Kushal Basnet

University of Illinois at Chicago
Bioengineering


Bioengineering

Sara and I spent the whole Wednesday of this week with Sergio, a bioengineer that Dr.Kotini set us up with. We had some issue finding him at first because we didn’t know what he looked like and he didn’t know what we looked like, but we did end up meeting up. Sergio started the day by taking us to his office on the 7th floor of the hospital. 

 His office was very interesting, because it actually looked like an engineering laboratory and not a hospital room. There were many broken devices and many tools that were used to fix the devices. Sergio sat us down and explained the many things he does in the hospital. He told us that he is in charge of fixing many of the broken devices in the hospital, but he is also an on-call engineer, so whenever a device breaks down and requires an immediate fix he will be called in to fix it. Even though he fixes many of the devices in the hospital, he is mainly in charge of the anesthesia machine used in the ORs. 

Sergio told us an interesting story about how he was called in to fix an anesthesia device that broke down in the middle of a liver surgery. Apparently the screen of the device stopped working, so Sergio was called in. When he got in to the OR and inspected the device he found fluid, which he suspected to be saline, in one of the compartments. The saline solution ended up making its way into the transformer of the device and shut it down. Sergio realized that there was nothing he could do it fix it, so they had to replace the device in the middle of this surgery that was going on. The anesthesia device has parts that come off incase of emergencies like this, so replacing the whole device took about 10 minutes. The surgery ended up going well and the nothing happened to the patient. Sergio was upset because someone had put a bag of saline solution in a compartment that was not meant to hold liquid and it almost ended up really bad. It is interesting to note that there was no sign on the compartment that warned users not to place liquid. The General Electric representative came in that day to look at the device and ended up agreeing with Sergio’s assumption. 

In the other blogs I had mentioned most of the doctors hated Cerner, the electronic medical record system. I found out that Cerner has a good device interface, while having a poor patient interface. All of the monitors that are connected to the patients in the hospital are connected to the Cerner’s database and Sergio could view each of them in his computer. If there was a problem with one of the monitors, Sergio could look at it in his computer and tell what was wrong. It seemed like that whole system flowed well and if there was a problem it could be fixed easily. All of the defibrillator devices in the hospital have a self-check interface, where the machines do a test run every night and prints out the results. The devices are also connected to the Cerner database, so Sergio gets an email if one of the machines doesn’t pass the self-check. 

Problems like the anesthesia device breaking down seem to occur many times at the UIC hospital even though Sergio told us that most of the device had to go through regular checkups. 80% of the problems that come into Sergio end up being user errors, where the physicians or nurse don’t know how to use the device. This day was very interesting because we got to see the hospital from an engineering standpoint. 

Ultrasound

There really isn’t much to talk about from the first two days of this week. Sara and I were only at the ED for a couple of hours on Monday and we took the morning shift on Tuesday. It seems like the morning shifts are usually quiet, but there is an unspoken rule in the ED where no one talks about the ED being quiet or slow because of some superstition all the physicians seem to follow. It’s actually rather funny.

Sara and I did spend a considerable amount of time following one of the resident and a fourth year medical student, who were doing a ultrasound rotation in the ED. The ultrasound machine is often used in the ED because many patients come in with some type of a pain that was caused by impact and the ultrasound machine can be used to check for internal bleeding or damages to an organ. There are two ultrasound machines in the ED; one is new and one is not so new. Most of the physicians prefer the old machine for some reason. I speculate it has to do with comfort of using a machine that the physician has always used. The machine itself is rather old, dirty, and has a lot of cords and probes attached to it. However, the machine is decorated with lots of stickers and even bedazzled, so I guess it makes up for it. 

We saw the ultrasound machine used many times this week. Every time the machine was used on a patient the resident would start off by scanning the patients bar code, then he would type out his name and the name of the attending on duty. The resident would have to do this every time and it didn’t take a considerable amount of time, but it did seem like a hassle. I noticed several things during our observations and made a list. 

  • ·      Lots of gel is used during the ultrasound examination. The gel would get all over the patient and would be wiped away with a towel at the end
  • ·      After the machine is used, the resident would wipe down the probe with a sanitizing towel.
  • ·      There was a basket that had many empty tubes of gel on the ultrasound machine.
  • ·      Most of the wires hang out of the machine and it didn’t seem like there was a place to hold them.
  • ·      The buttons on the machine were hard to press.
  • ·      The probes are uncomfortable to the patients at times.
  •      The machine would have to be plugged into the wall after every use

      I’m sure most of these problems have to do with budgeting and there are better ultrasound machines out there, but there doesn’t seem to be any direction on sanitation or maintenance of the machine. It’s hard to tell if that’s the physicians’ job or someone else.

