Today, I will be talking about a few of the patients that were going through something that is medically important. In the last blog, I talked about the same day, but focused on the emotional aspect of the patients we saw. Many of the things that were discussed were related to certain treatments or surgeries.
The first patient that I will be describing was a very interesting case. When the patient went into labor, the doctors actually believed she had a hole in her heart. Usually, a sonogram would have been ordered and then the patient would be immediately rushed to surgery. However, because the patient was pregnant, it was best to avoid surgery as it can harm the baby. Now, the cardiologist was trying to identify what this hole was caused by, and realized it was a mitral valve leak. There are 2 main ways for a mitral valve leak to happen: clefts and boggy. A cleft is a gap that has been there since birth. A boggy valve occurs when the valve is not staying stiff and becomes floppy. When treating this kind of leak, the cardiologist must determine whether it can be closed using catheters, which is determined by various other factors. In some cases, mitral valve leaking can be treated using a clip which is delivered less invasively through a catheter while other require open heart surgery. Holes in the heart can be treated using clam shells. Clam shells need a large landing area, and this is usually determined by ordering a TEE, to check the dimensions of the hole. The next patient we saw was on dialysis, after the patient had many problems with retaining too much fluid in the body when their kidneys failed to work and the patient was unable to make any urine. The fluid built up for months, which lead to coughing and having difficulty with breathing. At one point, the patient’s left lung was tapped to get rid of liquid. The next patient had a heart attack and also has type 1 diabetes. This patient had a non STEMI heart attack. The difference between non-STEMI and STEMI, is in the blood flow. During a non-STEMI there is still blood flow, but during a STEMI heart attack a blood clot in the coronary artery stops the blood flow completely. In this blog, we were able to evaluate the connections between parts of the body themselves and see that when one doesn’t work, it can cause the rest to fall. This can be cross applied to real life, when we look towards the real events that we are a part of everyday. Being a doctor tests how well you can learn to accept competition and respect cooperation, something that should be a big part of everyone’s moral compass.
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In this blog, we will be looking at the TEE procedure in more depth, as I was able to watch multiple on my fifth day of shadowing. We will also be discussing how emotional stability can have a great positive benefit on a patient’s health. A TEE procedure is done by doing an ultrasound and having the heart monitor running. The patient lies on their side after gargling and swallowing a throat numbing medicine. Patients are made sleepy with medicine, that essentially makes them drowsy. This is known as the twilight zone sedation, because the patient is unaware of what is going on, but can respond to the doctor. Then a safeguard is put on the mouth that has a hole in the middle. A long tube, with a camera attached is pushed through the tube near the patient’s heart.
Small doses of anesthesia are still administered through the IV throughout the procedure. The doses of anesthesia increase as the patient becomes more uneasy, which can lead to coughing, and distort the pictures taken. During a TEE, there are 6 people in the room: anesthesiologist, cardiologist, echo-technician, data recorder, heart monitor analyzer, and a nurse. The echo-technician and cardiologist work closely together to take conclusive picture of the problem areas of the heart. Everybody who records or analyzes also work together to ensure that the patient is doing fine during the procedure. This procedure is done to get a better idea about what is going on in the heart. It gives a better look at certain parts of a heart than a TTE. One of the patients was having a TEE because they had just had a valve replacement and the surgeons wanted to ensure that the new valve was working correctly. Many of the patients that we were seeing today dealt with a lot of emotional stress right before their appointment, which often leads to their blood pressure being high. For example, one of the patients, who was 95 years old, had just had a hip-replacement surgery, came in to have a post-op checkup. The patient quickly broke down in tears because her oldest son had recently committed suicide after reliving the horrors of the Vietnam War. At this point, the doctor must comfort the patient to avoid further issues to the heart. Another patient had family problems, involving their daughter that put a direct stress on the patient, which could be a factor in why the patient’s health was seeming to deteriorate. The other thing that is really common among older patients is asking about posts they have seen on Facebook or stories they’ve heard from friends. In this case, it is the doctor’s job to prevent this patient from spiraling into a hole of paranoia. In older patients, this can be especially harmful to their mental stability, which is of the utmost importance at that age. This blog is less than half of the information I was able to process on that day. I wanted to focus on looking at the procedure and specific patient interactions. This blog is important for people to understand some of the most common emotional states of patients when they go to see a doctor. Therefore, we are significantly closer to answering the question: How can these blogs allow upcoming doctors to prepare themselves for what is expected of them? The goal of these blogs is to allow people who are considering the medical profession to read about the relationship they have to have with others and be given an opportunity to see what their job will actually entail. These blogs hope to truly complete someone’s identity. This blog is going to be somewhat similar to the last, in that I will be talking about the relationship between the doctor and the patient. However, I will also be talking about a few medical terms I learned during this process of seeing patients in the office.
