Wasuwat Siewsrichol

University of Illinois at Chicago
Bioengineering


Thank you, This was Amazing

Finally! The Clinical Immersion Program has come to an end. I have learned do much from this whole experience, and I am very grateful to be a part of this program. This last blog post will be a reflection of my experience for the whole program.

In the Pulmonary and Critical Care department, one of the main ideas that I got out of that rotation was patience compliance and education plays a major role in the care of the patient. Patients need to be able to trust their doctor’s orders and be educated on the medications that they use. Similarly, since there are new medications that are constantly being introduced, continuous education to the healthcare providers is also necessary to provide the best quality of care.

On the technology end, one of the biggest issue I saw in this department was the lack of integration between various devices during some procedures. A good example is the Bronchoscopy suite, where there are monitors that show view from the bronchoscope and ultrasound, which are located in different parts of the room. The locations of the monitors are a problem because the physician have to constantly turn his head back and forth between screens while performing the operation, which is a big inconvenience for the doctor.

On the other hand, my experience in Radiation Oncology is much different than the Pulmonary and Critical Care department. First off, the environment in this department was much more relaxed and more technology focused. Coming into this department, I thought that I would be facing difficult conversations with the doctors and patients, but to my surprise, the conversations went very well. The doctor and patient interaction in this department seemed more extensive because treatments for each patient was very unique and depends on a lot of different factors, such as the progression of the disease.

The department did not have many technological problems that I saw, however, reproducibility was one of the major factors that is taken into account when treating the patients. Since most treatments take roughly four to six weeks to complete, all the initial parameters from day one to the last day of treatment must be consistent. Therefore, I thought that the stability polymer that was used to stabilized the patient while they are getting radiation could be improve. The stability polymer takes approximately half an hour to fully conform to the patient, I think that there must be a better way of improving this technology.

Overall, I thought that Clinical Immersion Program was an amazing experience because it really taught me how to look for needs in the medical environment and how to focus my future device design with the user in mind. In the end, I want to thank Dr. Kotche, Dr. Dudek, Dr. Koshy, Dr. Rondelli, Susan, and all the staff members that my team and I met these last six weeks. This has been an wonderful and unforgettable experience, and I am excited to use what I have learned during this internship in the future.

 

 

Last Days in a Great Department

Monday August 8th – Thursday August 11th: For our last week in the Clinical Immersion Program, we spent our time in the Radiation Oncology department. We saw patients again on Monday, and we attended the prostate cancer tumor board on Tuesday afternoon. Usual problems such as slow computers and poor internet connectivity is still an issue during the meeting because the physicians need to connect to the internet to get patients’ information. As mentioned in the past blogs, the setup for the tumor board involved a conference table with a microscope at each seat. All the microscopes are attached to one another, and then the pathologist explains what he sees in the biopsy. There were less people at the tumor board this week, and so I got the opportunity to look under the microscope itself. Even though I was very confused when the pathologist explains his interpretation of the biopsy, I thought it was very unique to see all the specialties to have an input into the care of each individual case. The specialties that was there during this tumor board were Radiation Oncology, Surgery, Pathology, and Intravenous Radiology.

On Wednesday, we had a small meeting with the head clinical physicist, and he told us that one of the issues that he sees on a regular basis has to deal with patient flow. He said that there is no protocol that happens when a patient is placed in a room, and the doctor has to have an emergency call in the inpatient unit. He said that in most of these cases, the patient sits in the room waiting for the doctor to come back to the room, and the nurses and other staff members could does not do anything about it. Even though patient flow is not a problem in this department, I feel like a protocol should be created to deal with these emergency situations.

Thursday was our last day in the clinic. Walking in today, I was happy that we did our jobs well by identifying problems in the clinic, but I was sad because I will be leaving this amazing department. The day stated off with a very tough case of a patient in the late stage of lung cancer. What was difficult about this situation was that the patient was very resistant to the treatments proposed by the doctors. He seemed to be against the doctor’s suggestion of him to stop smoking and using drugs. The doctor was afraid that the drugs could hinder his ability to come into treatments in the long run. Radiation treatments consists of the patient coming in five days a week to receive treatments, and the doctor was concerned that the patient would not come to his treatment consistently because of the neurological effects of the drugs.

After seeing the interaction between the doctor and patient, I realize that the situation was very tense because the patient did not want to give up his bad habits. I would not know what to do if I was the physician, but luckily, the patient’s family members were there to help the doctor convince the patient to be compliant with the doctor’s orders. The patient mentioned that he did try to stop taking drugs with one of the programs that the hospital offers, but it did not work so I thought there must be a better way of helping the patient to get over his addiction.

Later that afternoon, we gave our presentation to one of the resident because our mentor was busy with an emergency case. The resident gave us very good feedback about our presentation, and then we discussed our next step solutions with him. The resident gave me some really good ideas on a senior design project that I could pursue in the upcoming school year.

