doc w/ Pen

journalist + medical student + artist

Category: That’s Life

August 14, 2015

Embracing Change

Chicago skyline

For nearly a quarter century, the Chicago area has been my home. When I think “city,” in my mind I see a skyline like the one in the picture above. Navy Pier, Sears Tower (I’ll never be able to call it “Willis Tower”), Michigan Avenue, Art Institute, Field Museum, Millennium Park, Prudential Building, Northwestern University, University of Illinois at Chicago. And that just scratches the surface of the places I’ve worked and played over the years.

But as they say, the only constant in life is change. So I’m going to have to get used to calling another city home: New York City. Thus, this will be my skyline for at least the next four years:

New York City skyline

Clearly, there are key differences. New York City proper has more people than reside in the Chicago city limits (about 8.5 million compared to 2.7 million). There are different bodies of water, different landmarks, a different train system, different types of pizza. These differences will require adjustment on my part, of course, and there will be some uneasiness at first. I’m sure there will be days when I long for Chicago — Lake Michigan, the John Hancock Building, the El, and deep dish from Lou Malnati’s (with butter crust, of course). But I fully believe that before long, I will look lovingly at the East River and the Empire State Building. I’ll board the subway without trepidation. I may even be able to stomach New York-style pizza.

Change is scary, and it’s hard. I’m not going to pretend otherwise. But change is also good. It brings about new growth, opportunities, relationships, and interests.

The way I see it, I’m not leaving Chicago behind. I’m merely adding New York City to my repertoire.

2 Comments
December 14, 2014

Birth and Death

Home page of Now I Lay Me Down To Sleep, an organization that provides portraits to families whose babies are stillborn.

I’m in Florida for a few days. This morning, I went swimming with manatees. I might write more about that later. But now, about someone I met on the boat out into the bay. I sat next to a woman from Tennessee. As the only two single people on our boat trip, we temporarily paired up. We chatted. “What do you do?” I asked. “I’m a wedding photographer,” she said. “And a nurse.” Not your usual job combination, so I gently probed. She told me she did nursing no one else wanted to do. I tried to imagine what that could be. Trauma? No, there is the rush of adrenaline. Same with ER. Oncology, maybe? Hospice? Even with the grief in those fields, I know nurses who find them rewarding.

Not even close. This nurse really does do something unimaginable — she assists with the birth of stillborn babies. Then she puts her photographer’s hat on, and takes portraits for each family to remember the baby by.

The organization she works for is called Now I Lay Me Down To Sleep, after the children’s lullaby. The organization’s founder lost her own baby shortly after birth. In a blog entry of hers that I read, she wrote about the different nurses she met in the NICU while she was with her baby — the ones who were respectful, helpful, and kind, and the one who was cold and rude. I could feel the pain in her words, even though her own child died years ago.

Death is part of life. Especially in medicine. So the people in medicine — doctors, nurses, other health care workers — leave an emotional legacy to those who remain. That responsibility, and privilege, should not be taken lightly.

1 Comment
September 23, 2014

Tonsillectomy Tales

One surgery, 2 ambulance rides, 2 hospitals, 7 nurses, 8 ENTs (2 attendings and 6 residents), 40 hours in the hospital, and countless scoops of ice cream later, I’m feeling much better. But it’s been a nightmare. If you still have your tonsils, keep them if you can. For an adult, a tonsillectomy is serious business.

Losing mine was inevitable. Since having mono in March (read that story here), my tonsils remained very enlarged, to the point where swallowing was annoying. Add to that recurrent throat infections, and they were seriously interfering with my quality of life. So my ENT agreed that removing them was the way to go.

The surgery was brief, the procedure itself apparently lasting only about 15 minutes. Cut, cut, cauterize. No sutures, just a torched throat. I actually felt OK that night. Third day post-op was the worst. Swallowing ground glass would have felt better than every gulp I took. The thing about a tonsillectomy, unlike most surgeries, is that you can’t rest the affected area.

In the midst of the pain, I developed a bad cold. So along with pain medication, I was taking an antihistamine, a decongestant, and cough medicine. To prevent bleeding after the surgery, you’re supposed to avoid coughing or clearing your throat after the surgery. Needless to say, I was a total zombie. Right before I had my surgery, the ENT resident said to me, “I hope you have a lot of good books to read and movies to watch.” Yeah, right. I was lucky if I got out of bed.

