Birinci sene dahiliye asistanının gözüyle Cleveland Clinic
13 years 6 days ago - 13 years 6 days ago #1
by umc
Dr Ulaş Mehmet Çamsarı
Birinci sene dahiliye asistanının gözüyle Cleveland Clinic was created by umc
Bu tip paylasimlarin Amerika'daki hastanelerin icerden taniyabilmek icin degerli olabilecegini dusunuyorum, bu bloglar calisanlarin ulasabildigi intranet bloglarindan alintidir, faydali olmasi dilegiyle- ulas camsari]
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Cleveland Clinic Resident Blog
YAZAR:
Dr. Viral Patel is a first-year resident in internal medicine at the Cleveland Clinic. Dr. Patel is a member of the Editorial Advisory Board of Internal Medicine News.
Sound
April 08, 2011
Let’s do an experiment. Close your eyes for a minute and think about the sounds that you hear in the hospital.
I hear pagers beeping (over and over again). I hear telemetry monitors signalling S1 and S2 heart sounds. I hear ventilator alarms, the awkward silence in elevators, cash registers in the cafeteria, carotid bruits, code blues being called overhead. I hear patient care teams rounding the hallways, New Age background music in the lobbies, bowel sounds, the pounding of the MRI machine, asystole and telephones ringing.
Our lives in the hospital are filled with unique sounds, and each one has its own significance.
The most significant sound I heard in the last month was actually a voice. I had been taking care of a very sick middle-aged woman who had lost her vocal strength after extubation. It was an unfortunate story, and she was the sweetest, most gentle patient I can remember. It was hard to see her deteriorate in front of my eyes. I had seen her every day for 3 weeks, and every day I heard her whispers as she told me how she was doing.
I always wondered what her real voice sounded like. One night I had to obtain informed consent for a procedure we were doing and called some numbers to speak to a family member. The phone rang and rang until the voicemail came on. It was her, my patient speaking in her normal voice. Her voice sounded just as I had imagined it would and yet it still filled a void I had of her in my mind. The sound of voice is such an amazing and complex aspect of life, but we oftentimes forget to acknowledge it.
I went back into her room and told her about my call, and she held her hand out to me. I held it for a minute and she shed a tear and whispered, “Thank you.” It was an experience I’ll never forget.
Intertwining Fingers
March 02, 2011
We often forget the struggles that patients go through when faced with adversity. Within the last week two patients have reminded me just how much fight people have in them and the importance of taking care of not only the mind but also the soul.
One patient had a history of multiple treated cancers and multiple organ transplants, and he presented with symptoms consistent with metastatic disease to the vital organs. He and his family had clearly been through a lot during his illnesses, but when my colleagues and I spoke to them, I was somewhat surprised to see how well the family reacted. Although the prognosis was grim, they took the information found in the scans in stride. They acknowledged the severity of the illness, and the patient and his wife intertwined fingers and asked, “What do we do now? We can fight this. What’s the best way to do it?"
Every time I think about the "problems" in my life, I wonder about their true importance. The things I complain and worry about are so minuscule compared to the things people are fighting every day right in front of my eyes.
As a doctor, I’m on the giving side of the equation right now. I know that one day I'll have to go through serious health issues. I fear the day when I'm on the receiving end, when I cannot take care of my own health. It was heartwarming to see my patient's wife there; she held his hand the entire time. Her support was a powerful thing to see. I wonder if I'll be fortunate enough to intertwine my fingers with someone and have a health care team as good as the one that I am surrounded by every day.
Walking the Walk for Health
February 18, 2011
Before I started my residency at Cleveland Clinic I had to agree to have my urine tested to see if I had been using a very dangerous drug. Like all potential employees, if I didn't pass the test, I would not have been hired, I would have been referred to a free treatment program, and I would have been invited to re-apply for my position in 90 days.
Since 2007, Cleveland Clinic has been testing all potential employees for cotinine, a metabolite of nicotine, which is present in all forms of tobacco. Having never smoked, I had no problem passing the test, and it made me feel good to be part of an organization that acknowledges the hazards of the world's most dangerous legal drug.
Cleveland Clinic also prohibits smoking, not just in its buildings, but everywhere on the campus. This prohibition extends to employees, patients, and visitors. Although I know of two employees who are smokers (existing employees have not been required to submit to cotinine tests), and although I'm sure a significant number of our patients and their visitors are smokers, I am happy to say that I have never seen a single cigarette being smoked anywhere on Clinic grounds.