In the end, I thought that Radiation Oncology and Hematology/Oncology was a great exposure to the field of cancer technology. I learned so much from the resident and the attending physicians, and I am very happy with all the experience that I gained during this rotation. 

Eyeopening Experience

Wednesday August 3rd – Thursday August 4th: On wednesday morning, we spent time participating in rounds in the ICU with the Hematology and Oncology team. I also did rounds in the Pulmonary and Critical Care department, and I noticed that rounds in both departments were pretty similar. Issues such as communication between the fellows and the attending, and between various departments in the hospital is still prevalent and needs to be improved. However, I did notice that rounds in the Hematology and Oncology differ from the Pulmonary and Critical Care department by the amount of patients that each department does at once. In the Hematology and Oncology, the attending does go through the history of about three patients, and then he sees the patients afterwards, while in the Pulmonary department does each patient one by one.

 After the morning rounds, we headed back to the stem cell lab. There, Dr. Mahmund gave us a lecture about the current treatments that they offer for blood cancers, and the complications that come along with these methods as well. One major issue that he mentioned was that for someone to get a stem cell transplant, the donor’s blood must match with at least half of the human leukocyte antigen (HLA)  that present in the patient’s blood. Dr. Mahmund said that there is a blood donor bank that has all the donor’s data of HLA, however, the human body is so complex that finding a match between donors and recipient is extremely difficult. If a patient does find a match, but the donor does not live in the same area, Dr. Mahmund said that is is very difficult to transport stemcells across the country or the world because survival rates for these cells once they out of the human body is low if they are not kept in extremely cold temperatures. Next, he mentioned that stem cell collection and the actual transplant itself is rarely done in third world countries because they lack the resources such as liquid nitrogen and a refrigerator to keep the stem cells in. Therefore, he proposed that a new method of refrigeration without the need for liquid nitrogen can potentially bring the treatments for blood cancers to third world countries.

On Friday, we spent our morning in the Hematology and Oncology Clinic with Dr. Rondelli. Issues that I saw in the clinic was the scheduling process. The nurse mentioned that scheduling in this department is absolutely hectic because when a patient is late or miss their appointment, it will disorient the whole day. Furthermore, the nurse does her schedule on a large piece of paper, and manually writes out which patients goes into which room. As the day progressed, we noticed that the schedule has become a big scribble mess on the wall because of the rearranging of patients. I thought that a computer program that automatically does the scheduling for the nurse is useful to implement, but the nurse was against the idea because she believes that there are too many outside factors that goes into scheduling patients in each specific room.

After the Hematology and Oncology clinic, we headed back to Radiation Oncology. Today was a pretty emotional day at the clinic because I saw a patient who is at a late stage of lung cancer. She was in extreme pain during her examination, and it was very hard for me to watch. Seeing patients like her really makes me appreciate life more, and it really made me realize how lucky I am that my family and I are in good health. Before I started this rotation, I knew that I would be faced with difficult situations like this, and I actually regretted choosing this rotation at first. Now that I have seen cancer patients coming into and out of clinic for past two weeks, I could not be happier that I choose this rotation because it really opened my eyes on how difficult the lives that these cancer patients live, and this experience really made me treasure the life that I have.

Efficient But Not Perfect

Monday August 1st – Tuesday August 2nd: We spent our time last week in the Radiation Oncology department, and this week, we will see the other side of cancer treatment in the Hematology and Oncology department. Our mentor for this department was Dr. Rondelli, and he gave us a quick lecture that afternoon about the overall field of Hematology and all the diseases and treatments that are currently given in his clinic. After his lecture, I was pretty surprise that UIC is one of the few centers in America that do non-chemotherapy stem cell transplant procedure, and our mentor is one of the few people that are trained to do it.

On Tuesday, we were arranged to be in the blood bank at UIC. Surprisingly, the blood bank that is on the first floor of the hospital is not affiliated with UIC, but to an independent company. While in the blood collection center, we saw the various machines used for patients such as different kinds of centrifuges. I thought that it was awesome to see that the centrifuge was so advanced that it is able to draw blood from the patient, extract various compounds that the physician asks for, and then puts the blood back into the patient. The machine was also able to detect if it draws too much blood at any moment and if the patient is in ischemic conditions. In addition, one of the physicians told us that they also have the advanced centrifuge machine at other facilities in the area as well, however, when the other facilities have to use it, UIC has to send one of its nurses over to the other facility to perform the operation. I thought that this was an inconvenience for the nurse and patient because it does not make sense why the other facility that has this machine does not train their own nurses to use it since the machine is already there. 

