ISPP 2015

Career Opportunities in Pharmacy
DAY IN THE LIFE OF A DOCTOR: Respirology Rotation


Morning guys. I’m Siobhan, a 3rd year medical resident. It’s the first snowy day of the year, so I’m slipping to work. Currently I’m on a respiratory rotation. Some people call it pulmonology. It’s all the same thing, it’s a specialty of the lungs. So today you’re gonna see the type of things that we do and usually in the winter it gets a bit busier, because people get a lot of chest infections. So we’re starting the day with an hour of teaching. So we’ll go and meet the team now. Not actually sure of the topic. As residents, we’re doctors training to be specialists. So our days are filled with learning, as well as clinical work. So today we’re going in depth on how to interpret pulmonary function tests, where patients blow into a machine and then we can figure out the speed of the air and their lung volumes. Good morning guys. -Good morning. After printing our patient lists, we’re dividing up the list, assigning residents and medical students to each of the patients. So this is something I don’t always get to show you guys. One of the best parts of residency is working with great teams of residents. And here we might actually be having a little bit too much fun today, but they do say that laughter is the best medicine. Okay, so at this point we’ve divided up our patients. We each only are seeing about 3 or 4 patients today. We’ve got a big team, which is nice! And then any new patients that come into the emergency department or that we need to see, we’ll just divide it up as we go. The first patient that I’m seeing today is a man who was admitted last night for hypoxia. He gradually had become more short of breath over a few weeks and became concerned, so he went to see his family doctor. When he arrived at the clinic, his oxygen saturations were only 73%, so he was immediately sent to the emergency department. Okay, so this patient has a lot of fluid on just one side of the lung, which is called a pleural effusion. Now that can be for a lot of different reasons. Some of them are really serious, like cancer or infection that can get stuck there. And other times it’s not as serious, but we won’t know until they actually get some fluid off of that and analyze that under the microscope. So that’s what we’re gonna do. I’m gonna go get the supplies and we’re gonna do something called a thoracentesis. Getting supplies and setting up often takes the most time. So during that time, I like to actually visualize the procedure to help me prepare mentally and also so I don’t forget anything. I’ll be using ultrasound to put a needle through the patient’s back, just on top of one of his ribs and I’ll be draining out the fluid from his chest. The goal is to take off fluid and then decompress the lungs, so that he can breathe better, but also so that we can make a diagnosis. So I’ll be sending off the fluid in different containers and sending a whole bunch of tests, including bacterial culture, getting a cell count and differential to see what types of cells are in there and also cytology and flow cytometry to look for cancer cells. *Phone ringing* Okay, so we just got consulted to see a patient with really severe COPD and they’re coming in with extreme shortness of breath. So before I head down to the emergency department, I like to look things up on the computer, just sort of to have some background information. So let me just log on here. Okay… So COPD is a chronic lung disease and it’s caused primarily by smoking. It’s actually the 4th leading cause of death in the U.S., so this is a big deal. It’s something we see a whole lot and on the respirology team, we see it even more. So what happened basically is smoking causes inflammation and then destruction of some of the lung tissue, especially in the small little branches of the airways. And looking at this patient here, it looks like she’s got only about 14% of her normal lung capacity. So you can imagine it doesn’t take much for someone like this to feel really short of breath. It doesn’t take a lot to tip them over the edge. So I just want to go through the blood work and imaging and see what’s going on before we go down. I’m actually… Honestly this name, the name of this patient is so familiar. I’m sure I know her. So that’s kind of like a nice thing, cuz you already know the patient, but it’s obviously not a good thing if they’re still coming back into hospital. But that’s the nature of a chronic illness, it keeps happening and it gets worse over time. So I’m sure I will recognize her when I see her. Walking into the room, I recognized the patient right away and I can tell she’s working really hard to breathe, because she’s leaning forward and she’s even using her neck muscles, her accessory muscles, to breathe. Listening to her lungs, she’s got a super long expiratory wheeze. And that’s really classic for a COPD exacerbation. Okay, so the more I learn about this patient, the more convinced I am that this is all a COPD exacerbation secondary to an infection. Now people get short of breath for a reason and there are lots of different reasons, so you always have to think of all the causes. We’ve looked at an ECG and her troponin, so it doesn’t look like this is a heart attack. We’ve thought about whether there’s a blood clot in the lung. She’s been taking her medications, her puffers, regularly and she’s got this green sputum, lots of it. And it all just happened the last couple of days and apparently her granddaughter has been sick recently. So I think this is really an infectious cause, but here’s the trouble… Her lungs are so bad that she’s actually not able to move air in and out very easily. So I’m starting her on a BiPAP machine. So the machine is actually gonna push air down into her lungs to help try to circulate some of the oxygen better and get rid of some of the CO2 and hopefully she won’t have to be on that for too long. So we’ll follow up on her blood work later today to see if she’s improving. I just want to take this moment to talk to anyone who’s currently still smoking. You know, I just really want you to value your health and to make an effort to quit. I know it is so hard, but there are wonderful resources out there and great success stories. So speak to your doctor and find out about it. Alright… So I’ve just texted the team. So my attending physician and the rest of the team are all coming downstairs now and we’re gonna meet the new patient and go through the treatment plan. Okay, so it’s just after 2 pm. I’m having some food, drink some caffeine and yeah… Just giving myself a moment. I’m done with my consults and the patients on the ward. And we’ve kind of just chatted as a team to see where everyone is at. It looks like there’s 1 new consult in the emergency department. So since I’m wrapped up with my things, we’re gonna see that one next. We have a really strong team, lots of keen residents. So it’s been such a pleasure. And we got these pins for all of us. These lungs, to have some lung pride for respirology. So anyway, this has been a great… It’s a great rotation. Also I really want to thank you guys for so much love and support in the last video, when you found out that I was matching to rheumatology. You guys could probably tell that it’s pure emotion and joy and happiness and excitement. So all of that starts in July, so honestly I’m so excited for what’s to come. Okay, so let’s just quickly check on that new patient’s blood work, it should be back now. Great, so to her CO2 levels since starting the BiPAP have started coming down, which means the treatment option is working. Excellent! Okay, now we’re seeing a patient who was slotted into the urgent outpatient respiratory clinic. Dana, one the other residents saw her, so we’re just gonna meet her there. We hear a full case presentation from Dana including the patient’s past medical history, medications, symptoms, physical exam and investigations. We actually all look at the CT scan together and then interpret the pulmonary function tests. So we got to apply what we learned this morning. So 4 senior internal medicine residents and a staff respirologist all discussing the best treatment options. Not only is this excellent training for us, but I definitely believe that it benefits the patient. Wow, so many consults today. Each of us have been doing at least one. So now we’re all meeting downstairs in the emergency department to go through another consult, one I already did. So I’m just kind of running all over the hospital, catching up with all the different patients. I kind of like getting… It keeps things interesting. Alright thanks for the handover guys. Hopefully, it’s a quiet night. Yes! Okay, but the day is not over yet. We now have a 3 hour lecture to prepare us for the big internal medicine exam at the end of the year about pre-operative management of patients. So now I’ve got to get my student brain on and go for a lecture. Well, there you go. That’s a typical day in respirology and then even more of the day of what it’s like to be an internal medicine resident, studying a little bit after the day. If you have any questions, let me know. I am so excited to hear from you guys. And otherwise I’ll be chatting with you next video. So bye for now. Man, it is dark and it is cold, but the weirdest thing, it’s like every single year I forget how cold it’s gonna become and how snowy it is. I love Canada, but like the adjustment is jarring. Anyway, that’s all I was gonna say.

