Wednesday
Breakfast at 8:00am at UTMB.
The first thing on the schedule for today was a talk given by William Winslade about the seriousness of brain trauma. Points from the talk: brain trauma is the leading cause of death for teens under the age of 19 (roughly). Usually results from some sort of accident such as a crash or fall and is a relatively easy injury to sustain. Tissue in the brain is highly dependent on a constant supply of oxygen. If the blood supply to th brain is cut even for a few minutes, the results could be drastic and long lasting. William Winslade was telling us how when he was a child he fell off a two story building and suffered serious injury to his head. Luckily the doctors were able salvage his life by putting a shunt in his head to drain the fluid and a metal plate. Somehow William lost no mental capacity or any motor function and lived a normal child/adult-hood. We also watched a video on the effects of brain trauma on other people in the hospitals that they had been seeing. Until relatively recently, we haven’t fully understood the severity of brain trauma injuries. I guess the major incident that has brought the issue onto center stage was the case with Terry Schiavo. We’ve all seen on TV how it drastically change her life and the lives of her loved ones. The video that William made was about 5 years before Terry Schiavo. Some of the cases we saw were very similar to Terry’s. It was just very sobering to watch home videos of this woman who previously was an amateur country dancing national champion to someone who could barely talk and process what you were saying.
Another interesting thing Dr. Winslade talked about was human response while in the vegetative state. We saw on TV how although Terry Schiavo couldn’t respond to any sort of human stimulus, she was awake and her eyes could move and blink. Personally I always wondered if she really could hear her family and the doctors but just wasn’t able to respond. In some cases, doctors have determined that the person isn’t able to see what’s going on around them because their retinas are damaged or detached. However, they have performed MRI’s and other scans on the brains of people in near vegetative states while prompting them to respond. For example they would say, “I want you to think that you are back home somewhere with a loved one.” Then they would step back and scan the person. They found that the certain portions of the brain corresponding to memories and emotions like happiness would light up. Very cool.
We also talked somewhat about the ethics involved with people in vegetative states. Terry Schiavo is a good example that we all know. Another example Dr. Winslade presented to us was of a young man who was jumped by a local gang and nearly beat to death. He was in a coma for about 7 months until he woke up, but was in a vegetative state. Over time, he suffered many complications and had to undergo nearly 30 different surgeries. He had thousands of prescriptions, and required many forms of medical care including been transported back and forth been health facilities. Over the course of three and a half years, his medical bill accumulated to over $2.5 million dollars. SO the issue is that if he had no chance of ever recovering from his vegetative state, how long should his insurance company continue to pay his medical bill? Basically how long should they keep him alive? Well his insurance company wanted to cut him off but his father took ths issue to the press and the insurance company conceited.
Anyways so this was an eye opening talk on the prevalence of brain trauma and the issues that I often overlook.
Then we went to lunch. Afterwards we had our second problem based learning session with the same doctor we had on Monday. I’m a fan of these sessions.
For the rest of the afternoon, we were split up into two groups of 5. UTMB had set up a time for us to go to a learning session with Stan, the computerized mannequin we saw on Monday. I was in the second group, so we sat around for an hour and a half while the first group took their turn.
While we were waiting, playing spin chair pictionary.
Suggestion. This year’s program did have a lot of down time. Please do not misunderstand me, in no way at all am I complaining. A little down time is good to rest and recuperate, but at times I felt like we were sitting around for periods of time with nothing to do. Take this time for example, we sat around for a while. Just a recommendation, I am very grateful for the opportunity.
So during this time Mike Y and I discussed our idea for our quality improvement project. I think we got a good idea, we just need to work out the kinks. It has to do with outpatient discharge from the hospital and their medicines.
When it was our turn we walked down to the area to meet with Rachel, Dr Ainsworth, and the attending doctor, Doctor Levy. This guy is sick. He has done two residencies, one in surgery and one in anesthesiology. Understand this: that’s 5 years for surgery and 4 for anesthesiology. Nine years on top of medical school’s 4 years. Like I said, this guy is a baller.
SO when we get there, we did some random trivia for a while. Did you know that the only other organism in the world that carries leprosy is the armadillo? Yep, and it has 4 baby armadillos, all identical. Nice.
Ok back to Stan. Basically here’s the way it goes down. Dr. Levy will give us a scenario in which a patient has been brought in for a clinical reason. He will then go back to the computer room and adjust the mannequin to simulate the conditions he just described. We weren’t really sure what we were supposed to be doing with the patient, I suppose we were a team of anesthesiologist trying to stabilize the patient. I didn’t figure this out until the end though.
So the first scenario we got was a man involved in a car wreck. He sustained some injuries and complains of pain in his abdomen. Then Dr. Levy went to the back. While we were checking the monitors, Dr. Levy started talking to us through the mannequin It was great, he even pretended to injured. So we had no idea what to do. We would talk back. He wanted something for the pain, so we gave him morphine. Then his blood pressure dropped and his pulse went up. His O2 saturation also started dropping. We really had no clue what to do. We started giving him a random assortment of drugs, trying to slow his pulse and raise his blood pressure. We relied heavily on Dr. Ainsworth to guide us. Eventually he suggested we call in a surgeon to give an analysis, so we did. Dr. Levy came in and was like how am I supposed to give him an examination if he can’t tell me where he feels pain? He’s also asleep. Whoops. We then debriefed the situation and discussed the best options.
Next scenario, I forgot. Last scenario: chest pains, possible heart attack. We did better with this one and successfully stabilized him.
This was a great experience and I felt like I learned a lot more from this session than I would from reading a textbook. It provided a real life environment with unknown conditions and also pressured us to think harder and focus because a patient’s life was at risk.
Then we caught our ride home. We did absolutely nothing until dinner and we walked to a wings place for dinner. I had a whole chicken. It was spicy.
Michael and Travis
These guys are never on time.
Michael limbo.
Then we went back and went to sleep.
-James
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