Next, we headed to the blood laboratory, and the technician was very helpful and open to all of our questions. She showed us the kit for obtaining the stem cells from patients and the process of preparing and freezing the specimens. I did not notice anything that needs to be improved during these processes except for one thing: the sound that the freezer makes during the freezing process. The freezer makes a very weird and loud exhale of gas sound that I thought was a little disturbing. Moreover, the freezing process takes about an hour because the specimens have to be frozen at a slow pace so the cells does not die. I asked the technician about it, and she said that the noise does not bother her and her colleagues. One of the issues that rarely comes up, but when it does it becomes a big burden for the staff working in the blood bank in the monitoring system for blood storage.

 

The monitoring system has a detection mechanism that first makes produces a loud alarm when it senses that something is wrong in the blood bank. After 15 minutes, if no one comes to the machine and tries to fix the problem, the machine has an automated system that calls the staff to rush to the machine immediately. The technician said that this occurrence rarely happens during the year, but when it does, it’s usually happens over the weekend at night. Therefore, a staff member has to come into the hospital at night to manually turn off the alarm. The technician mentioned that every time the alarm goes off, it’s always due to an error in the software, not the blood supply itself. As a result, I think that a better monitoring system that can be manually controlled from one of the staff’s phone and a specific report of the type of error should be sent to the technician when the alarm goes off. Other than the freezer noise and the alarm on the monitoring system, the work flow in this blood bank seems to be working efficiently. 

Full Body Radiation

Wednesday July 27th – Thursday July 28th: The start of wednesday was exciting because it will be the first time that we will see a full body radiation being done with a patient with sickle cell disease. The patient will be penetrated with low dose of radiation to completely wipe out her immune system so she could get a stem cell transplant later that week. Sadly, we did not get to see the stem cell transplant, however, observing the full body radiation was very interesting. First, the patient is placed in a rectangular box. Then, the radiation technician places rice bags around her body so the machine would recognize the patient as a symmetrical rectangle. The reason that the patient has to be placed this way is so the machine can recognize the symmetry of the object that it is radiating. I’m not sure why the patient’s body has to be oriented that way, but I feel like the software of the machine could be improve so that the technician would not have to manipulate the patient’s body in such a way that the sensors can recognize it.

 

After the total body radiation was over, I noticed that the patient gets out of the glass box, and then immediately gets covered from head to toe with a face mask and towels. This method of protection concerns me because I feel like the patients should be put in a full body suit that fully protects her body, and does not leave any of her body open to the outside world. Next, the patient was transported to an open waiting room where people can simply walk in and out without even noticing that there is a patient in here that has her immune system erased, and is highly susceptible to infection. Therefore, I thought that it would be better with regards to the patient’s health is she was placed in a more sterile environment  rather than in open space.

 

In the clinic during these past two days, there were somethings that the residents mentioned that is really slowing them down: insurance policies and  the Cerner system. The residents said that they have to complete a lot of paperwork for the insurance company, which really slows down the treatments of the patients. Next, the major issue in the clinic is the flaw in the Cerner system, which is a communication system that the UI health hospital uses for all medical communication such as writing notes, and retrieving test results. The residents mentioned that the system takes a good amount of time to load and log in that the process of configuring the system during the day could take up to 30 – 45 minutes of their time, which they could have been used for patient care.

 

On Thursday, we were able to watch a full body simulation, which is where the doctors take a full body CT scan, and then use this scan to plan for the radiation treatment with the least amount of damage to the surrounding tissue. As mentioned in the previous blog, the patient has to be stabilized while laying sideways on the CT scan. The patients lay on a blue bag  with a polymer mixture that inflate as the mixtures cools down. The technician has mentioned that the mixer bottle has once actually blown up because someone kept the cap on the bottle for too long after mixing the two chemicals. As a result, the pressure generated from mixing the two chemicals cause a small explosion that splattered in the room. Even Though the explosion did not cause major damage, I would think that if someone was in the room during the splatter, there could have been injuries. As a result, I believe that the mixing bottle of the chemical needs to have a safety unlocking mechanism that safely removes the lid if the pressure in the bottle get too high.  

Goodbye Pulmonology, Hello Oncology

Friday July 22nd – Tuesday July 26th:  We’ve finally made it to the end of the Pulmonary and Critical Care Rotation! It was an unforgettable experience, and I have learned so much from the physicians, fellows, and resident in the department. I am truly grateful for taking part in this department. Today was also the day that we give our presentation to Dr. Jacobson, one of the attending pulmonary physicians. Our presentation went very well, and Dr. Jacobson said that we mentioned all the crucial issues that he has been experiencing, such as the communication between hospitals and the lack of patients’ education.         

My next rotation after the Pulmonary and Critical Care department is the Hematology and Radiation Oncology department. We will spend our first week in Radiation Oncology, and then the next two weeks in Hematology. On Monday, we visited the Hematology Clinic and our mentor was Dr. Koshy. Dr. Koshy showed us around the clinic, and I have to say that this department has one of the most technologically advanced medical equipment that I have ever seen. Specifically, the radiation machine, which is approximately 6 – 8 feet tall, and the clinic itself also has a built in particle accelerator which surrounds. The particle accelerator is used to power the radiation machine, which is said to be 100 times more powerful the normal x-ray machine.