Slowly, things started to improve. Minutely, but noticeably. Then nine days post-op, 7 p.m. to be precise, I started coughing up blood. First phlegm with blood, then just … blood. I’m not normally one to panic, but blood isn’t supposed to come out of your mouth in quarter-cupfuls at a time. Naturally, I called my dad, who lives not far away. Dads—especially dads who are doctors—can make everything right. Right?

“I’m coughing up blood,” I told him. “Can you take me to the ER?”

“If you are coughing up that much blood, you need to call 911,” he said. “They can get you there a lot faster than I can.”

So, somewhat reluctantly, I dialed 911. Put my shoes on, got my purse and phone—somehow I thought to bring my phone charger too—and went outside to wait for the ambulance. It came, flashing lights, sirens, handsome paramedics and all. I stepped up into the ambulance (no stretcher? what about the stretcher?) and off we went to the community hospital. In better times, I could walk there in 15 minutes. Clearly, these were not better times.

The benefit to arriving at the ER in an ambulance, I suppose, is that you jump the queue. Immediately to a curtained-off gurney I went. Vitals taken, throat examed, IV fluids started. My dad arrived soon after to keep me company. He had left a message for my mom; I’m living with her, and she had just left for a church function before I started coughing up the blood. She called back while we were sitting there.

“Yeah, I’m here with Lorien,” my dad told my mom nonchalantly. “She’s covered in blood head to toe. There are these cool blood bubbles coming out of her mouth and nose.”

Laughing after a tonsillectomy is really painful, so I was trying not to—he was totally egging my mom on, as he has done since I can remember. I later found out that she believed him. I guess I can understand why—when she left I was fine, then she gets a voicemail that I’m in an ambulance and on my way to the hospital. She’s my mom. She gave birth to me. Of course she was traumatized.

“I was very fragile!” she told me later.

The ER doctor looked at my throat. She didn’t see any blood or evidence of bleeding. In fact, the bleeding had mostly stopped at that point. She called the on-call ENT doctor at the main hospital in the Chicago. They wanted to see me—at the Chicago hospital. Hence ambulance ride #2. No flashing lights or sirens this time, although I did get a stretcher. About time.

Déjà vu. This was exactly what happened when I got mono. Went to community hospital ER. ENT docs in Chicago wanted to see me. Ambulance ride to main hospital. I didn’t complain, though. Who knew if the bleeding would start again. I certainly wasn’t taking any chances.

Once in the Chicago ER, more IV fluids, more vitals, more doctors and nurses asking questions—not fun, since talking after a tonsillectomy is painful. Once the flurry calmed down, I looked around the room. The wall clock said 2:05. I did a double take. I knew it was closer to 10 p.m. Then I realized I was in the same room as when I had mono. The same broken clock, still broken. Déjà vu indeed.

Observation for 24 hours, and NPO (no food or drink) for the time being. That was the ENT verdict. So I tried to get comfortable. Not easy when you’re hooked up to an IV, a pulse oximeter, and a monitor. Not to mention that with all the IV fluids I was getting, I had to go to the bathroom every hour. At least, that’s how it seemed. But since I was so tied up, I had to call my nurse to unhook me from everything, and then hook me back up. For a person as self-sufficient as I am, being that helpless and needy was very hard to accept. I had no choice.

Since I couldn’t take pills, they gave me morphine via IV. I got four milligrams every four hours, which my hospice mom tells me is a low dose. Even so, it was … interesting. Almost instantly, my whole body felt heavy, invisibly weighed down. The morphine did a little, though not much, for my pain. At least it helped me sleep.

As this was a dedicated observation room, not a regular ER room, it had a normal hospital bed as opposed to a gurney. So I was much more comfortable. It also had a TV, although the first thing I did when the paramedics brought me in was to turn it off. I didn’t want to watch the news, the weather, sitcom reruns, or bad talk shows. I wanted to sleep. As I said, the morphine helped, some. But I quickly realized—or remembered, from last time—that the hospital is no place for resting. It is, in fact, the worst place for a sick person to be. Electronic monitors chirping constantly, people talking, walking by my room. At least I had a sliding glass door, which they allowed me to keep shut, and a curtain. That helped. The worst was the number of people who kept wandering in: doctors, nurses, social workers, volunteers. All had what I’m sure they considered to be important questions. But many of them seemed irrelevant to me at the time.

“Do you have stairs at your home?” was the worst question I got.

Say what? I had a tonsillectomy, not a hip or knee replacement. There’s nothing wrong with my legs. What does it matter that I live on the second floor? I understand that they ask everyone the same questions. But it was overwhelming, especially since my throat hurt so much.

