Category: Work

About jobs and work.

RSNA: Radiological Society of North America OR Rad Stuff of the New Age

I will now call it Rad Stuff of the New Age. RSNA is a yearly medical conference in Chicago, specifically radiological, with 60,000 + participants each year, making it the BIGGEST MEDICAL CONFERENCE IN THE WORLD. Not because Radiology is the largest field of medicine, or even the one with the most money, but because it has the most technology associated with it- the most cool stuff!

Entrance to the conference

You could walk around it forever. You could get lost in the GE booth or the Siemens booth, testing out their new, spiffy, minimally-invasive radiological equipment. (Well, you wouldn’t actually get an MRI or anything, but you can look and touch.) It’s like going to Brookstone and not really intending to buy anything more than an alarm clock, but sitting in the massage chair for half an hour.

That’s how I felt while working a booth at the conference this week, but many people come to the conference for REAL business. They are looking to invest, looking to buy new equipment, looking to merge companies, to showcase their new technology, to see what’s out there. Radiologists come to see what’s new and to watch famous people in their field present work and give lectures. Vendors come there to sell their patented products (and to spy on the competition). A lot of people come to see their friends in the field. It’s really the place to be if you’re in the field of medicine, radiology or medical sales.

I worked at the Fovia booth! Fovia, Inc. is a software company that takes huge data sets from radiological equipment like MRIs, CTs and Ultrasound, and makes it into high definition 3D images and movies in which you can see extreme detail. It’s the new wave of rendering medical data! and it’s awesome. You can see more here.

Oh, and the conference is so big that I failed to see the FLASH MOB that occurred on the second day of the conference! But I later found it on YouTube. Check it out!

Internships!

Hey all!

I’m writing this article in the radio studio right now! Our theme this week is Battles. Anything ranging from personal battle to epic scenes in movies and video games. Which reminds me, since my exam week is over, I’m facing a huge dilemma, whether to buy Modern Warfare 3, Battlefield 3, or Skyrim.

Other than that, I also attended the UIC Engineering Poster Competition. This competition showcases various research projects that graduate students are working on, such as the ones depicted below:

Since exams are over with, I’m on a hunt for my summer internship. If there was a one-book guide to career hunting, I would recommend “What Color Is Your Parachute?” That book is also a self-exploration book in which can improve your chances in getting a job by finding your hidden talents and skills.

So here’s my tips for “Getting an Internship”

3. Focus Your Resume
A tip I learned from the Engineering Internship Coordinator is to focus your resume for the job you are applying for. Any relevant skills that will help you will increase your chances of getting the job.

2. Research the Job You Want
If you can do me a favor, and know what type of job you want. What exactly do you want to get out of it? Job benefits, opportunities for promotion, certain job hours? If you compare the same paid job for the amount of benefits versus work, you will see how important it is to research the job.

1. Get Out There
I heard a weird comparison, “career hunting is like dating.” You have to have manners, skills that appeal to the person who decides to hire you. So if you want to get a job, get out there and sell yourself.

I’m attending RHA Ball tomorrow! It’s a dance held for residents, staff workers, and their dates of Campus Housing hosted by the Residence Hall Association. Here’s the link to the place it will be hosted at: Holiday Inn at the Chicago Mart Plaza, just above the Loop. http://www.martplaza.com/

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TOPIC NEXT WEEK: I’ll think of something awesome, stay tuned =)

ANSWERS LAST WEEK:  I learned that Youtube is what creates 2011 music. Popularity through Youtube

QUESTION OF THE WEEK: Best song to slow dance too!

Think Before You Speak: Lessons for a Motor-mouth on the Pediatric Cancer Ward

I’m a fast talker, the majority of the time unabashedly so.  In any given conversation my mouth is going a mile a minute, with tangents, emphatic inflection changes, and wild gesticulations all part of the equation.  So you can imagine my discomfort upon entering the realm of pediatric oncology earlier this week, where everything you say holds a gravity so great even Sir Isaac Newton would be impressed.