After Dr. Koshy showed us the radiation machine, he mentioned that one main problems that arise when using the machine is the patient’s stability during treatment. The patient has to first get a CT scan, and then the radiation oncologist marks the CT scan with the location that they want to administer the radiation. As a result, the patient has to be in the positioned in the same location that he or she took the CT scan in so the radiation can be applied to the previously marked location. Currently, the clinic uses a self-hardening polymer that the patient lies on, and then the mixture a foams up and harden in accordance to the patient’s body position. However, the doctor did mention that this method maybe in effective when patients lose or gain weight after the initial CT scan. In addition to looking at the radiation machine, one of the resident also explained to us the physics behind the technique of administering the medication, which I found to be very interesting and complicated.

Entering the clinic on Tuesday, I felt a bit nervous because today was the day that I will get to interact with patients. I was nervous because I know that this clinic deals with cancer, which is an emotional topic for me. I saw three patients today, and surprisingly, all of them went smoothly. I did not notice much problems in the clinic, except for the usual communication issues that I have mentioned in the previous blogs in the Pulmonary and Critical Care department. For example, one patient that we saw was a bit drowsy during his consultation because he just came out of the emergency room. Therefore, communication between the doctor and patient was compromised.

One issue that I did notice with the technology during the administration of radiation was with one of the tools that the doctors use give radiation inside the body. The tool was similar to tweezers, but radioactive isotopes can be administered at the end of each rod. The two rods on the side are meant to separate the tissues surrounding the tumor, and once the doctor has isolated the tumor itself, he would tighten a knob at the end of the device to lock in the two rod’s position. However, the locking mechanism often does not work because the pressure between the opening of the tissue is often too large that the two rods would snap back to its original configuration. The doctor would then have to manually tape the two rods apart so that they would stay open during the operation. As a result, the current method to stabilize the equipment was an inconvenience for the doctors to always have to use tape during the surgery, and the safety of the patient is also compromised because I am unsure of the sterility of the tape being used. 

Is That Bed Even Clean?

Tuesday July 19th – Thursday July 21st:  

 

Tuesday morning, we spent our time doing rounds with the residents. While rounding, one of the attending physician mentioned that one of the patient was not eat well, if at all. The patient was under a ventilator, she could not feed herself, and they could not pull the ventilator out because the patient cannot breathe on her own. As I was listening to their discussion, I thought that machines like the ventilators should be equipped with feeding tubes because the caretakers have to be able to provide proper nutrition to the patient. In the end, the doctors decided that only thing that they could do for her right now is to give her liquid glucose because that is the solution given her ill condition. I would guess that giving liquid glucose to the patient would give her enough energy for the body to do its basic metabolic functions, such as breathing, but what about for patient who are under her condition for a long period of time? I would think that giving the patient just liquid glucose would  hinder the recovery process because the body would not have enough nutrients for recovery. Therefore, a feeding tube should be implemented into the breathing system in future devices.

 

We headed to the sleep clinic later that afternoon and I was excited because I was curious to see the technologies that is involved in monitoring sleep. Unfortunately, there were no sleep study scheduled at  the time that we were there, so I did not get to see patients using the various machines. While there, I was paired with one of the sleep fellows, and we saw patients who are experiencing sleep apnea. Sleep apnea is a condition where patients stop breathing while they sleep, and the disorder can contribute to other pulmonary diseases, such as asthma. While in the clinic, one of the patient had brought his CPAP (continuous positive airway pressure) machine with him. I took a look at the machine, and I thought that it was a very innovative machine because not only does it allows the patient to breathe at night, but it also takes data of how often that patients undergo apnea. The data is then obtained from the doctor by removing a memory card in the back of the machine.

 

One way this machine can be improved is to add wifi capabilities to the machine, so the patients can send their sleep data to the doctors prior to the appointment to improve the efficiency of the appointment. Other than that, another issue the patient brings up is that the face mask for the CPAP machine does not fit his face very well because of his beard. Therefore, the simple solution to this problem is to get a bigger mask to accommodate his beard.

 

There was one issue that I keep coming up as I saw more patients, which is the sanitary of the beds that the patients are sleeping in for the sleep study. The clinic is set up so that each room had a bed in it, so during the day, the doctors who do his normal clinic work in this room, Then at night, they would use the same room for the sleep study. Then I saw a sign on one of the beds that read something along the lines of “Please do not sit on  the bed. Bed has been sterilized  and used for for sleep study patients only.” This sign got me thinking because if the doctors use these rooms to see patients during the day, and if the bed sheets have been sterilized in the morning, wouldn’t sterility of the bed be compromised if the bed is exposed to patients during the day? I don’t know if this is a problem, or if the staff replace the sheets before the patients undergo the sleep study, but this is one of the biggest issue that I saw at the Sleep Clinic.