The first thing that the doctor tends to do when they see a patient is take time to inquire into the patient’s life. They are trying to build a repertoire that can be maintained for future meetings. This can be done through asking about some of the hobbies a patient has, such as golf, to know more information about the medical background of the patient. It was also a common theme for the doctor to give credit when credit was due. In one case, the patient was 68 and proudly stated they hadn’t smoked since the age of 32. For some “funny” patients, there must be a doctor able to take and dish out joke as well. Part of being a doctor is understanding when the patient might be right. For example, if the patient believes they are taking a certain medicine, the doctor should make the extra effort to check whether this is possibly correct. Some of the patients we saw that day were extremely frazzled and/or upset, and Dr. Vallurupalli started with trying to calm these patients down. Most of the times, these patients were upset with how they were being cared or not cared for, in terms of other doctors. They wanted a certain procedure done that they had read about, and it was the doctor’s job to explain to them why or why not this should happen. By listening to what medical conditions the patient had and what medicine the doctor prescribed, I was able to pick up on certain things. A diuretic helps the body get rid of fluid. A patient who had been on diuretics for a small amount of time had lost 13 pounds! However, when a diuretic is prescribed, most doctors will also prescribe potassium as the diuretics eliminate too much potassium when removing fluid. The other medications that was heavily talked about fall under the classification of beta blockers, which all end with -lol. I also learned about a few different procedures that are extremely common. For example, to get somebody out of Atrial Fibrillation, something called an ablation procedure will be done. This can now be the first-line response, along with medicine. However, the most common solution for a lot of cardiac issues is weight loss. If a patient is overweight, or bordering this region, the first thing a doctor will do is alert them that this could be dangerous for their heart condition. Blockages of heart arteries can be corrected by 2 different methods: bypass graft vs stents. Bypass grafts last longer. I also learned the normalities of many things in the body. For example, when analyzing the labs that come back from testing the blood, Dr. Vallurupalli told the patient what is considered normal and therefore the goal. The normal blood count should be around 12 or 13. The normal heart function is 60-65%. After a heart attack, the heart function can drop depending on the size of heart muscle damage. Through this blog, we can easily see why it is so important for a doctor to understand their patient, regardless of whether it is their first encounter or their last. Despite new medical advances, nothing can be done without the cooperation of a patient, which is usually a result of a good doctor-patient relationship. This is what can lead to a positive influence on the patient’s health and well being, as well as their lifestyle choices. Though this usually goes unnoticed, a patient with a good attitude can help the doctor with their own identity formation and self-esteem. This was the second day that I shadowed at the hospital and I got the amazing opportunity to watch open-heart surgery. In this blog, I won’t be using as many technical terms, but really examining how interesting this was. The first noticeable thing is that there’s always music playing to create a calmer, more casual setting, but the volume was lowered once they had reached the most important part of the surgery. The next thing I saw and was reminded of MANY times was that everything in the operating room that was blue or green, was sterile. When I walked in, tensions were high, as many were worried that I was going to accidentally touch something.