The fact of the matter is that this field deals with very ill children whose illnesses may be life-threatening, but are always life-changing.  And one of the challenges – beyond the medical behemoth of fighting the cancer itself – is communicating the specifics of the situation with the parents, such that they have an honest, realistic assessment of what is going on with their child.  In other words, this is not the time for word vomit.

One of my patients was a tow-headed toddler undergoing her second round of multi-agent chemotherapy (6 toxic medications in total) for a non-resectable, incredibly rare sarcoma.  With only a handful of cases reported in the literature, and virtually no data with regards to treatment protocols, the attending physician sought out opinions from national experts in the field, only to find that the prognosis was most likely around a 1 in 6 chance of survival.

Little did she know that the mother of the child had contacted the same experts herself and had received the same troubling news, setting the stage for a potentially messy situation.  Luckily, this attending has an incredible way with words, and a knack for articulation that ensures that the words leaving her lips are exactly what she means to say in that moment, no more, no less.  And so she reported what she knew to the mother, succinctly yet compassionately, and in the process gained her trust.  Above all else, she seemed to be relieved that she wasn’t being placated with sugar-coated prognoses; the fact that the mother knew beforehand, and received the same news from both doctors meant that she was fully integrated into the decision-making process regarding her daughter’s care.

And so, content in that level of trust, she went on to ask a more subjective question: was the attending optimistic that her daughter would be the 1 out of 6 that beats the odds?

Of course, placed in this position, anyone would want to say yes and be able to reassure the parent that things would be okay.  Yet, in cases like this, where things actually may very well not turn out well, you can’t act on that impulse.  So in that moment the doctor did something so simple, yet so profoundly important: she paused.  It was clear that she was in deep thought during those several seconds, finding exactly the right words, fully aware of the subtle importance of syntax and semantics, because when she spoke, what came out of her mouth was the absolute perfect response for the situation.

“By my nature, I am an optimist, and I truly believe that we have found the absolute best treatment that we know of, given the specifics of your daughter’s case.  I also want you to know that she is in incredibly good hands at this institution, and that we will do everything within our abilities to aid in her treatment.  But with regards to the statistics, I cannot say one way or the other how I think it will turn out; as you know, this is a rare cancer with unpredictable course, but we will continue to do our best on her behalf and yours.”

The incredible level of respect, compassion, and empathy implicit in that response is all anyone could ask for in such a trying situation.  What the attending did was provide much needed healing during a time of suffering and uncertainty, and offered a healing of the spirit when healing of the body was uncertain.  And all because she paused and thought before she spoke.

No Kidding… A Week on the Pediatric Ward

This week I began foray into the land of runny noses, worried parents, and whaling children, otherwise known as the pediatric ward.  Above all else, I’d like to take this opportunity to express my new found admiration and respect to every single person who at one point or another was, has been, or currently is, the parent of a small child.  Seriously, one week down on the general pediatrics service and I am exhausted to the point of delirium.

I guess it had never quite occurred to me that pediatrics encompasses everything from newborns to adolescents – a full 17 and some years and countless developmental stages therein. With this wide spectrum of ages comes a whole spectrum of physical exam maneuvers and differential diagnoses, because children of different ages get sick with different diseases, and may even present differently even when they do have the same ailment.  For example, say in a given day, you see a 10 month-old, a 2 year-old and a 17 year-old, all in the hospital for a cough that sounds productive (i.e. they’re coughing up mucus).  Although, taken at surface value, the chief complaint is the same, there is very little chance that they are all suffering from the same disease process.

All this makes the field incredibly challenging.  The vast breadth of information that a pediatrician has to master is impressive to say the least.  And what is more, they have to do it all, often being unable to ask the patient questions – after all, a child younger than 5 probably isn’t completely aware of what’s going on with their body when they’re sick, and most of the time won’t know how to answer questions about their illness.