 

On Wednesday, we were in the ICU and the Pulmonary Clinic. Not much happened today because all the issues that I have been seen have been noted in previous blogs. Problems with the communication between hospitals are still a reoccurring issue that needs to be addressed in the healthcare system for efficient patient care.

On Thursday, were back to the Pulmonary Hypertension (PH) Clinic Shadowing Dr. Machado. Clinic went on as usual, and I did not notice anything out of the ordinary other than the fact that communication between hospitals still needs improvement. Today, one patient had gotten her tests done at an outside clinic, and when she came to the PH clinic, she was missing some tests that the outside hospital had told her that they had given her. Therefore, her visit was wasted because the doctor could not have treated her until he receives all results of the test. If only all the hospitals have the same communication system, the healthcare system would work much more efficiently for the patient and the doctors.

I Could Feel Its Heart Beat

Thursday July 14 – Monday July 18th: This Thursday consists of our team spending time in Pulmonary Hypertension Clinic with Dr. Machado. Once we entered the Clinic, Dr. Machado immediately gave us a quick lecture on Pulmonary Hypertension (PH), and his lecture was great because the information he presented to us fitted in well with the materials I learned in my BIOE 310 course.

 Our first patient was Hispanic and recently underwent a surgery on her lungs. The patient did not speak any English, but one of the resident did, and so she translated all the patient’s information to the fellow. After watching the resident translate to the fellow, a thought came into my head. Would practicing medicine be more efficient if the medical students are required to learn a second language before they graduate? There are translating devices or mechanism out there that the hospital can use, but I feel that some information from the patient, such as their symptoms and its severity, may be lost during translation. Then again, requiring medical students to learn a second language before they graduate may put too much stress on their already work-filled schedule.

One issue that I noticed while in the room with the patient has to do with patient comfort. I noticed that with the first and second patient that we saw could not get up on their examining chairs because the seat was too tall. The doctors tried to lower the seat to its lowest setting, but it was still now low enough for the patient to comfortably sit on. One simple solution that out team came up with is to add a pull out stool to the examining seat. Next, the major issue that I saw in the clinic that day was with a patient and her oxygen tank. After examining the patient, the doctors said that the flow of oxygen needs to be increased. However, when the patient tried to increase the flow, she realizes that the oxygen tank does not go any higher. So then the doctors had to spend time ordering another oxygen tank that would accommodate the patient’s needs. I thought that this was huge issue because if the patient does not get enough oxygen to her lungs, she could have a major injury that could lead to death. Therefore, the solution to lack of flow from the tank is that tank needs to be engineered so to produce a wide range of flow to assist the patients in all her needs.

We spent later that afternoon in the ICE, and once we got there, we heard the intercom reported that there was an emergency situation on our floor. After the announcement, I saw approximately fifteen to twenty people rushed into one room, and as I walked slowly to the action, I realized that it was just in the right place at the right time. The emergency was actually a simulation given to the residents and fellows as part of their training a few times a month. The devices used in the simulation was one of the most technologically advanced pieces of equipment that I have ever seen. The simulation uses a human model that is able to produce measurable vital signs such as heart rate, blood pressure, and blood flow. I tried laying my hand on the model’s chest, and it felt so real that I could feel the model’s heart beat!  The human model can also undergo various medical conditions, which is controlled by the medical technicians. The doctors can even administer drugs to the various parts of the body, and the technician can control how and if the model will respond to the given drug. If the physician performs the correct procedure in that scenario, the condition of the model will improve, and if the physician performed the incorrect procedure, the model’s condition will get worse. After examining the model even further, an improvement that I could make to this model to add bleeding to one of its capabilities.

 

On Friday and Monday, we spent our time again the ICU. One the things that I noticed that needs to be improved is the communication between the patient and the physicians when the patient is intubated. I saw one patient who was raising her arm to get the doctor’s attention, however, the doctors tried asking the patient what’s wrong, but they could figure it out. The attending tried to use various methods such as having the patients nod for yes and shake her head for no and holding up one finger for yes and two for no, but none of these methods worked. Therefore, our team discussed this problem and we thought that it would be a good idea to put a yes/no diagram for patients to effectively communicate with patients.

Breathing like the Patients!

Monday July 11th – Wednesday July 13th: I am very excited to go to the ICU today because our  mentor  has scheduled us see a live demo of the ventilator that we saw last week. After a the pulmonary technician taught us how the ventilators worked, he actually allowed us get on the machine and try it ourselves! Awesome! Jerry handed us a sterile mouthpiece, and we pinched out nose to simulate what patients would feel like if they were on the assisted breathing system. I tried the two modes of breathing: automated and assisted breathing. While under the automated breathing, I felt very uncomfortable because it felt weird to have cycles of air forced into my body. Especially when the automated is not in sync with my own breathing, it felt like I was choking because I would be breathing out and the machine would simultaneously push air in. That feeling was not very comfortable at all.