While many health care organizations talk the talk about healthy living, I'm happy to see that Cleveland Clinic walks the walk as well, and not just regarding smoking. You won't find any french fries – no fried foods at all – in our cafeteria. The cafeteria uses only trans-fat-free cooking oils. We refuse to sell sugared soft drinks, and visitors often ask, "Where can I find a non-diet soda around here?" And when you enter the cafeteria the first thing you see is a bountiful salad bar.
Of course, we're not perfect. There is a McDonald's restaurant in our food court. Our president and CEO, Dr. Toby Cosgrove, a renowned heart surgeon, made national news in 2004 when he attempted to have the McDonald's removed. It is the only place in the hospital where residents cannot use their call money. Because of the fast-food chain's 20-year lease, the administration has not been able to remove them, but the very fact that we tried says something about us as a health care provider.
We haven't yet reached the stage of testing employees' urine for Big Mac metabolites, and perhaps we never will. But we're making a very public stand for healthy living, and other institutions have started to follow.
Musings from the MICU (CCF dahiliye yogun bakim tecrubeleri)
January 20, 2011
This is turning out to be an amazing month. I’m in the Medical ICU and learning so much not only about my patients, but also about myself. Once my training is over, I may never be around this many very sick patients in one place again, much less be responsible for their care. And each of these patients provides an opportunity to learn such a vast amount. Understanding each patient’s condition in terms of systems leaves me marveling at how complex the human body is.
Family members sit by the patient’s bed as often as our visitor policy allows. I have a new appreciation for what a difficult task it is to update them about their loved ones, balancing compassion against the requirement to report facts about status and overall prognosis. These encounters have been eye opening and a privilege.
It’s such a humbling experience to admit a patient who is in septic shock or a patient who coded on the floor and know that part of me is confident in my knowledge and other part is scared for the patient.
Luckily, my senior resident is there to keep me balanced and to offer support.
An afternoon walk through the hallways offers multiple glimpses of family members sitting vigil at bedsides and makes me wonder about my own mortality and how one day I will be the patient that an intern pre-rounds on. What do I want my own code status to be? How will I feel about being in a strange place away from my home and having different people come by and poke and prod me? I’ve gotten into the habit of telling my patients who I am every time I step into the room, even if they are on a ventilator and sedated because there’s a slight chance that they can hear and understand me. For the sake of it making a difference to them, I want them to know who I am and that I’m there to care for them.
This month has been tough both physically and emotionally, but I wouldn’t trade it for anything. With the support of my peers and the guidance of the nurses, the fellows, attendings and the senior residents, the service has been invaluable to my education.
Alinti : Cleveland Clinic Intranet Asistan Bloglari
_________________________________________________________________________________________________________
Cleveland Clinic Resident Blog
YAZAR:
Dr. Viral Patel is a first-year resident in internal medicine at the Cleveland Clinic. Dr. Patel is a member of the Editorial Advisory Board of Internal Medicine News.
Sound
April 08, 2011
Let’s do an experiment. Close your eyes for a minute and think about the sounds that you hear in the hospital.
I hear pagers beeping (over and over again). I hear telemetry monitors signalling S1 and S2 heart sounds. I hear ventilator alarms, the awkward silence in elevators, cash registers in the cafeteria, carotid bruits, code blues being called overhead. I hear patient care teams rounding the hallways, New Age background music in the lobbies, bowel sounds, the pounding of the MRI machine, asystole and telephones ringing.
Our lives in the hospital are filled with unique sounds, and each one has its own significance.
The most significant sound I heard in the last month was actually a voice. I had been taking care of a very sick middle-aged woman who had lost her vocal strength after extubation. It was an unfortunate story, and she was the sweetest, most gentle patient I can remember. It was hard to see her deteriorate in front of my eyes. I had seen her every day for 3 weeks, and every day I heard her whispers as she told me how she was doing.
I always wondered what her real voice sounded like. One night I had to obtain informed consent for a procedure we were doing and called some numbers to speak to a family member. The phone rang and rang until the voicemail came on. It was her, my patient speaking in her normal voice. Her voice sounded just as I had imagined it would and yet it still filled a void I had of her in my mind. The sound of voice is such an amazing and complex aspect of life, but we oftentimes forget to acknowledge it.
I went back into her room and told her about my call, and she held her hand out to me. I held it for a minute and she shed a tear and whispered, “Thank you.” It was an experience I’ll never forget.
Intertwining Fingers
March 02, 2011
We often forget the struggles that patients go through when faced with adversity. Within the last week two patients have reminded me just how much fight people have in them and the importance of taking care of not only the mind but also the soul.