My own ENT—the one who operated on me a week and a half prior—came to see me the next afternoon. Apparently, bleeding around day nine is not uncommon, he said. The scabs on the throat are starting to fall off, and sometimes healthy tissue is torn off too. My throat looked OK, he added. But since my pain was still uncontrolled, he suggested staying another night. I remained skittish, so I agreed. I would get a regular room on the floor soon.

My mom came to visit me that afternoon after my ENT left. It was a nice diversion, after trying somewhat unsuccessfully to sleep all day. At that point, I was on clear liquids (exciting!) so I feasted on green jello and apple juice. Considering how hungry I was, it actually wasn’t bad.

After she left, they took me to a regular room. More nurses, but no doctors this time, more questions. I discovered that they monitored different things on the floor than in the ER. My urine output, for one—what goes in must come out. They checked me for skin breakdown, and I had to wear inflating sleeves on my lower legs to prevent deep vein thrombosis (blood clots in my legs). My wonderful nurse apologized for the hassle.

“This is really for older people,” she said. “But we have to do it for everyone.”

Another night of morphine, in-and-out sleeping, hooking and unhooking to go to the bathroom. The next morning, I was more than ready to leave, regardless of my pain. Around 10 a.m., I unceremoniously took a cab home. And then I took a long nap.

I spent the weekend recovering from my hospital stay. I’m back to work, starting with half days for this week. I’m better, especially on the pain front, but I still don’t feel myself.

Like I said. If you still have your tonsils, do yourself a favor and keep them.

 

Author’s note: Those 40 hours were awful. But I want to thank everyone who cared for me at the two hospitals where I stayed: the doctors, nurses, and other staff. Especially the nurses. Without their help, those 40 hours would have been much, much worse.

1 Comment
March 21, 2014

The Difference a Day Can Make

One of my mom’s patient’s died during the night. Given that she works in hospice, this is neither out of the ordinary nor surprising. Death is a daily part of life for her. What makes this particular situation heart breaking is that the patient’s son and granddaughters – whom she hadn’t seen in years – were traveling from across the country to visit today. One day too late.

I don’t know the family situation, and it’s not my business to. What I do know is that I feel sadness for the patient who died without seeing her son and granddaughters again, and for the family, for missing her by only a day. But this day spelled the difference between life and death.

At the same time, this situation serves as a reminder, to care for and nurture the relationships that matter. Like it or not, that day comes for everyone. For you, for me, for the people we love. I don’t want it to make such a difference.

March 12, 2014

From Abscess, to Aspiration, to Ambulance: An ER Adventure

At least the IV stick didn’t leave a bruise on my arm.

That was one of my first thoughts upon waking up Monday morning of this week. Not a typical waking-up thought, but understandable given what I had experienced Saturday and Sunday. I’d had a health care adventure, all of it quite accidentally. The 18-gauge needle down my throat and ambulance ride (among other things) were never supposed to happen. But they did …

It all started around 4 p.m. Saturday afternoon with a trip to urgent care for something seemingly simple – a sore throat. I figured it for strep. Along with the pain, though, I had developed some difficulty swallowing, problems breathing at night, and a slightly muffled voice. The urgent care physician took one look at my bulging left tonsil and told me I needed to go to the ER immediately. “You don’t have strep,” he said. “You have a peritonsillar abscess.”

Peri-what?

Peritonsillar abscess: a bacterial infection of the head and neck that can progress into what is basically a collection of pus that forms next to the tonsil. Severe cases can lead to a muffled voice (check), difficulty swallowing (check), problems breathing (check), and eventually complete airway obstruction (yikes!). Hence the need to go to the ER.

So head to the ER I did, at Rush Oak Park Hospital, which is just blocks from my house. The nurse practitioner (NP) who saw me agreed with the urgent care doctor’s diagnosis, and said she would attempt to aspirate the abscess. In other words: poke a hole in it with a big needle and suck out some of the pus with a syringe.

Gulp.

She and the nurse took me back to the ear/nose/throat (ENT) room, sat me in what looked like a dental chair, and prepared their instruments. As the NP was unwrapping the syringe and needle, my eyes widened.

“What gauge needle is that?” I asked. “Is that a 16?” I would know, having seen the gamut of sizes during my mouse work in the research lab at Northwestern.

She smiled wanly. “An 18,” she said. “I didn’t want you to see it because I thought it would make you nervous.”