This patient was having a bypass for coronary disease. There are two parts of having this kind of surgery. The first part involves getting a vein form the leg and the second part is actually connecting this vein to move around the blockage. I noticed that moving the leg vein up is similar to a video game, because the surgeon watches a screen as they try to move around obstacles. The thing that “collects” the leg vein looks like a rod with a camera at the end, to be able to see and navigate the vein inside the body. The surgeon uses a cutting tool, called a cautery, which produced a smoky smell. This was the most unpleasant part of the entire thing, despite the fact that I was actually watching a human cut open another human. It freaked me out when I came to realization that this person was so unaware of what was going on. Their body was essentially lifeless, and this was so weird to see as the doctor took towels and stuffed them in both sides of the opening to puff the chest up and absorb blood. That was a REAL human being that these people were putting towels into! There are a few medications that are given to the patient through the IV during the surgery. For example, the patient is given heparin just before the bypass part of the surgery, to prevent blood clots. To increase blood pressure, a drug called phenylephrine is administered. The shocking part of the entire surgery was when the body was attached to the machine and the heart was simply not beating! In this blog, it is easy to see that a large part of medicine revolves around identities and relationships. For example, in the operating room, success is determined by how well everyone can work together. First, there must be a connection between the cardiologist and the echo technician to take good pictures of the heart, allowing the surgeon to see what needs to be fixed. Inside the room itself, there is one main surgeon along with a few others that are doing different parts of the surgery all at one. There is an anesthesiologist who has to listen carefully to identify what doses of medication need to be increased or decreased. Medicine is an example that people who study to get different “identities”, all have to form relationships once they get to the hospital. In this blog, we are going to be focusing on exploring the main procedures that are done for cardiac patients. We will also look at analyzing a heart monitor. There are a few main diagnostic procedures that are used to determine what is going on with a patient. The 2 main ones are both part of a category called echoes, which are imaging tests used to see how the heart is functioning and certain specific structures of the heart. Starting with the TEE, which stands for Transesophageal Echocardiogram, is a procedure that involves taking a camera down the throat and taking pictures, that can be later analyzed. The camera is simply a small camera attached to a long tube, and is connected to an echo machine. One thing that this can be used for is to identify valve infections, for example, if a patient has symptoms of a mitral valve infection, this test can be performed to determine if this is the correct diagnosis. A mitral valve infection is when bacteria gets into the bloodstream and begins collecting on the valves, known as vegetation, which causes the blood cells to clump together. This is can also be categorized as endocarditis. The second type of echo is a TTE, which stands for transthoracic echocardiogram, which is commonly used for diagnosis. This is an ultrasound in between ribs, which shows images of the internal structure of the heart. Echoes show which way blood is moving, either towards the camera (backwards) or which is moving forwards, by applying color to the pictures. This allows us to see whether a valve is leaking.
A heart catheterization is an invasive procedure, to look inside the coronary arteries. It is done by finding an access point, and then working backwards to get to the artery. Catheters are threaded into the artery and try to reach the aorta, which then injects dye that flows with the blood. Another thing very common in any medical department is an EKG, which displays the electrical activity of the heart, like rhythm. A normal rhythm is called the sinus rhythm. Atrial fibrillation, or AFib, which is the most common irregular heartbeat usually happens after heart surgery, and needs to be carefully monitored. This is because AFib can drop blood pressure, make you more at risk for strokes. To get out of AFib, a patient will usually be shocked to a normal beat. I was able to watch an echo technician perform a TTE. The patient has to lie on their left side, while the room is made dark. The ultrasound gel is first placed in the center of the chest, which only shows a cross section of the heart. The second spot is under the breast, which provides better structural view and allows the technician to take measurements of each part of the heart,. The third spot is right higher on the stomach, which shows a better view of the heart from the ribs. The final spot is lower on the neck to see the aorta. This patient was actually very unique. Their tricuspid valve, which has three leaflets, had one leaflet hanging by a thread. This meant that a lot of the blood that was going in came back out. Next, I went to the NeoNatal ICU. Here we saw many different children, usually as young as a few days or weeks, that have heart problems. For example, we saw a child that was around 2 weeks old, whose heart was flipped upside down, meaning the top chambers were on the bottom and the left chambers were on the right. During this \visit, the more apparent thing was not the cardiology issues, but instead the emotional and moral values attached