 

One of the attending set Sara and I up with a bio-engineer that works at the hospital on Wednesday, so I am looking forward to that. Hopefully that will be informational and I will have more stuff to talk about on my next blog.

The First Week of ED

The first week of ED was very interesting to say the least.

I had to move around quite a lot in the Emergency department, unlike my first rotation in Ophthalmology. It got pretty confusing at times on where to go, because there isn’t one physician Sara and I follow. We sort of just bounce from one physician to another while they go in to see a patient. We saw many patients this week and each of them had their own set of problems. Whenever I got the chance to talk to one of the patients, I asked them what sort of problems they encountered while they were at the ED and made a list.

  • ·      Wait times. This was a big one and almost everyone said this
  • ·      Space too small or not enough privacy
  • ·      Beds were uncomfortable
  • ·      Place was dirty
  • ·      The lights were too bright or to dim in some rooms
  • ·      There was too many annoying sounds

Sara and I also went around talking to the nurses on Thursday and asked them if they encounter problems. There were a lot of complains about how most of the equipment didn’t work. One of the nurses mentioned an interesting problem that caught my attention. Apparently a trend started at UIC ED a long time ago where when the nurses would draw up a patient blood, they would draw 1 or 2 more tubes than needed. This was done incase one of the primary tubes were lost or something. The nurses were suppose to leave the extra tube of blood on a tray in the room, but a big problem is that the tubes would always go missing or the nurse would place the tubes in random locations. So if you walk around the ED you would see random tubes of blood everywhere.

One of the other nurses was very adamant about how dirty the ED was. When Sara and I went to asked her to identify her main problem, she instantly said she couldn’t stand the filth. She talked about how many of the machine or chairs were full of dust. She told us about how many bugs or insects were in the lights or how all the curtains in the ED were never washed. At the end of her long rant she told us to just take a walk around the ED and look at how unclean the place was, so Sara and I did so. We did notice all the trash and dirt that was in the ED and we were shocked by the state of the curtains in the ED. There were many curtains in the ED and most of them were used to act like walls. We could see the amount of dirt that was accumulated on the curtains from use and we understood why the nurse was so adamant about the sanitation of the ED. If I were a patient in the ED I would have noticed the lack of sanitation and would have been very uncomfortable. 

 

I identified many problems in the first week and hopefully the next two weeks will be just as informational.

Emergency

The Emergency Department (ED) at UIC is nothing like I was expecting it to be.

The first day started of with Dr.Gehm giving us a tour of the ED and I was overwhelmed by the amount of problems I saw during the tour. There were many small problems like, random carts and wheelchairs blocking the path in the hallway, random noises that seem to be going off for no reason, and many posters and signs on the walls. The structure of the department was not well organized. The hallways had sharp turns and not enough room for the gurney to comfortably move.

There were also some big problems like the supply cabinet in the hallway having a broken lock. The supplies in the cabinets were not properly organized and some of them were not properly sealed. During the tour Dr.Gehm mentioned that the lock had been broken for 6 months and they have even caught people trying to sneak supplies out. This shocked me because this problem is huge and it has a simple solution, but no one is trying to fix it. Another problem that was overwhelming was that most of the devices used in the emergency department was either outdated or broken. Some of the equipment were even ducked taped or had exposed wires.

The second day was a little different. Sara, my partner, and I decided to do a night shift to experience the full scope of the department. We started off talking to Dr.Lin and it turns out she is working on a medical device herself. She is trying to make a small device that can plug into any phone and it would take various vitals of the patient. The patient would use this device and then it would be relayed to their heath care provider. This idea was very interesting and I could see the usefulness of this device in the ED, where having a small portable vital reader would make a big difference.

Sara and I then went around the department to ask the staff about the problem they encounter in the ED. I will provide a list of complains below.

  • ·      Lights were too dim. It was very hard to see the vain sometimes for IV
  • ·      The room were too small and they didn’t provide privacy to the patients
  • ·      There was too much noise and that could lead to noise fatigue
  • ·      There was no place to hang the cords for the devices
  • ·      The computers were old

These were just some examples of the complaints we got. Figuring out the good problems from the sea of problems will probably be the biggest challenge of this rotation. 