For those of you unfamiliar with needle gauges, the smaller the number, the bigger the needle. When it’s about to be shoved down your throat and into your tonsil, an 18 gauge looks like a silver coffee stirrer with a pointy end. Lovely.

Not wanting to decrease my gag reflex, the NP didn’t anesthetize my throat at all, just swabbed the spot where she was going to aspirate with a bit of betadine (a solution to prevent infection). As her hand, and the syringe, neared my mouth, I closed my eyes. And then … owwwwww. When I opened my eyes again, I looked at the syringe. Empty.

After the nurse had suctioned my mouth, I asked: “Did you get anything?”

“Just a few drops of blood,” the NP said. “I’m going to try again.”

Hooray.

The second time was just as painful, with no better results.

After more suctioning and rinsing my mouth with peroxide (“Don’t swallow this!” the nurse said), I asked what was next.

“On to Plan B,” the NP said.

“What’s that?” I was understandably nervous, given Plan A.

“I haven’t figured that out yet,” she replied.

So back to my corner in the ER, where I was given IV antibiotics, steroids, and some painkillers. Shortly after that, I got a head/neck CT scan to see whether the abscess had infiltrated other tissues. It had not, thankfully.

Eventually, the NP came back. “I talked to the ER doctor, and he said you need to be transferred to Rush downtown [an affiliated, and much bigger hospital] to see ENT,” she said. “We’re calling an ambulance.”

By now, it was about 10 p.m. I was exhausted and in pain. Not to mention hungry. I hadn’t eaten since lunch. My plan had been to eat dinner after my trip to urgent care, but that went out the window. At this point, though, because they didn’t know what ENT would want to do, which was a comforting thought, I was NPO (nil per os, Latin for nothing through the mouth, aka no food or fluids).

After what seemed like ages (more like an hour), the ambulance came. One thing about an ambulance ride is that you feel every single pothole in your bones. And there are a lot of them on I-290 heading toward Chicago.

Rush University Medical Center in the city, nearly brand new, is impressive. I had my own room (with lots of bells and whistles) and a real hospital bed (exciting after having been on something resembling a padded cot for several hours). My nurse quickly hooked me up to a monitor and gave me more antibiotics and pain meds. Oh yes, and drew more blood.

At this point it was after midnight Sunday, and I had been up since before 5 a.m. Saturday. But the ER is not exactly a good place to sleep, with alarms constantly going off, people chattering, and an IV sticking in my arm. Not to mention a painfully swollen throat. As I drifted in and out of semi-consciousness, various people came in and out of my room to check on me. My nurse. The ER doc (who took one look at my throat and said: “Yep, that’s a peritonsillar abscess”). A fourth year medical student (at 3 a.m.) who had never seen a peritonsillar abscess before. Yep. Glad to be of educational service.

I had been told ENT would come around 7 a.m. Which came and went. It was 8, then 9, then 10. Finally, two residents came. One of them did all the talking. He basically said there was good and bad news. The good news: “You don’t have a peritonsillar abscess.” The bad news: “You have mono.”

Seriously?

They gleaned this from the CT scan I’d had done at Rush Oak Park, my bloodwork, and then finally their physical exam.

After relaying their news, the residents left to confer with their attending. They all returned a bit later. The attending physician repeated the diagnosis and gave his treatment instructions. For at least a month: no alcohol, no strenuous exercise, at least 8 hours of sleep a night. And basically, no stress. Yeah, right.

“Just from meeting you, I can tell you’re the kind of person who needs to be told to take it easy,” the attending said. “If you don’t rest now, this will return with a vengeance, and you will be on your butt for two months.”

I certainly don’t want that. So I’m taking a week off work, at the doctor’s suggestion, sleeping a lot, and trying to avoid stress. Which is a challenge when you’re in the midst of medical school applications. But I’m doing my best.

While I wouldn’t exactly recommend this adventure to other doctors-to-be, it was very much a learning experience.

For one thing, nurses can make or break a hospital stay. I was fortunate enough to have three fantastic ones throughout this ordeal: Amelia, Carma, and Laura. All three were helpful, kind, compassionate, and responsive, both in big and little things. Doing an IV stick that didn’t leave a bruise. Bringing me a warm blanket. Ordering me breakfast even while I was still NPO, in anticipation of ENT allowing me to eat after their examination (which they did). I felt like a person, not merely a bar-coded patient.