 

 

The next mode I tried was the assisted breathing. The assisted breathing uses sensor to detect the negative pressure generated from your lungs, and then the machine a puff of air that is supposed to be in-sync with your body. This mode was much more comfortable for me because it felt like I could take air in and out without much resistance. After being on the ventilation machine for approximately five to ten minutes, I decided that I needed a break because I felt this weird tightness in my chest and a little bit fatigue. This has made me realize that being on that machine was exhausting! I cannot believe patients can tolerate this much discomfort while being on the machine. Dr. Dudek later explained to our group that the reason that we feel so much discomfort while using the machine is because it uses a positive pressure system to put air in our lungs, while the human lungs uses a negative pressure system to bring air into the lungs. Even though the ventilator is a great system that helps the patient breathe, the discomfort level is extremely high, and a negative pressure-based ventilator system needs to be introduced to increase patient satisfaction.

 

Later that afternoon, were assigned to visit the Allergy Clinic to observe Dr. Nyenhuis, an allergy and immunology attending physician. While in her office, I did not notice much technological problems. However, one aspect that I noticed about the allergy clinic that could be improved is the allergy testing itself. There were two types of allergy testing that was provided in the clinic: skin test and the patch test. The skin test involved applying different allergens to the skins of the patient with a brush. The nurse described tool as a small brush/needle with a blunt tip. Then, we asked one of the patient that was doing the allergy test if she felt any discomfort during the procedure, and she said everything went well. Next is the patch test, which involves putting a big piece of cloth filled with different allergens on the patient’s back. The cloth is then covered with an elastic tape for a duration of 3 days, and then the patch will be removed. After the removal of allergens, the doctor wait for 2 more days until she can read the results. One of the problems that I noticed for this test was the duration discomfort for the patient. The discomfort does not involve pain, however, the patient has to be very careful not to get the patch on their back wet. Therefore, I thought that the test methodology could be improved by reducing the duration because time it takes for the test to work.

 

On Tuesday, we went back to the ICU again, and after usual morning rounds, we sat down with one of the senior fellows to talk about problems that he has been experiencing during his time here. Surprisingly, he did not mentioned any technological issues, but he said there are problems between the communication between the residents. He said that residents are typically works in the ICU for about sixteen hours, and when his or her shift is over, the resident would then pass on the information about all the patient that he is taking care off to the next resident that is scheduled to take his place. He mentioned that this method was extremely ineffective because some information about the patient could be lost during the transition phase. Our team discussed this issue, and we could not come up with a good solution to this problem. This has made me realize some simple such as passing on information from one person to another could not be easily solved to a device.

 

Next, one of the emergency response team member, an anesthesiology resident, showed us what was in his emergency response box. The response kit has various emergency medicines in it, devices, and equipment that could be useful during emergency situations. One of the most advanced device that I saw in the kit was a glidescope with an attached camera and small screen on it. The resident told us that having the camera and monitor on there is a huge improvement to the old version because he could easily intubate the patient faster and at a more successful rate. One improvement that I would make to the scope is to improve the resolution of the screen on the scope, or even add wifi capabilities to the scope so it is able to transmit data to other departments during emergency situations.

 

On Wednesday, we spent the majority of the day in the pulmonary clinic. During my time in the clinic, I did not notice any significant problems that needs to be addressed. However, I did notice one technological advances that I have never seen before. While I was shadowing a pulmonary fellow, I saw him drew blood from a patient. After he was done, I noticed that the needle on the syringe adapter had automatically snapped back inside the adapter after the fellow was done drawing blood. I remembered one of my professors mentioning that there is a big problem with injuries relating to uncapped needles, and after seeing the problem being addressed in the clinical setting, I am happy to see new innovations that addresses the current health issues.

Keep Calm and Breathe On

The morning of day three of the clinical immersion program started off with us spending time in the intensive care unit (ICU).  The ICU was filled with residents, fellows, and attending physicians that morning, and our team asked them what they thought could be improved about the ICU. One major theme that showed up was improving communication. As I was doing rounds with the ICU team, I noticed that communication between departments in the hospital was not very consistent. For instance, one of the fellows seemed very confused and frustrated when he found out that the other department had given his patient too much of a drug before admitting patient into the ICU. Another communication problem that everyone seemed to agree on is the pager system. The physicians believe that if pagers were replaced with cell phones, the communication between them and the hospital would be greatly improved. Next, one of the fellows mentioned that monitoring vital signs is crucial to the health of the patient, so he suggest that vital monitors should be placed in every room in the ICU.