100 thoughts on “DAY IN THE LIFE OF A DOCTOR: Respirology Rotation

  1. This is brill!! Since you're on the respiratory wards, would you be able to do something on ventilatory/oxygen devices? Always so confusing knowing when to switch to CPAP

  2. This popped up in my suggestions, maybe because I'm a Nurse Practitioner in a hospital. It's interesting to see the difference in a US hospital vs a Canadian hospital. You seem like such a genuinely caring person, I hope you never lose that. Fantastic video, new subbie here! 💜💜

  3. I see my pulmonologist, a lot. I recently went from having a bad case of asthma/COPD to finding I have a rare condition called tracheamalasia. If you want an interesting condition, it is tracheamalasia

  4. omg i miss the snow and negative degree temperatures but i unfortunetly live in sc where it doesnt get cold or snow and it sucks and i miss it so much but i will be back in it next year since im moving back to PA. i love winter stuff

  5. I’m so glad to see your new videos! I have a very rare auto immune disease, so I’m curious what types of cases you’ll be seeing! Much love to you!!!!💗💗💗

  6. I am a nurse and I love your attitude! I would love to work with a doctor like you! Good luck in your Rheumatology fellowship!
    Side note! I have an autoimmune disease that can’t get diagnosed that’s causing so many problems right now! I think you would be great for this chronic illness sufferers! You seem to be so thorough and caring

  7. With all of the dumb pointless things that fill you tube and social media, its heartening to see a young, intelligent, and motivated person doing worthwhile things.