Another thing that struck me was that everyone (up until ENT came) thought I had a peritonsillar abscess: multiple doctors, nurse practitioners, and nurses. This got me thinking about how easy it can be to misdiagnose something – how two different issues, in my case a peritonsillar abscess and mono, can have very similar symptoms and pathologies.

In other words: It takes everyone working together as a team to make the medical magic happen.

One of my first thoughts as I woke up Tuesday, thinking back on all that happened this past weekend:

At least I have fantastic insurance.

1 Comment
April 2, 2013

A Hamburger, and a Lesson About Medicine

Last Friday I learned an important lesson about being a doctor – at Five Guys Burgers and Fries.

I was waiting at the counter for my order. Standing next to me was a woman, probably in her 60s, with a walker, also waiting for her food. There must be something about me that looks friendly, because this woman started a rather personal conversation with me. I’d had a rough day, wasn’t really in the mood for chatting, but I could tell she needed someone to talk to. So I listened. The woman told me she’d had heel fusion surgery around Thanksgiving, and was very unhappy with the result. As I listened, I realized it wasn’t the actual result of the surgery that frustrated her, but it was the disconnect between the surgeon’s optimistic attitude and her realistic outcome.

I know there are two sides to every story, and obviously I haven’t heard the surgeon’s side. So it’s quite possible that back in November, when she and her surgeon were discussing the surgery, she heard what she wanted to hear. Her take-home message from those conversations, though, was that by June she would be wearing summer sandals and walking normally. “Instead,” she told me, “I will be wearing a brace that goes halfway up my leg.”

I don’t know for sure, but I think the woman would have been less angry if she felt she had gotten a more realistic prognosis from her doctor. True, it is important for physicians to give their patients hope. But it has to be an honest hope. As a doctor, I think you have to present the various scenarios that could  happen. Not to frighten your patients, but to prepare them.

It’s a fine line to walk, clearly. Optimism and hope can motivate a patient to work harder, to believe he or she can get better. But if you only present the best case scenario, you run the risk of angering your patients, of losing their trust. This woman didn’t say so directly, but I could imagine her considering a lawsuit against her surgeon. Not because he botched the surgery, but because she felt lied to, misled.

As I said, I don’t know the whole story here, so I am certainly not passing any judgment on this surgeon. It could very well be that this woman completely misunderstood what he told her. And as a doctor, you can’t control what patients decide to believe, or what they choose to hear. Even so, I think it does fall on the physician to do all he or she can to present the situation honestly to the patient. With optimism, yes. But also with realism. Because once that trust between a physician and patient is broken, I think it is very difficult, if not impossible, to repair.

2 Comments
February 16, 2013

Health Care: A Risky Business

A classic scabies rash.

A classic scabies rash.

There are, clearly, risks associated with becoming any health care practitioner, including a physician. One potential risk that comes to mind is an accidental needle stick. This can transmit bloodborne pathogens such as HIV or hepatitis. Obviously not good. Thankfully, I have never experienced that. However, this weekend I did experience the dangers of the health care profession firsthand.

I likely have scabies.

My mom is a hospice nurse, and one of her patients was recently diagnosed with this skin condition, which causes extreme itching and skin lesions. I have been itchy the last couple of days but attributed it to the cold Chicago winters and dry skin. But this morning, I was literally scratching head to toe – not normal. My mom put two and two together (and she has a couple of the classic scabies lesions on her arm) so we both went to urgent care. The physician there said she couldn’t make a definitive diagnosis, but she said we needed to be treated regardless. This involves literally putting a cream on your entire body, leaving it for 8 to 14 hours, and then washing it off. Like with a lice infestation, you also have to wash all your sheets, clothing, etc. A big hassle.

An image of the mite the burrows into your skin (and lays eggs there), causing scabies.

An image of the mite the burrows into your skin (and lays eggs there), causing scabies.

My mom was at first so embarrassed and upset. But I just laughed. What else could we do? It happened, there was nothing to do about it now. It was nobody’s fault. It’s an adventure, a learning experience. And I will definitely now know the signs of scabies should I ever treat someone with it!

When you go into health care, you have to be prepared for such risks. It’s easy to say you are. But less easy to deal with the consequences if it actually happens. I’m very glad this wasn’t a serious issue, and it’s one that is relatively easy to treat. At the same time, my reaction to it makes me aware that I seem prepared for health care-associated risks, not daunted by them. That is a good sign, I think.