One patient had a history of multiple treated cancers and multiple organ transplants, and he presented with symptoms consistent with metastatic disease to the vital organs. He and his family had clearly been through a lot during his illnesses, but when my colleagues and I spoke to them, I was somewhat surprised to see how well the family reacted. Although the prognosis was grim, they took the information found in the scans in stride. They acknowledged the severity of the illness, and the patient and his wife intertwined fingers and asked, “What do we do now? We can fight this. What’s the best way to do it?"
Every time I think about the "problems" in my life, I wonder about their true importance. The things I complain and worry about are so minuscule compared to the things people are fighting every day right in front of my eyes.
As a doctor, I’m on the giving side of the equation right now. I know that one day I'll have to go through serious health issues. I fear the day when I'm on the receiving end, when I cannot take care of my own health. It was heartwarming to see my patient's wife there; she held his hand the entire time. Her support was a powerful thing to see. I wonder if I'll be fortunate enough to intertwine my fingers with someone and have a health care team as good as the one that I am surrounded by every day.
Walking the Walk for Health
February 18, 2011
Before I started my residency at Cleveland Clinic I had to agree to have my urine tested to see if I had been using a very dangerous drug. Like all potential employees, if I didn't pass the test, I would not have been hired, I would have been referred to a free treatment program, and I would have been invited to re-apply for my position in 90 days.
Since 2007, Cleveland Clinic has been testing all potential employees for cotinine, a metabolite of nicotine, which is present in all forms of tobacco. Having never smoked, I had no problem passing the test, and it made me feel good to be part of an organization that acknowledges the hazards of the world's most dangerous legal drug.
Cleveland Clinic also prohibits smoking, not just in its buildings, but everywhere on the campus. This prohibition extends to employees, patients, and visitors. Although I know of two employees who are smokers (existing employees have not been required to submit to cotinine tests), and although I'm sure a significant number of our patients and their visitors are smokers, I am happy to say that I have never seen a single cigarette being smoked anywhere on Clinic grounds.
While many health care organizations talk the talk about healthy living, I'm happy to see that Cleveland Clinic walks the walk as well, and not just regarding smoking. You won't find any french fries – no fried foods at all – in our cafeteria. The cafeteria uses only trans-fat-free cooking oils. We refuse to sell sugared soft drinks, and visitors often ask, "Where can I find a non-diet soda around here?" And when you enter the cafeteria the first thing you see is a bountiful salad bar.
Of course, we're not perfect. There is a McDonald's restaurant in our food court. Our president and CEO, Dr. Toby Cosgrove, a renowned heart surgeon, made national news in 2004 when he attempted to have the McDonald's removed. It is the only place in the hospital where residents cannot use their call money. Because of the fast-food chain's 20-year lease, the administration has not been able to remove them, but the very fact that we tried says something about us as a health care provider.
We haven't yet reached the stage of testing employees' urine for Big Mac metabolites, and perhaps we never will. But we're making a very public stand for healthy living, and other institutions have started to follow.
Musings from the MICU (CCF dahiliye yogun bakim tecrubeleri)
January 20, 2011
This is turning out to be an amazing month. I’m in the Medical ICU and learning so much not only about my patients, but also about myself. Once my training is over, I may never be around this many very sick patients in one place again, much less be responsible for their care. And each of these patients provides an opportunity to learn such a vast amount. Understanding each patient’s condition in terms of systems leaves me marveling at how complex the human body is.
Family members sit by the patient’s bed as often as our visitor policy allows. I have a new appreciation for what a difficult task it is to update them about their loved ones, balancing compassion against the requirement to report facts about status and overall prognosis. These encounters have been eye opening and a privilege.
It’s such a humbling experience to admit a patient who is in septic shock or a patient who coded on the floor and know that part of me is confident in my knowledge and other part is scared for the patient.
Luckily, my senior resident is there to keep me balanced and to offer support.
An afternoon walk through the hallways offers multiple glimpses of family members sitting vigil at bedsides and makes me wonder about my own mortality and how one day I will be the patient that an intern pre-rounds on. What do I want my own code status to be? How will I feel about being in a strange place away from my home and having different people come by and poke and prod me? I’ve gotten into the habit of telling my patients who I am every time I step into the room, even if they are on a ventilator and sedated because there’s a slight chance that they can hear and understand me. For the sake of it making a difference to them, I want them to know who I am and that I’m there to care for them.
This month has been tough both physically and emotionally, but I wouldn’t trade it for anything. With the support of my peers and the guidance of the nurses, the fellows, attendings and the senior residents, the service has been invaluable to my education.
Alinti : Cleveland Clinic Intranet Asistan Bloglari
Dr Ulaş Mehmet Çamsarı
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