Hello everyone! I have the fortunate opportunity to shadow at Children’s Hospital LA for the remainder of this week, and next week. Oxy has a great partnership with CHLA that allows about 10 students every winter and summer to rotate through several units to shadow the physicians and other medical professionals. I’d like to just reflect on my experience as the days go on.
Today I was in the Cardiothoracic Intensive Care Unit (CTICU)! I’m really interested in cardiology, so I was very excited to be able to shift through this unit. I’m splitting my reflections into three categories to help me organize my thinking (I do have to write a report at the end of the two weeks so this will be helpful).
What I learned about the unit: There were a ton of very tiny babies in this unit! For some reason in my head, I did not expect that… but it makes sense since many patients who require cardiothoracic surgery are babies with congenital heart defects. Several patients were just days old because they needed surgery as soon as they were born. Almost all of the patients had all these different tubes in them: intubation for ventilation (usually nasal, rarely oral), NG tubes, G tubes, central lines, PICC lines, etc. I felt really proud to know what all of those things were. I was able to learn why nasal tubes were more popular than oral tubes (which I’ve seen with adult patients): it leaves the mouth free so that babies can be soothed with pacifiers, and so they can develop the sucking reflexes, and therefore increases the likelihood of normal development regarding feeding and swallowing! One of the favorite diagnoses I was first introduced to today was dextro-Transposition of the Great Arteries (d-TGA). Basically, the aorta and the pulmonary artery are switched, causing a disruption of blood flow. As someone who was obsessed with the flow of blood since the age of 12, this was a very interesting anatomical deformity to me. I wish I could switch my comps topic to this.
More things I learned about this unit: pediatrics is a specialty, and CTICU is such a niche. As I followed the doctors on their rounds, I was noticing many differences between normal adult ranges for heart rate and blood pressure and blood glucose concentration, for example, and contrasting that to how peds patients are. One doctor told me that even at different developmental stages in life, and even the number of days after surgery, the vitals can change drastically. It makes sense; I just never put much thought into it. I was just like, “Wow. Peds is hard.” You have to learn more than just what’s normal for one age; you need to know what’s normal at all developmental stages and a different of 10 points in HR or BP can really make a difference! And then dosage of drugs is also greatly affected by all of this too. It really put the unit into perspective.
What I learned about the job: When I first arrived to the floor early, we walked in on morning report. Not wanting to disturb the team, we waited outside until it was actually our time to enter. After morning report was finished, a doctor let us into the physician work room again and introduced us to the group. We got to meet with other physicians and talked about ‘situational awareness.’ Then we also went over the patients’ X-rays. I wish I could have asked more questions, but I was very shy. Next, I followed rounds with the attendings, two fellows, and nurse practioner. The attending went into every single room except one to greet the patient as well as any family present, and did a very quick physical exam on every patient. One of the fellows let me tough the chest of a patient whose heart was dilated, and the NP let me use the stethoscope to listen to the heart beat of a tiny baby. It was nice to have these small yet meaningful opportunities. The rounding session was very different from the rounding I do when I volunteer. When the CTICU team rounded, it included a dietician as well as a pharmacist. Sometimes the cardiologists also got involved! It was all very organized though, and the participants always spoke in a specific order (RN, MD/DO, NP or MD fellow, comments from anyone, recap by RN). I will also add that this process took about 3 hours and my feet were killing me since we were just standing most of the time, and not walking. Definitely will keep that in mind, but props to the professionals who literally do this every day.
Something unrelated to the logistics, but I was able to ask one of the attendings about how to emotionally deal with a unit that could potentially be emotionally taxing. While many patients survive following surgery, there are patients who don’t make it. How do you deal when that patient is only 4 days old? It’s such a devastating idea! The attending told us that for her, she has a lot of patience for pediatrics patients because they often have conditions or circumstances that are not the product of their own choices. To contrast this, she gave the example of being in adult medicine trying to treat a patient who has lung cancer, but was also a smoker for their entire life. It’s hard to have as much empathy when you know that patient did that to themselves. However, children are innocent and therefore, she was able to have unending patience for them. Her willingness to help those children made the very few that didn’t make it okay. At the end of the day, she knew she did all she could in her power to help that person, and that it wasn’t because of unwise choices the patient made. I thought this was such an interesting perspective I had never thought of before. I’d really like to think about it some more.
What I learned about myself: I really like cardiology, but I wasn’t WOW’D by pediatrics. Maybe it’s because I literally didn’t understand 90% of what was said during rounds. It’s very hard to be interested in something you literally can’t understand. I still don’t know how I feel about pediatrics yet. I will be visiting PICU on Thursday where the patients are a little older so that might change my mind. A fellow did say he liked PICU over CTICU because he was able to interact with the patients more, and who knows. I might be the same way.
An irrelevant thing, but I also learned that I’m much more comfortable in hospital settings than my partner. Maybe it’s because I don’t have as much of a personal history, although it’s more likely because I literally am at a hospital all the time. I felt pretty comfortable approaching nurses, NP, and residents about the patients or any general questions I had. I still felt very awkward around the attendings because I know they just have so much to do! It was nice to feel like I had a lot of confidence while on the floor. I was also super proud of myself for understanding a good amount of terminology despite very little exposure to it. Obviously I’m not in medical school yet, so I’m not expected to even be familiar with a lot of what was being said, but many of the terms were familiar! I think that was a big plus in having a really great time today.
Other than what I wrote above about the CTICU, we got to visit PICU to listen to an attending give a lecture to three residents about acute kidney injury. It was so intimate and nice, and the attending really took the time to teach the residents and test them on what they should have learned in medical school. I hope that my future attending is like this too, and I’m glad I got to sit in on that.
Day 1 at CHLA was a success! I can’t wait to learn more about the hospital as well as all the different units I’ll be rotating through 🙂