November 3, 2012

Stupid Google! (and some HTML resources)

Dear Google:

Your Dynamic layout series is wonderful, in many respects. It is interactive, reader-friendly, and attractive. However, there is one major problem: The inability to change the HTML coding stifles creativity, and seems to go against the philosophy of Google itself. I hope you will fix this problem. In the meantime, I am sadly restricted to one of your lesser templates, simply because it affords me the ability to customize my pages. Were it not for my followers (however few they may be), I would consider changing blogging platforms. For now, though, I will hold out hope for your listening to the many complaints online about this omission in your template design.

Sincerely,

Lorien Menhennett
mybedsidemanner.blogspot.com

For those of you who may have visited my blog in the last few days, you may have noticed that it has been a revolving door of layouts and templates. For this, I apologize. I realize this can be disorienting and confusing to readers … I know it is to the author.

The reason for this is as follows: I found a very wonderful template, called the Dynamic series. However, I wanted to customize it by changing the HTML coding. After about an hour of frustration on both my blog and other blogs dedicated to helping bloggers blog, I discovered that this template series does not allow you to edit the HTML code. It is fixed, so to speak. I find this very frustrating. Hence my faux open letter to Google in my faux version of The New York Times (at right).

I find it humorous that this was a problem for me (at 5 a.m. on a Saturday, especially). I never would have dreamed that I would be editing HTML code. But I have learned bits and pieces of it, through different Web sites and others’ blogs. This post is a shout-out to those of you who are experts at this foreign language, which I am slowly learning. This post is also a complaint to Google for not making it possible to speak this language in the Dynamic template series, which aside from this issue is pretty darn cool.

With that said, here are two sites I have found helpful in learning HTML code. Just in case, ya know, you want to try it out too …

html tagshttp://www.quackit.com/html/
This site is great. It offers tons of code HTML code resources. One of my favorite things about this site is that it has “code generators.” I know, I know … the purists will call me lazy, but I really like that I can just specify the number of columns, rows, background color, etc. in a table and have the site churn out the whole table’s code for me, which I can then copy and paste into my blog. (Here is the specific table generator link: http://www.quackit.com/html/html_table_generator.cfm.)

http://blogger-hints-and-tips.blogspot.com
There are blogs about everything. Including blogs about blogging. This is a great one if you need tips on technical things (I have found it quite useful).

October 21, 2012

Survey Says!

family feudPicture an episode of the game show “Family Feud.” The question: One hundred health care workers were asked, “Name the first feeling you have when you hear the words ‘The Joint Commission.’ ”

Chances are, when the show’s host shouts his famous “Survey says!” line, TERROR will be the top answer on the six-item list. (Followed by fear, anxiety, dread, panic, and shock.)

The Joint Commission (http://www.jointcommission.org) is the organization that accredits most hospitals and many other health care facilities in the United States via so-called “surveys” (a nice phrase for “inspections”). Accreditation is the key to Medicare reimbursement, as well as a generally recognized standard of patient care. So organizations desperately want to comply with The Joint Commission’s standards, for both financial and public relations reasons. Complying with these standards, though, can be a challenge, due to the sheer volume of requirements. The updated 2012 version of the CAMH (Comprehensive Accreditation Manual for Hospitals) is more than 750 pages long. No joke; I’ve got a PDF of it on my laptop. So this terror response to an impending Joint Commission survey is somewhat understandable.

But I believe in The Joint Commission, and its mission statement:

To continuously improve health care for the public, in collaboration with other stakeholders, by evaluating health care organizations and inspiring them to excel in providing safe and effective care of the highest quality and value. 

Maybe that sounds corny, and naive (given that I am not yet in the trenches of health care work). But I am currently doing freelance editing and writing for Joint Commission Resources, the publishing arm of The Joint Commission. And the materials I have been exposed to have convinced me that overall, The Joint Commission isn’t out to punish people, it’s out to protect patients, and ensure the best possible care for them. And isn’t that what physicians, nurses, and other health care professions should strive for as well?

I am both a journalist and a scientist, and out of service to both of these roles, I will provide evidence to support my claim. Others may or may not agree with me, but I hope that this post will at least provoke some thought, and perhaps some discussion.