to working at a hospital. During a test, regardless of whether the doctor or nurse sees something, they cannot mention this to the patient. This is pretty self-explanatory, because it’s extremely important to maintain peace with the patient. Especially in the NeoNatal ICU, social issues came into play. For example, one of the children we saw had actually recovered from their original problem and was ready to get discharged, but the parents were actually drug abusers and the doctors weren’t sure whether that was the safest route for the baby. In these cases, doctors might try to elongate the child’s stay until the parents try to change something. This blog and the blog before it, put together, are what happened on the first day I visited. The biggest part of being in a hospital for me was seeing who you were treating. This was a lot to take in, especially when we were dealing with babies that had heart problems. This really expands your idea of sympathy, empathy and just care in general. It makes you want to do something in your community and in your world, seeing people, parents, and children in pain. It takes your world view and pulls it apart a little bit, meaning you have to look at the bigger picture. For me, this was realizing why being a doctor was always so important to me. In the end, it’s about what you do for the people around you and in the long run, the world. My first day shadowing doctors at the hospital truly felt like I was beginning a new chapter of my life. That seems dramatic, but this opportunity really opened my eyes to what the medical field was actually like. As a teen, it’s easy to get caught up in the appeal of jobs for the simple reason that we don’t know what it takes to actually apply ourselves in this. As confident as I was before this that I was going to be a doctor, this experience reinforced why I’ve always wanted to be a doctor, to help people. From the first day, it was clear that Dr. Vallurupalli and her colleagues were doing just that, and that’s what I wanted to be a part of.
We started out early in the morning, in the cardiac ICU. At that moment, it was quiet and calm, with the only noise coming from the nurses speaking about their plans for the next weekend. Dr. Vallurupalli was on rounds that morning, which essentially meant that she was checking up on various patients who were in the ICU. This entailed checking their vitals and trying to evaluate when a good discharge time would be. Before actually visiting a patient, Dr. Vallurupalli had to read a consult note. A consult note is essentially a summary of medical history about the patient, and for doctors a consult note is read when this is the first time they are seeing the patient. After every visit to see a patient, doctors must write a progress note, which allows the next doctor to see any clear updates. This was really surprising for me to see, as an outsider, because I didn’t realize how much paperwork came with being a doctor. I always just thought they would just mark things on the patient’s chart and that would be it. Next, we visited a few patients that had a pacemaker in, and though I had somewhat of an idea on what a pacemaker was, it was good to hear the explanation from a cardiologist. Essentially, a pacemaker sends electrical currents to “jump-start” the heart beat, and these electrical currents can be made faster or slower. When testing the need for a pacemaker, the currents will be lowered to 30 or 40 beats per minute, to determine whether the patient is able to create their own heartbeat as usual. Many of the patients in the ICU were there after having a bypass operation. A bypass is needed when blockages are formed on the coronary arteries. Coronary arteries are arteries that supply blood to heart muscle. These blockages can be from cholesterol, which Dr. Vallurupalli described as “calcified peanut butter”. During this surgery, the surgeon will take a vein from the leg, cut it to length needed, and stitch it from aorta past the block, and this can now bypass the blockage. After surgery, or post-op, is extremely important to maintaining the stability of a patient’s health. Even if they got their valve replaced or fixed, there are still many things that can go wrong and reverse the effects of the surgery. For example, insulin can be given to patients after surgery, since too much sugar can create infections on the surgical wound. A person’s creatinine is also closely monitored after surgery, which is something that needs to be excreted in the urine. It is used to monitor whether the kidneys are working well. Weight gain of a patient is checked to see if it has increased, meaning they are retaining the IV fluids, causing swelling and puffiness. The weight must go down to ensure proper elimination of excess fluid and water retention. Patients who are awake are asked to breathe in using an incentive spirometer, which monitors the progress of deep breathing after a surgery to guarantee that the patient is taking big breaths to prevent infections. This only about half the information that I learned on just the first day, which goes to show how much more I can learn throughout this process. It was so breathtaking for me to be in a real hospital, interacting with real patients. Just being at a hospital and seeing how many people come through in just a day allows you to really understand what it means to be human. It shows that the human nature of doctors is to simply hope that after a visit, a patient can make healthier lifestyle choices, and never have to come back. During rounds, it’s easy to see not only the cooperation between doctors, but the cooperation between a patient and their doctor. |
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