A pediatrician acts as a detective, a cryptologist, and an interpreter, all in one.  They have a variety of physical exam tricks in their arsenal, specific for age and ability level, using the results as clues as to what is going on with the child, deciphering body language and other non-verbal cues at the same time.  Most importantly, they have the keen ability to relate to parents, and ease their fears and concerns, such that they’re able to provide a thorough history and strengthen the other findings as to the etiology of the disease.  All in all, it’s a monumental task, which demands remarkable skill and the patience of a saint, what with screaming, flailing, and projectile body fluids thrown into the mix.

Admittedly, sometimes on the floor it feels like a zoo.  But at the same time, it’s refreshing to see the resilience of children when faced with adversity, something I think we can all learn a lesson from.  For instance, a young child who felt crummy on Thursday, by Friday, will have forgotten the trial of the day before, and will play as if nothing had ever happened.  That innocence that allows them to truly live in the moment is beautiful, especially in a field like medicine, where often those moments are limited.  So far it has been inspiring to walk in the shoes of a pediatrician, and get a glimpse of the long-forgotten joy for life that we all had as young children.

Can’t We All Just Get Along?

A relationship without communication ends in expletives, tears, and likely a breakup.  A hospital stay without communication ends in close calls, medical errors, and in the worst of cases, death.

The patient had a complicated history, with a recent kidney transplant managed with immunosuppressants, a subsequent ear infection, and complications which led to him to get parts of his facial bones resected in order to avoid any further spread of the infection. Nevertheless, by the end of that hospitalization in July, he was doing fine and was on the road to recovery.  With some help, he was walking short distances and overall was showing signs of improvement.

That being the case, it was quite a surprise when he came back just a month later, with leg weakness so severe that he could barely lift a foot, let alone take a step.

So he was admitted to the hospital once again and was placed under the primary care of the transplant service, despite the fact that his current symptoms were likely neurological in origin.  Now, it’s important to understand the logic here, which in itself isn’t wrong:  given his complicated medical history and kidney transplant — the complexities of which are likely to complicate any course of medical treatment — it was absolutely appropriate to have the transplant team see him.  However, the unfortunate design of the medical system (records, billing and all) meant that this initial determination of primary service precluded any other specialty (for example neurology) brought in to care for him from making medical decisions; anyone other than the transplant team were consultants, and would ultimately have limited control over his clinical course.

For the neuro team, this meant that we could only make recommendations for tests and procedures to be done, all of which would have to go through the middle-man approval of the patient’s primary team before being executed, slowing diagnostics and impeding treatments that would prove to be time sensitive.  In the case of our patient in particular, the decline was quick and severe.

Though he had come into the hospital with generalized muscle weakness, he was still able to move all of his extremities, even if that meant only a little lateral movement of his legs and wiggle of his toes (remember, his legs were the worst off).  He was also able to speak, only requiring occasional help from his daughter when communicating with us, and overall, seemed to be in no acute distress.  Over the next few days, though, he began a steep decline, as his speech rapidly worsened along with his motor capabilities.

On the second day I saw him, he was barely understandable, with marked facial weakness and the beginning signs of labored breathing.  The neurology attending I was working under realized the gravity of what she was seeing and told us to make sure we put in an order for a blood analysis known as an arterial blood gas, a test of oxygen absorption which would help us determine how well the patient was breathing.

At the top of out differential diagnosis was something called Guillain Barre Syndrome, an autoimmune disease where the body produces antibodies directed against a certain type of myelin (the fatty material that insulates nerves) found particularly in the peripheral nerves of the body.  Over a variable period of time (the process can be slow or fast, as was the case of this patient) these antibodies destroy the nerves, leading to both loss of reflexes, sensation, and ultimately paralysis of pretty much any part of the body.  In its classic presentation, the paralysis ”ascends” or goes from the periphery inward, starting in the feet and legs, (sometimes the arms) and heading towards the trunk, where it ultimately paralyses the most important muscle of all: the diaphragm.  This is the main muscle reponsible for breathing, and its paralysis basically means death.