First of all, most of The Joint Commission standards I have seen – while complex and extensive – make sense and have a purpose. For example, organizations are required to have a formal, written “Emergency Operations Plan” (EOP) that takes what is called an “all-hazards” approach to emergencies. Basically, what this means is that a hospital (or other facility) has to be prepared for whatever may happen, along with having specific steps and procedures in place for dealing with certain types of more likely situations such as fires. The EM (Emergency Management) standards and related EPs (Elements of Performance, which are basically broken out objectives) literally comprise 20 pages of the CAMH. There are standards related to evacuation, utilities management, licensing of independent practitioners in event of a disaster, and many other scenarios and issues. That’s a lot to keep track of, obviously. But think of it this way – if you were a patient, or had an ill family member in the hospital, wouldn’t you want a hospital to have such a plan in place and ready to initiate at a moment’s notice? Without such a plan, an emergency or disaster would cause absolute mayhem. Of this I am completely convinced.

TJC bldg

One of the things I have enjoyed most (and also benefited from) with regard to my freelance work for Joint Commission Resources is reading case studies related to implementation of certain standards. For example, one of the case studies I read involved a small community hospital that faced a major hurricane. The hospital lost power, and risked losing generator capability as well, so was forced to evacuate all of its patients to surrounding facilities. Without electricity, though, such an endeavor is a feat. Consider that the hospital was several stories tall, and the elevators were out of service. So non-ambulatory patients had to be carried down the stairs on gurneys. Remember also that without electricity, photocopy machines were not working. Which meant it was impossible to copy patients’ charts prior to their transfer elsewhere. The solution to this problem was that hospital staff accompanied patients to the transfer locations, copied the charts there, and brought the original charts back to the community hospital (because both locations needed the patients’ records). While the case study (and the hospital administrators) acknowledged room for improvement, and a few hiccups in the process, for the most part this complicated evacuation went pretty smoothly. And that was because the hospital had a detailed EOP.

Second, The Joint Commission genuinely (in my opinion) tries to provide resources to help hospitals better comply with all of these standards (via Joint Commission Resources publications). Many of these resources are articles and books that specifically address complex standards. Some of them are best-practice examples from organizations that have gone above and beyond in developing a particular policy, procedural checklist, etc. I have been working with Joint Commission Resources to secure permissions for some of these best-practice examples, and have seen how Joint Commission standards can inspire organizations to improve their own workflow, procedures, and policies with the ultimate goal of providing improved patient care.

Third, I have been inspired. I know I’m not even in medical school yet, much less a practicing physician facing a Joint Commission survey. But some of the case studies, and responses to Joint Commission standards, have given me ideas on how to better provide patient care in my capacity as a Spanish medical translator, as well as ideas for patient care practices in my future as a doctor. For example, one case study I read referenced the development and use of something called a “Patient Care Notebook.” This was in response to miscommunications and accidental gaps in care, especially after a patient was discharged from the hospital and went into the outpatient setting (or vice versa). The Patient Care Notebook is just that – a notebook (rather, a three-ring binder) with dividers for different types of information, medication logs, doctor’s visit logs, space for patients to write down their own questions (and the practitioners’ answers), important contact information, discharge papers, care plans, etc. This helped organize a patient’s medical information in one place, and provided a tool for both the patient and his or her practitioners. It was something the patient could bring to every visit, hospital stay, etc., and add (or remove) information (medications, etc.) as time went on.

As I came across this, I thought to myself, “How brilliant!” I immediately e-mailed the community outreach coordinator at the clinic where I volunteer, to see whether she might be interested in incorporating this tool into the patient health literacy initiative she is working on (and I am helping with). I also realized that this type of tool is something I could develop and customize for my own patients in the future, as it is not readily commercially available. (Which does not make sense to me at all, given how beneficial it has the potential to be.)

So if I were one of the health care survey respondents, and was asked that question I posed at the beginning of this post, my answer would be different: “Gratitude.”

October 7, 2012

Long-Overdue Update

Well, it seems it’s been 2 months since I last posted. How time flies, doesn’t it? But I’ve been keeping myself out of trouble, I promise. Here is a bit about what I’ve been up to …

I wrote in a previous post that I had a tentative part-time job at the University of Illinois-Chicago Anesthesiology lab where I worked as an unpaid assistant for two summers (2010 and 2011). I started that job (paid this time!) back in mid-August. Working there, being paid to do what I do, and having so many more responsibilities than I ever did before, I feel just a little bit more like a “scientist.” If that makes sense. I’ll see if I can explain.

When I was a summer lab assistant at UIC, I worked with a wonderful post-doc named Olga who has become something of a mentor to me. She still works in the same department, and her lab room is actually next to mine now. When I have a question about something, I usually go ask Olga. Not only will she help me (or help me figure out where to find the answer to my question, if she doesn’t know), but she does so happily and willingly. Not everyone is like that. Olga taught me to pipette, to set up PCR, to run gels, to culture cells. It was while I worked with her that I discovered my love of bench science and research.

