organ cool while the surgeon works on the patient. However, this flusher would keep getting colder and colder instead of automatically turning off when it reached the ideal temperature. Dr. Oberholzer complained that this made it very difficult to preserve the organ while performing a surgical procedure because someone had to constantly monitor it. 

Soon after, we saw Dr. Oberholzer at work on the da Vinci, synchronizing hand and arm movements all while maintaining a visual on the patient’s internal anatomy. Dr.Oberholzer said it was difficult to communicate through the da Vinci’s speaker system because it was quite muffled and required a very quiet OR. I got to view the surgery through the eyes of the surgeon as well because there was another da Vinci that allowed one to simply view the procedure. The 3-D view was amazing. The da Vinci provided proper depth perception and had good quality resolution. I noticed during the surgery Dr. Oberholzer would have to stop every now and then to take excess tissue off the cauterizer because it would collect on the device over time. In addition, Dr. Oberholzer’s view would become obstructed by the smoke from the cauterizer, and one of the nurses had to remove the camera to clean the lens. The opening in the patient had to be vented to allow the smoke to escape. 

A technician talked to us about the patient beds in the OR. She said the beds often malfunction for high BMI patients: sometimes they won’t go any lower or can’t accommodate improper weight displacement across the surface area of the table. Sometimes surgeons have to stand on a step stool if the bed won’t go any lower, which is something they would otherwise never do. Also, the bed remote stopped working so someone had to climb under the sheets to use the control column on the bed. 

There were definitely major equipment and technical problems this time around that should be fixed to allow surgeries to go more smoothly. 

OR

7/28/16

Today we got to see a living donor kidney transplant. The OR was an intimidating place. Everyone was scurrying to accomplish their respective duties all while maintaining the utmost sterility in designated rooms. Prepping for surgery seemed difficult because there were so many people who had to maneuver around one another and unused machines in the OR. Blue cloths were placed on tables that had to be sterile before and during the surgery. The attending Dr. Jeon wore a special kind of gown made with a different kind of material during the surgery. I wasn’t sure if this was because the material might have been more comfortable for the surgeon or if that’s just what he always liked to wear. The nurses took inventory of all the instruments that might be used during the surgery to make sure nothing is left inside the patient’s body. One nurse explained that one reason this is a very important task is because sponges shrink and crumble up once they’re soaked with blood. Those sponges can be easily overlooked once the surgeon is ready to stitch the patient back up. The anesthesiology attending and residents had a difficult time finding another catheter in the OR and had to call an outside nurse to bring another one in. I noticed that the anesthesiology attending inserted a metal device to separate and hold up the many tubes and wires attached to the patient.

Once the surgery started, I noticed that there were some staff who were wearing shoe covers and some who were not. It was an inconsistency in their hygiene policy for sure. We were confused among ourselves as to whether or not we should wear shoe covers. In addition, it was very difficult for the attending and residents to adjust the lamps looming over the surgery table. It was difficult to make minute adjustments to the lamp’s position and to even reach the lamp for some people because it was too tall.

7/29/16

The next morning we sat in on a donor/recipient transplant qualification meeting. Dr. Oberholzer, nutritionists, pharmacists, financial aid officers, social workers, and other staff members sat around a large table discussing individual cases. They looked at each patient’s past and current medical history to catch patterns of noncompliance, suicidal behavior, drug abuse, etc. All of the above behaviors make a recipient less likely to receive an organ for transplant. The committee tries to help these individuals with improving certain behaviors, such as having them work with a psychiatrist to treat depression.

At the end of the meeting, Dr. Oberholzer inquired as to whether the staff could find living donors who were rejected recipients in past cases. Staff members vocalized difficulties with finding these cases because they are not traditionally entered into the system. In addition, a nurse brought up the ethical dilemma of having donors lose weight before transplant surgeries. Hospital policy does not require donors to lose weight, but it likely lowers risks during surgery. However, an ethical situation might arise if the donor feels that the hospital promised him/her something in exchange for losing weight before the surgery. They all agreed they needed to consult with each other more on the topic. Finally, Dr. Oberholzer mentioned that other hospitals have implemented a practice called Donor Swap. This occurs in a situation where recipient and donor at hospital 1 are not a match, and donor and recipient at hospital 2 are not a match. However, donor at hospital 1 is a match with recipient at hospital 2, and recipient at hospital 1 is a match with donor at hospital 2. They two donors would thus switch their respective recipients. This method is more efficient and likely to save more lives since organs are in high demand and hard to come by.

