Day five

Today I worked a total of seven hours, and sadly it was my last day. I thoroughly enjoyed my time in the clinic with dr lee and the other physicians. I learned an extraordinary amount and was restrained in my belief that I want to become a doctor. We started off the day by two patients. Today after all I taught this week I was allowed to give explanationsto the patients of their diseases, and subsequent treatments got which I was very excited. The first case was extremely textbook, sleep apnea, sleep study needed etc, the second case was far more difficult. The 67 year old male came in after a referral and complained of long held sleep problems in talking with Him we diagnosed him with insomnia, althoughnwe will do a sleep study to check for apnea. We gave him the options for treatment aqnd once he left dr. Lee asked for my opinion. I told dr. Lee that I believed the patient would benefit from psychiatric care to help cure the roots of his insomnia as well as receive some drugs that would be beneficial to his sleep. Lee agreed as a i pointed out specific things about the case and the patients history to back up my claims. Next I attended a pulmonary conference on a controversial lab study, which the entire pulmonary department was attending. After meeting more doctors who worked with my dad and were freaked out by our resemblance me and dr. Lee went to our last task: his lecture to med students on copd ( chronic obstructive pulmonary disease) a very well done lecture on how to diagnose and treat the fourth leading cause of death in the united states. At the end of the lecture me and dr. Lee parted and expressed our gratitiudes to each other. I had an absolutely fantastic week.

Day 4

Day four I was able to work from 12 to 4 and I have to say the first two patients I saw contained perhaps the most bizarre set of incidents ive seen all week. The first patient was an African American female 60 years old accompanied by her husband. At first she seemed completely normal as I shook her hand and introduced myself. But as our forty five minute session went on it was very clear something was very off about the patient. She was extremely shy and quiet, looked around suspiciously, could not make eye contact, or make anything resembling a decision. To the average person she would simply come off as extremely "crazy". We were barely able to convince her to come in and do the sleep study. She had been referred to us by a neurologist named Womack who spent a 130 minute session with her. Upon her departure I shut the door and me and dr. Lee exchanged dumbfounded glances, we immediately sat down at the computer and started reviewing notes from the neurology visit etc. Upon further review of her notes the neurologist had written he had never seen anyone quite like this patient. She failed several parts of her brain cognition test memory, ability to make decisions etc. At the end of the session he wrote a referral for her to see a psychiatrist. Which we asked her about she seemed very reserved and not at all excited about the psych appointment. She had been admitted to the hospital before brought in by her sisters who said she was extremely paranoid, thought her mess were poison could not make even the simplest of decisions etc. So it would have been possible to conclude that she was schizophrenic, psychotic etc. If not for the kicker: this lady had a masters degree was on a high level of thinking a short few years ago and had seen dr lee and 09 upon which he did not remember her having her symptoms this bad. Also as weird as it sounds during our session with her she did not give off the air of someone who had. A psychiatric disorder, it was almost as if she was autistic. Upon further discussion with dr. Lee we both come to the same decision: this was not something psychiatric but rather some sort of neurodegenrative disease. This lady did not need a psychiatrist but rather a brain biopsy, because very clearly her physical brain was in decline. So anyway that was an extremely interesting case especially for someone who was referred for sleep apnea. The second gizzard incident was shortly after a man with post polio came into the clinic for a referral, sat down in the exam room and was subsequently bitten by a spider, and sent to the er, both unprecedented and hilarious