While walking around the ICU, I noticed that almost every patient was intubated and are breathing with an assistance from a complex and sophisticated ventilator. The ventilator was probably the most advance medical equipment that I have seen in the department. The ventilator works by pumping air into the lungs of patients who cannot breathe on their own.  The ventilator has several breathing settings such as: 1) automated breathing: the physicians adjusts the flow rate and frequency of the air that is flown into the patient’s lung 2) assisted breathing: patients do some of the work, while the machine takes care of the rest. For example, the machine can sense that the patient has started breathing, but then it gives the person an extra push of air so they can take their own breath 3) Pressure mediated breathing: This setting is similar to the automated breathing, but doctors can designate the pressure gradient that they want in the lungs so the lungs can expand and contract based on the changes in pressure. Out of all these three settings, the assisted breathing would be the most comfortable for the patient because they are breathing on their own, when compared to the other methods where the machine forces air into the patient.

One of the most surprising thing that I noticed in the ICU is how calm and in-control the attending physician and the senior fellows are. Even in emergency situations, I saw that the doctors seem very patient and composed. For example, while the senior fellow was showing us how the ventilators worked, the patient that he was working on stopped breathing. Earlier, when we entered the room, the patient was very responsive to our presence, but now he just laid there. He was completely still. He looked dead. At this moment, I began to panic, and I looked at the fellow. To my surprise, he kept his composure, and he calmly went to work on the machines by pressing various buttons. A few seconds later, the ventilator produced a huge puff of air into the patient’s lungs, the patient’s chest exploded upwards, and he began breathing again. Watching the patient laid unconscious on the bed with no active vital signs was probably my most stressful experience that I went through during this program thus far.

Following the dramatic experience with the patient not breathing on Thursday, on Friday July 8th, we headed back to the bronchoscopy suite to observe a thoracentesis. The procedure involved inserting a needle from the patient’s back to remove the fluid from the bottom of the lungs. The doctor started off my using an ultrasound probe to locate the fluids the lungs, and then marking that spot on the patient’s back, which indicated the location that he will insert the needle. During the procedure, I saw that the doctor had taken out a huge needle, which was about ten to twelve inches in length. I was shocked by how big the needle was. The next surprising thing was that the doctor simple inserted the needle directly into the patient’s back, and then he uses a syringe, catheter, and three-way stopcock to remove the fluids from the body into a drainage bag. Before the procedure, the doctor told us that he estimated there would be approximately half a can of coke worth of fluids in the patient’s lungs. After the drainage, the total fluids that was removed from the lungs was approximately one liter! It was very surprising to me that the lungs can hold that much fluid given her small body shape. After the surgery, we went to a lecture given to the all the new fellows on the anatomy and mechanisms of the lungs. I thought that it was interesting that even doctors who recently finish their residencies still need to review the basic anatomy and physiology of the lungs.

 

 

First Hand Experience: Bronchoscopy and PFT

On the morning of the second day of the program, my heart was already racing at 8 am in the morning because today is the day that we will be visiting the bronchoscopy lab. This is the first time in my life that I will be observing a medical procedure so I felt nervous, and at the same time, excited to see what the doctor does and how he uses medical devices during the operation. The procedure involves the physician inserting a bronchoscope into the patient’s lungs to collect tissue samples from enlarge nodules found on the lumen of the airways. The bronchoscope consists of a camera, light source, ultrasound probe, and a suction mechanism for the excess saliva.

Once the procedure has started, I immediately saw that the doctor was holding the main body of the bronchoscope in his left hand while controlling the catheter that is going into the patient’s trachea in his right hand. If the procedure was a short five to ten minutes, the setup with the doctor physically holding the device would not be a problem, however, this type of procedure took approximately thirty to forty-five minutes to complete. Therefore, for the doctor to hold the bronchoscope for a long duration of time would be an inefficient setup because of the toll that the weight of the scope would have on his arm. Our team discussed this problem, and we thought that one solution would be to develop a flexible stand for the scope so the doctors could perform the procedure more efficiently.

One shocking thing that I saw during the procedure was how much the patient was violently coughing from the buildup of saliva in the trachea. Luckily, the patient was under sedative medication so she did not feel the discomfort, but the image of the patient choking was very disturbing to me. That is when I thought that there must be some way that the bronchoscope can be improved.  One of the ways that the scope can be improved is in its suction mechanism located near the tip of the catheter because it seems to have a very low suction power. Next, the actual catheter itself is relatively thick and could possibly cause a major obstruction in the airway. These are the two issues that I saw with the current bronchoscope, and if these two issues were addressed, I believe that the patient would feel more comfort, and the time of the procedure would be greatly reduced.