 

(the image used for this blog post is not from the actual operating room we observed)

Hemodialysis

7/26/16

Today we had the opportunity to visit the transplant clinic with a few of the residents. For our first patient visit, I noticed that there were no hand sanitizers outside of the patient rooms, only inside. Although this may not seem like a huge design flaw (or even a flaw at all) I feel like it’s harder for the staff to sanitize their hands as frequently as they need to. Some of the hand sanitizers inside the patient rooms are difficult to access. 

The first patient had a heart catheter, fistula, and graft done prior to the appointment. A fistula is when the vein and artery are connected to make the vein bigger over time. This enlarged vein is used for hemodialysis so that a strong enough flow can turn into the machine. Arteries are too deep to access so veins make for a better alternative. Grafts are another option, although they are more prone to infection because a plastic tube is inserted to connect the artery and vein. Introducing a foreign object into the body always poses a risk for rejection reaction. Heart catheters are a third object for hemodialysis but they can be very dangerous for patients because they provide an opening from the larger vessels to the external environment. 

Another patient we saw had a very large, developed vein from being pumped with a high volume of blood for hemodialysis. We had the chance to place our fingers over the bulging vein and feel the turbulent blood flow. 

In the middle of clinic hours, a couple of nurses were arguing with one another about room booking. One nurse complained that a patient had been on a liquid diet for days and now had to continue that diet until he/she came to the next appointment since the current one was cancelled due to a room booking conflict. Apparently, transplant patients took priority every other patient in the clinic. The nurses felt angry for their patients. 

7/27/16

Today I got to catch up with my previous GPPA teacher, Dr. Andrew Gonzalez. He wanted to know what Clinical Immersion was all about and pitched some ideas to us during lunch. He mentioned how difficult it is to come across a long enough vessel for many bypass surgeries when bypassing arteries from the thigh to the foot. He sarcastically asked us to solve this problem in a couple of years by growing stem cell vessels using a long scaffold. 

The Big Picture

During clinic with Dr. Machado today, we came across a patient who was on many types of medication. Her only way of remembering all of them was by thinking of them in alphabetical order. It was a clever way of keeping track but otherwise seemed hectic.

I’ve noticed that physicians, nurses, and pharmacists all have a difficult time creating a complete picture of patients’ past and current medical histories. It’s not due to any lack of cognitive function by healthcare workers, but rather by the inefficiencies of the entire healthcare system. Lists of medications, tests, and diagnoses appear on most patients’ medical records. Dr. Jacobsen mentioned that many mistakes can carry over with the use of electronic medical records. Whether it’s the matter of copying and pasting “not” into a patient’s records, many mistakes can be quite harmful, even disastrous for the patient.

Dr. Jacobsen gave the hypothetical situation of a patient suffering from extremely low blood pressure in the ICU. Physicians administer many fluids to raise the pressure and over flowing the body with too much can lead to pulmonary edema, or fluid in the lungs. This is also symptomatic of congestive heart failure. Someone unfamiliar with the patient may very easily type in “congestive heart failure,” which will continue to exist in that patient’s medical record for future doctor visits. A patient who has never had congestive heart failure continues to be labeled as one anyway. 

It’s difficult to get an entire industry, such as the one responsible for the incredible yet flawed electronic medical record system, to standardized their protocols and software. How do you get giant corporations to understand the importance of administering the highest quality of care? Of increasing efficiency in order to save both the physician’s and the patient’s time? Not all of this will come without the cost of cutting dollars on the side of these corporations. It’s unfortunate we live in a world where money comes before health-where life is at the expense of profit. 

Sleep Center

It was a blistering hot day. The sun was beating on our backs, and the humidity was smothering. We were venturing to the Sleep Center on West Harrison Street. Once we arrived, I silently thanked the cold air that blasted our faces. In the break room, Dr. Singla was busily typing up patient notes. He was incredibly friendly and introduced us to the fellows also working the clinic that day. I noticed that every patient room had a typical desk and chair in one corner and a giant bed in another. The beds, fancily decorated with old-fashion comforters, are used for sleep studies. 

Most of the patients who visit the Sleep Center have sleep apnea: a condition where the airway is obstructed during sleep, causing the person to stop breathing and wake up.  CPAP machines help prevent sleep apnea by blowing air, much like ventilators do, into the patient’s airway. Air is drawn into the machine and humidified when released into the face mask. Our group was curious to know as to why these machines do not use HME filters, something also found in ventilators. HME filters warm up and humidify air exhaled from the patient so that it can then be inhaled again for the next breath. These filters use an internal air source, which reduces the risk of infection for the patient. It is very likely that patients using the CPAP machine can contract fungal, bacterial, or viral diseases if the air is contaminated or if the machines are not maintained properly. 