Day 3

Today was a short day as I logged four hours. Their were no clinic patients scheduled this morning so I rolled in at about one. Again I rotated with Viroslav this time in the company of dr lee. Their was a huge rush as coincidentally four patients were schedulednright on top of one and other. Two with ALS, one with polio and scoliosis, one with muscular dystrophy and one with a spinal cord injury. Then first guy we saw had polio and by looking at his numbers co2 levels, ph, capacity etc. It was pretty clear this guy was getting progressively worse. He had a ph of 7.3 (normal is 7.4) co2 levels were way up, and his lung capacity was about 1.03 liters (that's awful) so this guy who has been a patient of viroslav's for twenty years is basically now considered as having respiratory failure. He's going to need to be on ventilation 24/7. He also needed a particular type of power chair which Medicare wouldn't cover, (btw Medicare absolutely blows) needless to say Viroslav was not happy about the chair. The next three patients were very quick all were getting their trache and feeding tubes changed. Last and perhaps the most memorable patient ive seen all week. Middle aged married male with ALS, apparently very successful was a young CEO moved here from the east coast and diagnosed with ALS. Obviously the patient is emotionally destroyed, apparently last visit there was lots of crying (there was this time too) the options for these people are terrible and the disease is an absolute death sentence and perhaps one of the worst ways to go that I can think of. The helplessness is pretty apparent, I'm definitely going to touch on ALS in my presentation to the faculty members next week.

Day 2

Started off today at nine and worked seven hours. I went over sleep studies in the morning with dr lee. I can now read these sleep studies and properly diagnose a patient with sleep apnea. Also dr lee lectured me on OSA (obstructive sleep apnea). Again the biggest thing to look for in terms of risk factors is definitely obesity. There is a staggering chart I will use in my presentation demonstrating the fattening up of our country. We went over treatments for sleep apnea as well as what happens if left untreated (elevated chance of cv event and fatality). Then Dr. lee took me to the ICU. That has been my dream since I was a kid to work there, these patients are very very sick. First I freaked out the nurses when I sounded and talked like my dad, then I saw patients on ventilators, dialysis etc. One guy had an lvat a device that contracts the heart starting in the left ventricle. ( dick cheney has one). Then I sat through a picture on discharges and hospital transitions. There are several staggering statistics when it comes to patient awareness as well as readmittance. Then I met dr. Joseph Viroslav. Just to get a sense of how long hes been around my dad was a fellow when Viroslav was on staff at utsw. Dr Viroslav is the breathing part of the sleep and breathing disorder clinc. His patients are very chronically I'll. I saw two with ALS and one with polio. The patients with ALS can be depressing as they are almost completely immobile and very dependent on caregivers. We changed the tracheostomy tube as well as the feeding tube on one patient. An extremely painful process for the patient and not for the weak of stomach. The patient with polio had some major compliance issues, it is amazing how many patients dontlisten to their doctors and can wind up getting killed because of it. So today overall took a step from more light hearted work in the sleep clinic to very seriously Ill patients in the ICU and in virsoslav's rotation.

Day One

My first day on the job working at the sleep and breathing disorder clinic at UTSouthwestern medical school lasted about six hours. I was trained at human resources in the morning for about thirty minutes then I was sent to the outpatient clinic where I worked under my mentors for the week: Drs Won Lee, Gregory Carter, and Joe Viroslav. Drs Lee and Viroslav are pulmonary physicians while Dr Carter is a neurologist. What we do in the sleep Nd breathing disorder clinic is generally see patients who have been referred to us who have possibly developed sleep apnea or other sleeping disorders. Generally the patients are overweight can have diabetes, down syndrome etc. Sleep Apnea is a disease in which the patient wakes up during the night due to inability to berth when sleeping. There are several treatments however the most common are the use of a cpap or bipap machines. Oxygen masks that keep the airway open during the night. Although not life threatening a very large group of patients have sever chronic illness. Many patients in the afternoon are wheeled in on gurneys or wheelchairs and may not have possession of any muscle control via ALS. Also I saw a patient this afternoon who suffered respiratory failure in February. Tonight I have been given reading material over ALS (amyotrophic lateral sclerosis) or Lou Gherig's disease. We see many patients in the clinicnwith this terrible disease, 100% mortality rate, no cure, barely any treatment. General prognosis indicates a three year survivability period. Tomorrow I will rotate with Dr lee in the morning, than switch to dr Viroslav and a far more grim series of patients. Note: also attended lecture on hypoatremia and how to treat it.