This was our main concern, and more than anything else, we wanted to make sure that our patient didn’t progress that far.  But alas, per the system, he was not actually our patient.  And so we had to go through convoluted means of communication to get anything done, with every suggestion we made seemingly under-appreciated with regards to the urgency at hand.  So our attending, fearing that the patient could (and would) go into respiratory failure any minute, offered to take responsibility for the patient and have him transferred to the neurology service and moved floor where we’d be able to expedite the treatment plan which we thought, from a neurological standpoint, would serve him best.  Unfortunately, likely due to some inane hospital politics that never fail to surprise me with their absurdity, the primary team refused the transfer, and our poor patient stayed in the same room, on the same floor, and under the same primary service, when hour by hour he needed more and more monitoring and urgent care.

And so, with a growing sense of frustration matched only by our resolve to do right by the patient, we set out to make sure that our treatment plan would be carried out as quickly and efficiently as possible, despite the communicative obstacles. We had to breathe down the necks of the primary service to get the arterial blood gas we’d requested the day before drawn, and had to jump through hoops in order to ensure that he was getting the proper work-up for his condition.

This included an invasive procedure known as a lumbar puncture, in which a sample of cerebrospinal fluid (the fluid that surrounds the brain and spinal cord) is drawn up through a needle inserted between the patient’s 4th and 5th lumbar vertebrae while lying on their side.  So we went about preparing to do the procedure, and positioned the patient accordingly.  My job was to hold him in place from the front while the residents did the procedure on his back.  While holding the patient in this position, alternating words of encouragement and comfort, I noticed something odd about the movement of his abdominal muscles that coincided with his now erratic breathing pattern.  It looked like something I vaguely remembered from my pulmonology lectures years before called paradoxical abdominal breathing, a unique phenomenon which signified exceptional impairment of the respiratory muscles, top among them, the diaphragm.  In other words, if this were the sign I thought it was, our patient was in trouble.

But never having actually seen it outside of an illustrated textbook diagram, I was less than positive that I was actually seeing one of the harbingers of respiratory failure, and not wanting to bother the residents during the stressful procedure, waited until I saw the attending shortly thereafter back on the neurology floor to report what I had seen.  By that time, she was already on the phone getting word that the patient’s respiratory rate had doubled with decreased oxygen saturation levels (the ultimate sign of respiratory failure) and that he was about to be intubated and placed on a ventilator to make sure that he would continue to breathe while we worked on getting his muscle function back.

Fortunately, he was successfully intubated minutes later, for which the primary team deserves the credit; indeed he received the care he needed when he needed it most.  Since then he has been receiving various treatments for his condition with some improvement of motor and respiratory function (although he’s still on the ventilator). All that aside, the question remains as to whether or not we could have prevented the close call and stopped him from progressing to that stage of severity had we been able to act more preemptively and aggressively. It’s debatable, but certainly not outside the realm of possibility.

Whether it was the lack of cooperation/understanding between the teams, delayed diagnostic testing, or my own personal failure to convey a significant physical exam finding in a timely manner, better communication probably could have made a real difference in the case of this patient.  And while disaster was averted this time, it warrants thought for the future.

It seems, as in the case of a relationship, a little communication early on can go a long way in preventing less-than-ideal outcomes down the road.

I Don’t Want No Scrubs

The jade green scrubs given to operating room employees (surgeons, nurses, house staff, etc) are anything if not uninspiring.  What seems comfortable in the hazy hours of the early morning (we’re talking sometime around 4:45) ends up feeling like a grimy, sweaty encasement by the end of the long, grueling day (anywhere from 12 to 16 hours later).

And while some seem to love it – “It’s like wearing pajamas to work!!!” being a common sentiment – I found myself losing a piece of my identity.

In terms of utility it makes perfect sense.  In the case of emergency, there’s no diverting to the locker room to change into operating room attire; as a result, everything becomes a little more streamlined.  But from a psychosocial point of view, it can start to feel a little like the prescribed outfit in an authoritarian society.  The way one dresses is no longer a means of self-expression when everyone is relegated to these jade colored Mao Suits.  So I asked myself: what can I do to make these scrubs my own?  And with a little imagination and the inspirational words of Project Runway’s Tim Gunn in my head – “Make it work!” I set out to find a few ways to give some individual flare to the humdrum surgical scrub.