Overall, it was interesting to observe the many conditions/illnesses related to quality of sleep. Much of the current technology used to treat these ailments can be modified and improved upon for better patient care/treatment. 

Poking Around

Week 2

7/13/16

There wasn’t much for us to do in the PFT labs so we ventured off towards the cardiac catheter lab. I’ve never seen or heard of such a procedure so I wasn’t sure what to expect. I learned that a cardiac catheter and dye are used to locate major blockages near the patient’s heart. The surgeon begins the procedure by inserting the catheter through the right femoral artery and snaking it up through the aorta. Once the aorta is reached, the dye is injected and an x-ray scan of the patients chest is shown on a screen in front of the surgeon. 

On one side of the room there are technicians and nurses helping the surgeon prep for the surgery and to help visualize where the catheter is in the heart. A St. Jude’s bioengineer was on site that day and explained that she was using software to create a 3-D image of the heart by placing electrodes and several more catheters in the heart. 

Their patient today had an arrhythmia that was producing tachycardia (fast hear rate). The arrhythmia may be corrected by burning/killing certain heart cells near the tricuspid valve. The bioengineer described it as stopping the heart from “short circuiting”. 

I noticed that in the prep stage, the surgeon and nurses were having a lot of technical difficulties with troubleshooting. A cable would sometimes pull out of its socket or someone would forget to plug in a cable somewhere. Once they got the procedure going, the C-arm of the fluoroscope machine sometimes bumped into the screen monitors the surgeon was looking off of to view the patient’s chest x-ray. There were 9 monitors in total suspended form the ceiling, which I thought was a smart way of maximizing floor space. In addition, the x-ray itself is hard to use because it is 2-D and has no depth perception. So, the surgeon has to be very careful guiding the catheter around the heart. 

As the procedure continued, it was amazing to see the 3-D image of the heart slowly  come to fruition on the screen in front of us. The surgeon and bioengineer worked together to find all of the “hot spots” in order to kill heart cells. However, I did notice communication between the two could be improved. This is because the bioengineer and surgeon had to be separated by a glass window to protect those who weren’t wearing led-protected clothing from unnecessary radiation. The bioengineer had to keep pressing a button in order to speak over the intercom with one hand while navigating the computer with the other. 

7/14/16

I walked into the clinic that day and met a very enthusiastic and amiable doctor near the front door. His name was Dr. Machado and he specialized in pulmonary hypertension (PT). Right away he began to explain the physiology behind PT by comparing the circulatory system to a circuit. I liked how he took the time to explain this all to us before we went to see patients. He kept everything in simple terms and made sure we understood what he was talking about. Once we did get to see patients, I noticed twice in a row that patients had trouble getting up on the examination chair. They were either too short or too weak to get up on the chair, and the chair couldn’t go any lower. It seemed to hinder the diagnosis process because the doctors had to improvise with a stool instead. I wondered what they would have to do if even a stool wasn’t available. 

Vent

Week 2

7/11/16

We had the opportunity to try one of the ICU’s latest ventilators called the Nellcor Puritan Bennett 840. The 840 includes an HME filter that humidifies and warms up air to body temperature so patients’ lungs do not dry out. Each of us used a mouthpiece that connects to the ventilator. We wanted to experience what it feels like to have a machine breathe for us. Normally, humans breathe through negative pressure, which allows air to readily enter through the respiratory airway and the lungs. Ventilators, on the other hand, utilize positive pressure to push air into a patient’s lungs. If air is pushed too aggressively into the lungs, then the patient can suffer from lung damage. 

A respiratory technician set the parameters on the ventilator and instructed me to hold my nose. A sudden rush of air entered my mouth, and, at first, it was too much to handle. I had to take my mouth off the mouthpiece to regain my breath. I tried once more. This time, I anticipated the sudden gust of air and exhaled slowly. It was absolutely tiring to be breathing on the machine. The technician eventually adjusted the settings so it was similar to the type of breathing one would experience while scuba diving. This setting was much more comfortable and felt more (although not completely) natural. The entire experience left me with more empathy for patients who have to depend on this machine. 

An advantage to using the 840 is that patient ventilator information can be easily downloaded onto a computer at the nurses’ station. Physicians can also place ventilator orders for their patients on the computer. Information can be sent to and from patient rooms, decreasing foot traffic and increasing efficiency in the ICU. 

Later that day, we shadowed Dr. Nyenhuis in the allergy clinic. I went with her to see a patient who was suffering from allergies. After recording the patient’s medical history, Dr. Nyenhuis walked over to the patient to perform a routine physical examination. I noticed during the examination that it was difficult for Dr. Nyenhuis to use the retinoscope and otoscope on the patient because both instruments were attached to the wall through a long, coiled cord. It was the kind of cord you would see on old landline phones. 