With the wonderful background Olga provided me, as well as what I learned in my post-bac coursework and research at Dominican, I felt I was ready for a position with more responsibility and autonomy. Well, I got it! While there was a bit of a rough start, things are going quite well now. And in that rough start, I learned a great deal about the scientific process, and my aptitude for it.

I was hired at UIC to genotype mice. My department is trying to breed double knockouts (DKOs, for short) of several genes in order to study these genes’ combinatorial roles in lung diseases. Genotyping mice, at least the way we are doing it, involves (in part) two techniques that are quite familiar to me: PCR and gel electrophoresis. I did both of these with Olga, as well as in my Research Methods course at Dominican. But genotyping involves many more steps as well, steps which were new to me. In addition, while I had done both PCR and gels, I had never done them completely from start to finish. By that, I mean from ordering primers to taking the gel photo in the dark room. I had done the middle part – the actual PCR and the gel – but not the initial and final steps. So I definitely had a lot to learn when I started this new position.

So here is the basic outline of the genotyping process:

1. Cut small pieces (about 0.5 cm) of mice tails
2. Digest mice tails to extract DNA
3. Run two rounds of competitive PCR (one for each gene) to amplify the DNA
4. Run a gel to determine whether each mouse is a wild type, knockout, or heterozygote for each gene
5. Analyze results, and hopefully set up new breeding pairs if you get any DKOs

Steps 1 and 2 were brand new to me. But I am proud to say that I am now a mouse anesthesiologist and surgeon! On one of my first days at the lab, my supervisor took me down to the animal facility and taught me how to anesthetize the mice, tag their ears, and snip of a bit of tail into an eppendorf tube (being careful to wipe with ETOH in between each mouse to avoid DNA contamination).

One of my gels, from last week. Pardon the over-exposure and the line of dNTPs at the bottom. I'm still working out the kinks with my primer concentrations and still getting the hang of working the darkroom camera ... it's a work in progress, but I'm getting there!

One of my gels, from last week. Pardon the over-exposure and the line of dNTPs at the bottom. I’m still working out the kinks with my primer concentrations and still getting the hang of working the darkroom camera … it’s a work in progress, but I’m getting there!

The tail digestion step was a bit of a debacle to begin with. I started out with a complex and time-intensive protocol that was handed down to me by another post-doc at the lab. It involved using proteinase K and several other reagents, heating the tail tubes in a 55°C water bath for four hours, and then inactivating the proteinase at 95°C for 10 minutes. When you counted prep time (thawing reagents, pipetting, labeling tubes, etc.), the whole process lasted somewhere between five and six hours. And I was getting very inconsistent results. But honestly, I wasn’t sure whether it was the tail digestion or the PCR that was the problem. For example, my primers could have been bad, or I could have been over- (or under-) digesting the tails. I literally worked with this protocol for a month, to no avail. Then my supervisor suggested I go talk to the woman, Debbie, who runs the Molecular Core, where the PCR machines are. I asked her how long she incubated her tails for.

“Oh, I use a kit,” she said, nonchalantly. “Why, what are you doing?” After I gave a brief outline of my method, her co-worker literally busted out laughing and said, “Wow, you’re really doing it old school!”

This “kit” is a miracle: while my protocol was taking five to six hours, the kit takes 30 to 45 minutes. And, as if that weren’t enough, the kit comes with a pre-made PCR master mix that contains a Taq JumpStart antibody which prevents the Taq from activating at room temperature … meaning you can set up PCR on the lab bench rather than on ice! It’s absolutely amazing.

Debbie let me borrow her kit to try it out, and it worked beautifully. My results are now consistent, and I even determined last week that we indeed did have several DKO mice – three males and one female.

While it’s obviously exciting to get results, what’s also exciting to me is the process of science. I faced frustration, and I didn’t give up – I worked on figuring out what was going wrong. Also, one of the things that always amazed me about Olga (when I worked with her those first two summers) was that she always had several experiments running simultaneously, and somehow the timing all worked out. I am learning how to do that as well – how to time my agarose melting, reagent thawing, and PCR and gel running (along with meticulous notebook note-taking) so that I get the most out of my time there.

I work at the UIC lab three days a week. This past Thursday I was working from home on freelance writing. When I woke up that morning, I felt a little sad, and thought to myself, “I wish I were going to the lab today.”

I think that’s a good sign.