Overview of my first rotation

The past 3 weeks in the department of ophthalmology has been a great and fun experience. I learned various amount of things like the primary devices doctors use to examine the eye, how the hospital functions from an internal standpoint, and how surgeries operate. All of the doctors that I worked with were intelligent and they were excited to have me there. I got to experience things that most people will never get a chance to do.

The first week was a bit chaotic. I had never been exposed to the clinical environment, so I was very nervous going into the rotation. I started off in the Department of Cornea with Dr.Sugar in the first week. Dr.Sugar turned out to be one of the best doctors I have ever met. He was very helpful and very willing to answer any questions I had. He let me observe all the patients that he examined and taught me many things. Most of them were from the medical perspective, but he believed that learning things from the medical side would help me better understand the problems from the engineering side. The first week I also visited the OR for the first time in my life. As the days progressed through the first week, I adjusted better and better each day. I got used to being in clinic and by the end of the first week I had lost all of the nervousness that I came in with.

The second week was when I learned the most amount of information and identified the most amounts of problems. I was placed into the departments of Pediatric, General eye clinic, and Glaucoma. I gathered copious amounts of information from physicians and patients. Most of the problems had to do with ergonomics and patient flow. The devices that the physicians used were very staining to the body, which can lead to many physical problems in the future. Most of the patients complained about the wait time, but this is a universal problem. Things also got a little hectic in the OR. I witnessed a code and realized how stressful the hospital environment is.

The last week of this rotation slowed down by a lot. Most of the doctors were on vacation, so it was hard to be placed into a department. I still got to shadow doctors and see many more surgical procedures though. This week was more for reflection and analyzing the problems that I identified the first two weeks. Trying to sort out the main problems from the sea of problems to write in the report was the hardest part of this week.

Just when I thought I was getting in the hang of things, I will be placed into another rotation. The past 3 weeks went by fast and hopefully my next rotations will be good as this one.                                                                 

Second Last Day

Things have slowed down dramatically in the last week of this rotation. Most of the doctors in the Ophthalmology department are on vacation, so it is hard for Dr.Sugar to schedule us in with different departments. Thankfully I ended up getting placed into the Contact Lens and Oculoplastic department for this week.

 

I learned many things during my stay at Contact Lens. I shadowed Dr.Joslin, who was very friendly and was willing to answers any questions I had. That day I saw about 8 patients and gathered useful information from my observations. One of the patients that I observed didn’t find his new contact comfortable, but was willing to comply for the better vision it provided. The balance between comfort and function is an important aspect of engineering. After seeing this patient give up one for the other, it got me thinking about how many other patients have to do the same. Another patient that I observed was misinformed or not educated enough on how to put on his contact, so his contact ended up falling out and eventually broke. The lack of patient educating seems to be a prevalent theme in the hospital. It is mostly due to patient compliance, but there are certain cases where the patient really wasn’t informed on what to do. Coming up with solutions, like having a video instruction for each medication, could be beneficial to every aspect of the hospital. The rest of the day I observed many more cases and took notes of all the useful information that I could use to write my final report.

 

My time at Oculoplastic was more relaxed than Contact Lens. Raahil, who is a member of my group, and I were with Dr.Setabutr for most of the day. He was very intelligent and insightful on the problems he had. He was very busy so Raahil and I just sat around for most of the time, but every once in a while Dr.Setabutr would let us tag alone. One of the patients he was seeing that day had chronic muscle spasms in her eyelids, so she had to get 9 Botox shots around each eye. The patient also had to get those shots every 4 months. Raahil and I discussed potential ways we could help the patient. One thing we came up with was to create some sort of a device that has all the shots preloaded and with multiple ports. This way the patient only had to get one shot. We then spend the rest of the day identifying many more problems and trying to come up with solutions for each one.

 

I only have a couple of more days in this rotation and until it ends I will try to identify many more problems. 

Code Blue

The OR is much different in real life than it is in the movies or T.V shows.

Dr.Sugar had made arrangements for our group to visit the OR this week. He wanted us to watch some pediatric ophthalmology and retina surgeries, so we can get the full scope of the department. We had gone to the OR last week, so it wasn’t anything new. My group didn’t get lost this time around and we made it to the surgery we were suppose to watch. The surgery that was about to take place was a Strabismus surgery, which is a surgery to fix a cross-eye or lazy eye. This was a routine surgery and the primary surgeon had done many, so it wasn’t very difficult for her. This operation was a two-man job, so there was another surgeon assisting with the surgery.  The surgery started off great. The primary surgeon was singing along to a song that was playing and even teaching the resident how to perform the surgery. I was fortunate enough to get a spot right next to the primary surgeon, so I could see the full scope of the surgery. All the other surgeries I had seen were on a monitor, so this one was different experience for me. It was very strange watching someone dig into the eye with multiple tools and take things apart.