During another physical examination, a patient received an allergen test. For this test, nurses apply a plate of small spikes, each containing a different allergen, such as tree pollen or dust, and press them into the patient’s forearms. The spikes only break the first layer of skin so it is a relatively painless procedure. I noticed it was difficult to dispose of the allergen plates in the biohazard waste container because the opening of the container was too narrow for the bulky plates. After 15 minutes, the nurses record any allergic reaction by measuring the flare and wheal of the bumps with a ruler. The sum of the measurements indicate a positive or negative result. An irregular circular shape (also called pseudo-podding) indicates a stronger allergic reaction.

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Spike used to apply antigen to patient’s skin  IMG_6736
Ruler used to measure flare and wheal of allergic reaction

7/12/16

We visited the ICU in the morning and learned more about pharmaceuticals. The pharmacy uses a relatively old-fashion pneumatic tube system to transport medicines all across the hospital. This method is more efficient than having a person deliver medications via a cart. The ICU also uses an Omnicell machine to store 50% of their medication. It is the most efficient method of retrieving medications because the machine stores pre-made medicine with long stability and can help track abuse. Physicians and nurses are able to keep track of sedatives and narcotics by making only one vial available at a time. I saw a resident restocking the Omnicell and questioned whether staff was ever afraid of stocking the wrong medication. The resident clarified that each medication is scanned and placed into its appropriate canister. Other canisters are locked to ensure medications are placed in their proper dispenser. 

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Omnicell machine

 

Later on, an anesthesiologist resident showed us a high resolution Guide Scope that is used for intubation. The end of the scope has a camera and a light that helps the user to visualize the vocal chords. Once the vocal chords are in view, an endotracheal tube can be put in place to open the patient’s airway. Th Guide Scope allows for greater precision so less harm is done to the patient, and physicians can restore the patient’s airway more quickly. 

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Guide Scope

 

A nurse in the ICU talked about new pumps available for the hospital that are better at protecting patient information. Pumps are individual units that deliver specific mediation at a determined concentration and rate to the patient. There is one pump for each medication. The hospital’s current pumps are a little more outdated and less protected from viral attacks. The nurse also explained that the current pumps are very heavy and have poor design. The front ridge of the pump may make for easy bacterial transfer because it is usually not bleached when the pumps are cleaned. Nurses must also go throw a number of steps in order to setup the medication specifications. Most importantly, the pumps do not indicate battery life and they have a relatively short battery life. Patients are in danger of receiving sub-optimal therapy as a result. For instance, there have been times where pumps have suddenly died while nurses are transporting patients. It takes a while for a new pump to be available, and the patient is deprived of his medicines for a period of time.

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two pumps on a stand

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closer look at a pump

It’s always very interesting to examine not only the machines and equipment different departments utilize, but also the processes that take place between nurses, physicians, and technicians. I hope to learn more about what can be improved and what has proven to increase efficacy in patient care. 

 

Inhale, Exhale

My second day of Clinical Immersion revealed the finer details of pulmonology. In the morning, we shadowed a respiratory technician who performed pulmonary function tests (PFT) on patients in a specially designed room. This room contained a transparent chamber, a sealed gas tank, and a computer. At the beginning of the PFT, the technician had the patient sit in the chamber with the door open and breathe into a mouth piece (shown below). The mouth piece had an internal filter that blocked any spit or bacteria from entering back into the machine.  20160706_111302The patient had to go through different breathing patterns, such as taking a deep inhale and slow, deep exhale or rapid, quick breathing cycles. At the same time, a graph of flow vs. time was generated on the computer screen. The end measurements obtained from a PFT is the forced expiration volume (FEV), residual volume (RV), total lung capacity (TLC), forced vital capacity (FVC), and vital capacity (VC). The purpose of all of this is for physicians to interpret whether a patient has either obstructive or restrictive pulmonary disease.  

Later on in the testing, the technician closed the door to the chamber where a known concentration of carbon monoxide (CO) or helium was released. A body pletismograph was obtained to measure lung volume and pressure changes. 

The technician mentioned how he wish the whole process could be automated such that the computer could indicate breathing patterns and decipher between good and bad collected data.

Earlier that day, we observed a bronchoscopy, which is when a physician uses a scope to examine a patient’s airways to search for enlarged/unusual lymph nodes. The procedure admittedly looks uncomfortable. Imagine having a long cord placed into your trachea while partially conscious. Many patients cough during it, which is normal. 