 

Later that afternoon, we visited the Pulmonary Functioning Test Lab. We were greeted with two pulmonary technicians, and we were on our way to observe the pulmonary lung functioning test. The procedure was relatively simple with the patient breathing into a big machine, and the computer would generate the flowrate and pressure of air as the patient produces. The PFT machine was also equipped with a mouth piece with a pyramidal filter that will ensure that the machine stays clean of saliva. Near the end the of the session, I noticed that the patient was absolutely exhausted from all the hard breathing into the machine. The pulmonary technician and our team discussed this issue, and he told us that one of the problem is that this style of testing requires so much sample size from the patient that they get very exhausted at the end of the testing session. The pulmonary technician suggest that we should come up with a new way of sample collection that will reduce the amount of work outputted by the patient. At the end of the day, one good thing that I noticed during the PFT testing was the great instructions that the pulmonary technicians gave to their patients. The technicians were so energetic and charismatic that I couldn’t help but smile at the interaction between the patient and the technician. 

 

It’s Simplest Things that Gives Us the Biggest Headache

The first day of the Clinical Immersion program started out with Dr. Kotche and her colleagues explaining the whole goal of the program and what we are expected to do in the clinical setting. We first had to define why we are here and what we stand for. Next, all the engineering and medical students went through exercises that teaches us to be in the moment, and how to communicate with each other effectively. The exercise were very fun and enjoyable because it taught me how to think on my feet, but honestly, all I could think about was the clinical rotation that I was about to embark on this afternoon. The morning session ended with all of us discussing all of our hopes and fears about the program, and for me, it was very encouraging to see that a lot of people had the same hope and fears as I do before we start our clinical immersion.

 

Finally! It’s 1p.m. and it was finally time for us to meet our physician mentor for the next three weeks. I was very excited that I was placed in the Pulmonary and Critical Care rotation with my good friend and senior bionengineer, Elise DeBryun, and medical student, Ana Brzezinski, who also has background in bioengineering. Our mentor for this rotation was Dr. Dudek, the chief of the pulmonary and critical care unit in the University of Illinois Hospital system. We entered the clinic ,and we were immediately greeted with a warm welcome from one of the nurse practitioner. She then explained to us about her current research and clinical experiences, and she told us about one of the biggest frustration about being a health care provider: patients who have to be readmitted because they do not know how to use their medicine correctly. I kept this thought in mind while I was shadowing Dr. Zaidi, a third year pulmonary fellow.

 

Dr. Zaidi’s first patient was a male patient in his mid to late 40s experiencing sarcoidosis, an autoimmune diseases that mostly affects the respiratory system, and the disease is very unknown to the medical community. While in the room with the patient, I felt empathy for the patient because he described his symptoms as “ feeling sharp pain like pins and needles in my chest every time I take a deep breath.” Then that got me thinking if there was a way that doctors can examine the lungs without it hurting the patient. I discussed the problem with my group members, and we concluded that it would be impractical to use a different method other than the stethoscope because of its ease of use and time-saving benefits.

 

As Dr. Zaidi and I saw more patients, something became very clear to me: patients are not using their medications properly, and that is one of the main reason why their conditions are not improving as fast as they should. Specifically for patients with asthma or lung related diseases, most of the patients either do not know how to use the devices that administer medications, such as an inhaler, or are not taking their medications on a consistent basis. That’s when I noticed that the first problem that needs to be addressed are the instructions on how to use the inhalers. I took a look at the directions and I thought that it was not complicated to understand, however, I realize that patients are less likely to read the instructions because it is very lengthy and sometimes do not give clear instruction on how to properly use the inhalers. My teammates and I discussed this situation, and we thought that one improvements we could make to the instructions is to add more diagrams and pictures, or even a link to a video tutorial of how to properly use these inhalers. Other than misuse of medications, I did not notice any major problems in the clinic today.

 

After we finished seeing all the patients, Dr. Dudek showed us x-rays of the lungs of patients with various pulmonary disorders. He told us that one the thing that really slows him down from his daily practice is the incompatibility of each images that were sent to him. He told us that he gets images such as x-rays and CT scans all the time, but most of them are generated from different programs and it is very time consuming to configure how to open and analyze these images. The team and I talked about it, and we thought that the best way to solve this problem is to generate a program that converts all types of data files into one consistent file that the doctors can use every time he gets images sent to him from different department.

 

At the end of the day, when one of the fellows told us about a very graphic story of what happened to him during his trauma surgery rotation on 4th of July weekend.  I won’t mentioned it here because it doesn’t really relate to the pulmonary clinic, but his story really opened my eyes to the other extreme side of medicine and that the need of advancement in medical technology more than I had ever expected.

 

 

 


About
My name is Wasuwat Siewsrichol and I am a senior bioengineer. Currently, I am in the Pulmonary and Critical Care and Hematology Oncology/Radiology Oncology department. I am very excited to be apart of the program because the experience will help me gain more insight into the advancements of medical technologies, and the current issues associated with these technologies. I plan to pursue a career in the field of pulmonology in the future, and I hope to use the skills that I learned during the internship to enhance my career as a physician.