A few rolls of the sleeves gave the illusion of a tank top.  Similar folds on each leg yielded an 80’s high-rolled look.  Trading in the ratty gym shoes I’d been wearing around the wards for a more stylish pair made all the difference in the world, but still didn’t quite do the trick.

I just couldn’t get over the fact that I enjoyed and missed dressing up in the mornings and representing myself through my wardrobe.  In the clinical portions of my first two years of med school I’d learned that even within the rather conservative field of medicine, it’s still possible to change things up with regards to what you wear; the key is nuance. As such, I strive to put a little extra thought into it every day, hiding a god amount of personality in the details.

The type of tie (skinny vs traditional), the particular matching or contrasting of colors, and the thoughtful use of accessories (a loud pair of socks with an otherwise dulled down outfit certainly makes a statement) all come together to speak to who I am underneath the short white coat.

And so, I guess I can say that jade isn’t really my color, and that, given the choice, I’d rather not wear pajamas to work.  Aside from that, I’m now more appreciative of any chance I get to wear what I want.  And whether heading to a meeting or just running out to the grocery store, I’m more likely to be dressed to the nines than sporting sweat pants.  After all, I don’t want no scrubs.

Tough Week

I screwed up in the lab for the first time, and it was such a dopey mistake. Okay, so maybe it wasn’t that bad, but I definitely wanted to smack my forehead onto my desk a couple times. I was running a qPCR like I always do, pipetting a billion times into the wells (it seriously takes a good one to one and a half hours), and I put it into the beautiful Applied Biosystems computer. After waiting around for an hour and a half filling up pipette boxes with tiny pipette tips, I took my sunglasses and threw on some sunscreen, and stepped outside to face the blazing hot, sunny weather. If you’re wondering why I had to go out of the Applied Health Sciences building, the qPCR machine is in the UIC College of Medicine building, which is arguably close by…but on a day like this, you’d wish it was closer! The walk was almost unbearable to the point that I could almost hear my skin cells screaming in pain.

Anyway, I got to my machine and selected the wells like I always do, and usually the screen would begin to pop up with pretty colors onto a graph as I clicked from well to well…but today nothing showed up period. After suffering a mere panic attack (I had a couple of those today while I was pipetting into the wells…Margaret, a PhD student working in the lab with me and my lifesaver, sarcastically accused me of coming to the lab drunk since I was so clumsy today, which is obviously false because I don’t drink…no one ever believes me T-T), I immediately called Margaret and she asked if I clicked on a check box labeled “FAM” before starting the qPCR. I couldn’t remember if I did or not, but something strongly tells me that I forgot—and now I am just beating myself up with the fact that I messed up. I would forgive myself and just re-run it again tomorrow if I could, but I had just enough sample to run the qPCR today since I was going to move onto a new project. Sigh. I hope Margaret will save me and magically get the results from what I ran today.

Phew. Rough day and week overall. I had a quiz today for chemistry and I blanked out at the end because we had to find the electron configuration for Gd3+. I mean, seriously, who asks that?! Tutoring at the writing center was really intense because all of the SEWW students were eager to complete their portfolio to get into English 160, but they still lacked a good thesis and they always want help with grammar when that should be the least of their worries.

Luckily work has been treating me well. I’ve been getting a lot of e-mails from the NRHH and RHA committees about updating their website, and coding is one of my favorite things to do! Too bad I am too busy to do it on my own time, but that’s okay.

Sigh. Two more weeks of summer school left. Exam next week, 7-9 page paper due next week, and even more work to do. Each night though, I play on my DS to learn Spanish! I would take it as a class here, but I already got rid of my language requirement with Chinese…and I would rather take an art class than Spanish. I’m thinking about taking Polish or Italian my senior year though. Those would be fun languages to learn. Ah…I can’t wait to have my two weeks of actual summer break! Oh yeah, and supposedly the shirts come in tomorrow. I’ll post up pictures when I can! (:

I want to go to Europe one day…

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