The patient lies down in the supine position with a guard placed over the mouth to prevent him/her from biting on the scope during the procedure. Anesthesia is administered moments before the procedure begins. The tip of the scope contains a 50 degree span ultrasound probe, a 35 degree needle, and a 30 degree camera. A physician holds a part of the scope (that looks like a game controller) near eye-level so that the scope remains straight while going into the patient’s throat. The “game controller” has many wires coming out of it that hook up to various connectors in the wall or to machines. 

At first, the team was having difficulties setting up the scope. Nothing was showing up on the screen and when it finally did, the colors weren’t correct. Everything looked too pink. This obviously delayed the procedure and the physicians and nurses had to figure out what was wrong while attending to the patient. Once they were finally able to get the scope working (it was a matter of inserting the end of the scope properly into a machine), I noticed how uncomfortable it must be to use it. Imagine having to steadily hold a part of the scope with one arm bent at the elbow while fishing the scope with the other hand into the patient’s throat. In addition, it was difficult for the physician to see where he was going since the camera was not directly pointed at the end of the scope. 

Near the middle of the procedure, a pathology team was called into the room. They rolled in a cart holding a microscope, various dyes, and containers. Once the physician obtained a biopsy from the patient, it was handed over to the pathologists for examination. It was intriguing to see how the physician and pathology team were able to directly communicate whether more samples needed to be taken and if the biopsy indicated a serious problem with the patient. Once the team was done, they rolled they equipment out of the room. 

The attending would spend a little more time to allow the fellows to practice using the scope. Every once in a while, the nurse would have to suction saliva from the patient’s mouth. On the screen I could see the larynx lead into the trachea, which then leads into the bronchioles. The pinkish lumens of the bronchioles were fascinating. It looked like a maze of tunnels – each one branching off into more and more tunnels. Every time the patient coughed the bronchioles would constrict and rise towards the camera. 

By the end of the procedure, I was amazed by how far medicine has come. A century ago, physicians could have never viewed the respiratory tract of a living patient. Their only option at the time was to conduct autopsies on cadavers. Although, I know even more can be done to improve current care. 

I Could Get Used To This

Week 1

7/5/16

The first day of my pulmonary/critical care rotation consisted of many unfamiliar faces/names, twisting hallways, and scary medical jargon. I was excited and nervous- excited to have the opportunity to work closely with physicians, and nervous I would mess something up or ask a stupid question. However, the staff was incredibly warm and friendly. My nervousness subsided for the rest of the day. 

The first person we came across was an advanced practitioner nurse who immediately delved into the complications of teaching patients how to use inhalers properly. Apparently, many people forget the first crucial step of using an inhaler. The steps are as follows: 1. Exhale as much air as you can out of your body 2. Place the inhaler to your mouth to simultaneously inhale and blow two puffs of the inhaler into your mouth 3. Hold your breath for 8-10 seconds. Another problem is that there are several categories of inhalers and several more options within each category. Patients must learn how to use their specific inhaler properly or else they will be readmitted for another visit to the hospital.

The nurse suggested creating separate education rooms within the clinic so nurses or physicians can teach patients how to use their inhalers properly. Effective teaching methods will significantly lower health costs for patients and the hospital. 

A little later that day we were paired with fellows working in Dr. Dudek’s clinic. The fellow I had the opportunity to work with was Dr. Usmani. For his first patient, Dr. Usmani had me follow him to a room where he greeted Mr. X and began his medical/family history. I really enjoyed observing how Dr. Usmani interacted with his patients and how he used given information to arrive at a diagnosis. He went through a general process of assessing initial medical information that was given to him about the patient, meeting with the patient to gain a full and complete history, and then finally studying the patient’s  x-rays or scans with Dr. Dudek. 

Patient x-rays were run through the computer system and displayed on one of the screens in the doctors’ office. They were fascinating, but I couldn’t see what the doctors saw. I didn’t have their specially trained eyes to decrypt the images. Dr. Dudek and Dr. Usmani gestured toward certain parts of the chest and lungs while noticing subtle differences in the patient’s anatomy. Sitting there I could only wish to gain their same ability some day. 

Dr. Dudek mentioned how it is sometimes difficult to upload scans into the system because not all hospitals and clinics use the same software. CD-ROMs are even used to store scans but are problematic for physicians. Precious time is taken out of their day to tinker with the software when they could be helping a patient instead. 

I still felt excitement by the end of my first day at the pulmonary/critical care department. I can’t wait to see more in the upcoming weeks! 


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About
Hi! I’m a senior majoring in bioengineering at the University of Illinois at Chicago (UIC) with a concentration in cell and tissue. I am also a student in the Guaranteed Professional Program Admissions for medicine. My goal is to become a research physician and to create advanced medical technology to improve patient care.