It was all very calm until the middle of the surgery. The primary surgeon heard a gurgling sound coming from the patient and asked the resident anesthesiologist to check to see if all the vitals were stable. As the anesthesiologist was checking the heart rate of the patient started to increase and the breathing stated to go down. The resident anesthesiologist realized that something was wrong and yelled at the nurse to get his primary attending. A code blue, which is an emergency, was called from the nurse and the room started to light up.

 The patient started to flat line, so the primary surgeon and the other surgeon immediately stopped what they were doing and moved away from the patient. Ophthalmology surgeons are not trained to handle emergencies, so stepping away is the best option for them. Within seconds the room started to flood with other doctors and nurses. I made my way to a corner to get out of the way and was called out of the room by one of the doctors. The tension in the air was very high for the first few moments, because all the physicians didn’t know what was wrong. I was outside of the room and had no idea what was going on, but after a minute I could feel the tension fade away. Some of the physicians came out the room and the code blue was called off. It turns out the patient somehow was unable to breath during surgery, so his vitals started to drop. Thankfully at the end of all of it the patient was fine and the surgery was a success.

Something that I found interesting during this while situation was that even though the primary surgeon was a trained physician, there are times when even they must step away. Another thing to notice was the sheer amount of people that flooded the room after the code was called. I don’t know much about emergencies like this, but it seemed like there was more people in the room than that was needed. Most of the people were watching while a few were trying to fix the problem.

This week in the OR has been an eye opening experience and I still have another 4 weeks left to learn.

Week two

 I was placed into the department of Glaucoma for my first day of week two. Glaucoma is damage to the optic nerve of the eye mostly due to high eye pressure. Dr.Sugar informed me that he did not have a set doctor for me to shadow in Glaucoma, so I basically had to walk around till I found a physician on duty. This was a daunting task because it was lunchtime and most of the physicians were out. I eventually came across Sofia, a technician, who allowed me to shadow her until one of the physicians was available. She was a bit skeptical about me after I introduced myself and told her why I was there, but she warmed up to me and was very willing to answer my questions. I asked Sofiaif she could identify any problems that she encountered in a day-to-day basis and she just started listing them all off. She was having problems with the slit lamp next-door, problems with her patients, and many more. I had only shadowed physicians before this point and after having met with the technician, I realized that talking to multiple personal, and not just the primary physician, can lead to better understanding problems that occur in and around the hospital.

After Sofia left, I started to shadow Dr.Wilensky and he was just as enthusiastic as Sofia about letting me know the problems he had. I didn’t want another long list, so I tried to limit my questions by asking him only his main problems. Surprisingly, patient compliance was a big problem. I wouldn’t think that placing eye drop was a big problem, but I guess it was. Many of the patients did not follow direction about the medication they were given, even when the instructing were clear. Dr.Wilensky said that as much as 40 t0 50 percent of the patients were not compliant and their recovery took a hit because if this. I spent rest of the day just following Dr.Wilensky around the clinic. I ended up with a long list of problems faced in this clinic and I was ready to come up with solution for each of them. 

The following day was much more exciting than the day before. I was in the general eye clinic with Dr.Sugar. That day in the clinic was particularly slow because the old residents had left and the new residents had come in, so the front desk did not schedule many appointments that day. Dr.Sugar was doing a simple laser eye surgery today and I was really excited to see how that procedure worked. Unfortunately the machine was having a problem and we had to wait for the technician to come fix it. After an hour or two the technician found the problem to be some loose wires in the machine. I was a little surprised to see that such a small thing could lead to a big problem and that there wasn’t some notification on the machine letting the user know what might be the problem. After the laser was up and running, Dr.Sugar proceeded to use it on a patient. It was a fascinating process to observe. The laser was literally poking very tiny holes in the eye to remove small tissue. The patient didn’t feel and thing and the whole process took about 5 minutes. Dr.Sugar even let me use the machine to poke microscopic holes in a piece of paper, which was very cool in my opinion. 

I identified many problems on the first two days of week two and I am looking forward to the rest of the week.