  8. My mom had COBD and got lung cancer. I hated her for years for smoking, because as a nurse (she was one herself) I knew with her heath it would kill her, and I lost her three years ago, when I was 30, and she just 55. So people, please stop smoking!

  9. You put the sterile gloves on like a pro. I ALWAYS struggle with them, especially when there are a lot of people around me hahah

  10. Hi am yeshaswini. Am a second year med student. I lost my right eye in an accident. I want to become a surgeon is that possible. I want to fight all the odds. My left eye is completely healthy. I was a topper in first year.

  11. you do a great job , great respect for you God bless your soul , you absolutely hero yes a true hero , you be so happy after life ❤🌷❤❤

  12. hello violin md i am an IMG wanting to prepare for mccqe exams i love to watch your videos when i can !!i wanted to pursue my MD in canada but i just need advice about which book or resources to prepare from !! thank you !!

  13. I just started working at the hospital as a nursing tech. Any tips you wanna offer us techs, I came form nursing homes and long term care facilities. Very different lol

  14. I think in between the snowy streets of Ontario and the similar Toomey architecture and seeing the inside of the hospital that seems to look like every other Canadian hospital all the way to seeing those Tim Hortons cups of your fellow residents during your lesson…. it's the small things but big reasons why I watch you my fellow Canadian!

  15. Since I started watching your videos I never even think to complain about any sort of waiting time especially in emergency because now I see what's going on behind the scenes, it's easy to get caught up in your own problems especially when you're hurting but it hasn't seemed to matter I always try to be as gracious as possible to the healthcare workers around me because they're put under a lot of stress and extremely long hours and their streamly knowledgeable and educated citizens just trying to do their job as best they can in a country where we offer free healthcare and therefore have very high volumes

  16. I love your videos and they're so educational but I always catch myself absolutely wincing while watching them the medical world really makes me squeamish but I suffer through it when it comes to you because you make it a lot more manageable

  17. I'm so happy that you're going into rheumatology. I suffer from fibromyalgia, and most of the videos about it are made by total quacks or from unrelated departments. I'm sure you'll probably make a video about fibromyalgia one day as you learn more and more. It'll be nice to hear some real facts from an actual doctor who specialises in the illness. And not only fibromyalgia, but all the other invisible illnesses.

  18. Would have been cool if you mentioned the respiratory therapists. How they're the ones who actually put the bipap machines on the patients then get ABGs to see how the patient is tolerating the treatment and titrate settings based on the ABG results.

  19. I love you! About a year ago I contacted you and you were so precious and answered my e-mail. I do have a question, at the time I had a Bilateral pulmonary embolism. I was put on the blood thinner Xarelto. Every thing seemed to be getting better, until about three weeks ago, when I began to notice a hot pain in my left leg. I went to my dr and she sent me to the Hospital. I had another DVT, they immediately said the Xarelto was not doing what I needed, and immediately was put on a Heparin IV and Warfarin. After a few days they discharged me, even though I complained that my right leg was hurting more than the left which had the DVT. It just so happened I had to go to another ER Stat as my hematologist thought the DVT had broken apart and was traveling. It was confirmed I also had another DVT on the right leg. All of this is actually caused by the Hughes Syndrome. My question is this. If Xarelto did not stop more clots from forming how can I be certain that Warfarin will? Also what causes the shortness of breath that I frequently get, just by walking from one room to another? Could that be scar damage from the PE?

  20. Can you use CPAP to the patient with COPD? And are there any specific criteria on whether using CPAP or BiPAP? Like for example according to the remaining functionality of the lungs? Also isn’t O2 somewhat toxic in a patient with COPD and hypercarbia?

  21. I had a few questions. During your first few years as a resident what was the name of your specific job you had in the hospital, what were some of the specific things you did to help patients on a daily basis,and what part of the hospital did you work in most often? Thanks. Love your videos btw❤️

  22. Good to hear those familiar diseases specially COPD. I’m in my 2nd year in RT (respiratory therapist) program. We are in charge of pulmonary function test and help those COPD patients and many more to breath better.

  23. Do doctors not feel kind of depressed or something when you get patients with serious conditions? I just get nervous sitting here and watching the video lol

  24. Hey there, I was so excited to see this video. Future respiratory therapist here! I just knew you were going to give a shout out to all of the respiratory therapist out there. However, still loved your video, your channel is one of the best. Keep up the great content!

  25. Please please through your career don’t forget that even though you are told to look for the horse (most are) don’t forget there are some of us Zebras! Also please don’t get jaded and tell people like us it’s all in your head just because you don’t blatantly see something ❤️🥰

  26. Can my grandson interview you for his career interview. He is in grade 6 so it is a short interview. Would need to to it this week by Wednesday. If he put all his questions on here, would you be able to answer them?