The first week of Clinical Immersion Program

The next three days after orientation were rather hectic. I was put into the cornea department of ophthalmology with Dr.Sugar, who happens to be the head of the department, for day two of my internship. Before I go into detail about my time with Dr.Sugar, let me tell you that he might be the coolest doctor I have ever met. Most of the day I was in Dr.Sugar’s examination room observing the many patients that came in to get checked in. Almost all the examinations that Dr.Sugar did were through a medical device called a slit lamp, which is a lamp that emits a beam of light into the eye. This allows the doctor to view different parts of the eye and examine it for certain diseases and abnormalities. The slit lamp also has a side binocular; so multiple users can view through it. While Dr.Sugar performed examination of the many patients that came in that day, I got to view what he saw during the examination. It was a really exciting experience. I can’t go into much detail, because Dr.Sugar is very much against taking notes, but I ended up learning many new things. Most of the patients had cornea or lens replacement and you could see that using the slit lamp. If the patient had a lens replacement then a reflecting of light would emit from the eye when it was exposed to the light of the slit lamp. The whole day Dr.Sugar was very informational and sometime even threw in a joke or two. The whole day was a fun learning experience.

The next day my group and I had to go to UIC surgery to view different ophthalmology surgery that was taking place. I have never observed any sort of surgery, so I was looking forward to this. My group got a little lost inside the building, but we eventually found our way to the surgery floor. We got our scrubs and I got to try on scrubs for the first time in my life. They were not that comfortable to be honest. For the next five hours we watched Dr.Tu perform surgeries. He performed mostly cataract surgeries, which is a surgery to replace the lens inside the eye. The very first time I saw the surgery, I was mesmerized. Dr.Tu was very quick with his work and he would use all sort of tools to poke into the eye and replace the lens. While the surgery took place, I just watched the monitor tying to organize my thoughts. It was very interesting to say the least. Each surgery took about fifteen minutes and Dr.Tu performed six cataract surgeries. After the first couple of surgery it started to get repetitive, but it was still exciting to see how thing were done. At the end my feet were exhausted from all the standing, but I got to experience something that most people never get a change to see live.

The last day was a half-day, thank god. I was pretty tired from the entire week. I was placed into the department of retina with one of my group members, Sarita. The doctor we were shadowing that day was Dr.Chow and he was also very nice. It was a very busy day, so Sarita and I just ended up followed Dr.Chow around different rooms as he took on many patients. We got to talk to him only when he was done with a patients and it was only for a few minutes. There isn’t much to say about this day because it was very busy at the clinic and we did not want to get in the way of Dr.Chow. We did get to observe how Dr.Chow handled various situations in an orderly and timely fashion. This skill is very useful in the medical field. After the clinic was over Sarita and I met up with our other two members and we did a debriefing of our week.

 

The first week was very fun and informational and I look forward to the rest of the internship and blogs.  

First Day

If I am going to be honest, I was pretty nervous coming into this program. I did not really know much about it and I am not comfortable going into things I don’t know much about. I did have some friends in the program, so it wasn’t all bad. 

Waking up was pretty much the hardest part of the day. I was accustomed to staying up all night and waking up late, because it was summer time. I put that all behind and headed to orientation. My heart rate started to go up as I entered the innovation center, but my nerves calmed down after I saw some familiar faces inside the building.

The program started and it went as I was expecting it to until the guest speaker came in. The guest speaker had us do various activities to warm up things. Most of the activities were rather odd, but they did have some sort of a purpose behind them. There was one activity where we had to get into groups of two and one of had to play the part of a time traveler and the other had to explain to the time traveler what a cell phone is. The purpose of this activity, I like to think, was to help improve our communication skills. I soon found myself enjoying the orientation and was a little sad when it ended. The Clinical Immersion program had officially started and we were sent off to our rotations.

With my group of 4, I headed to the eye and ear clinical at UIC because I was placed into ophthalmology for my first rotation. We got to the clinical not knowing what to expect, but we soon found out Dr.Sugar, who is our clinical leader, is super nice and very willing to help. He showed us around the building and took us to each of the department of ophthalmology. The tour was very detailed and Dr.Sugar explained many of the equipments the doctors use at the clinic. He was also very much against the idea of taking notes during his tour, so I have to leave out much of the details. The whole thing took about 2 hours and after we were allowed to leave after.

My first day was full of nervousness and excitement , but I got though it and I found myself really enjoying my first day. I was so tired at the end of it I took a nap as soon as I reached home and before I feel asleep I thought about how much I am looking forward to the rest of the program. 

 

 

 


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