  27. I appreciate doctors and nurses even more after your videos. You also inspirer me to become a better and stronger worker. I love seeing you succeed, working hard for your dream with a smile on your face! 💙

  28. Hello just started watching recently i was wondering have u done a video on immunology and algeric reactions i find it interesting

  29. I have been in the ICU for 14 months. I have appendicitis, dance and a baby in my stomach! I have been intubated multiple time and I am curly on life support. I have also been the one to have a code blue. I have had heart surgery to, during my 14 months. I have had many other surgeries too, during this time. One of the surgeries has been to remove my appendix, which is when it burst. So now I also have blood poising. I have cancer, and can not get the treatment I need as I am pregnant. I am on many medications and I have many, many tubes in me. Most of the medications I am on I am allergic to, but I have to be on them or I will die.

    One like will wish me and my baby to get out of the ICU quickly!

  30. If you do another video in your Respirology rotation, it would be cool to see how important respiratory therapists are to managing patients with pulmonary issues. Im a respiratory therapist so PFT's, ABG's, helping people to stop smoking and putting on Bipaps is what we do (among many other things).Thanks for your videos they are great.

  31. i been here since you wasa 1st year now look at you 3rd year well done on getting what you wanted 🙂 so happy for you

  32. Love coming to work with you, learning every day. Also Your voice is relaxing, so its amazing after a stressful shift. (am an air traffic controller)

  33. I'm 28 years old diagnosed with Parkinson's disease I'm in stage 3 of Parkinson's along with having vertigo diverticulitis and Claudia's 9 months ago I was 274 lb and now I'm 233 thank you for doing your videos I enjoy them

  34. And our temps in Manitoba keep going up and down! We were -18 then +6 now -6. Every time I get used to the cold it warms up. (Very weird for us)

  35. Do you get paid for residency and what you are doing or no? I know in the states it’s a low amount when you are in residency

  36. As a future SLP it's soo interesting hearing about the lungs since it relates to much of what I hope to do! Still so happy for you Siobhan!! 😀

  37. These are so helpful im doing a gcse science and I'm really bad at biology i need this this is so entertaining and educational thank you!

  38. I am a registered nurse who just started working in an medical ICU and before this I had zero hospital experience (I worked in a skilled nursing facility after I graduated). I found your videos very helpful in helping me getting familiar with all those procedure I need to help doctors to do as a nurse. Your thinking process and explanation also help me to work with doctors better in the future. Thank you so much!

  39. Siobhan, I really need advice when it comes to becoming faint and passing out when it comes to seeing certain medical things! I'm a high school senior and I'm in a program called New Visions where I spend some days rotating (shadowing really) around our hospital. During my last rehab rotation, we visited an AKA patient in the ICU to get him moving, but on my way out to the bathroom, I felt extremely hot and apparently passed out (which gave me a concussion on my way down 🙁 they think it was caused by stress and hormones. Then just today, I was on my dialysis rotation watching a line get put in and I felt extremely lightheaded, hot, and my vision was extremely blurry, but luckily I sat down before I passed out. It wasn't the needle being put in, it was watching the blood taken into the machine that got me. Please give me tips on how to avoid this! I always eat breakfast, but my blood pressure and heart rate are usually on the low side because I run. It's so embarrassing having the nurses, patients, and my classmates see or hear about it, and I have a rotation in the OR coming up which is terrifying if I don't get myself together. I really hope you see this, and btw your videos always help me through my other rotations to get some background knowledge so thank you for everything you do!

  40. Hey I have a question so long story short I have allergies to cockroaches and mold and I’ll start itching and my hands will turn purple also my hands aren’t really hot or really cold idk why can you please help me? Ily videos! ❤️

  41. First snowy day? I don't even remember when the last snowy day was here. Maybe a few years ago? Anyway, how can anyone be so happy and so positive all the damn time?

  42. Can you please make a video about how you applied for a medical resident and the process? You inspired me to want to become a doctor, can you please explain your experience? ❤💕

  43. This is so cool! Im studying medicine as well, (Naturopathic medicine) and we’re currently learning about dyspnea/ lung pathologies and diseases in our clinical medicine course. It’s so cool seeing this in applied residency! You’re making studies for exams and clinic rotations much more fun and interesting, thank you!! 🙂

  44. As a nursing student I love these videos so much and love that I can understand what youre talking about 🙂 thank you for such great content!!!!

  45. You’re a pure inspiration Dr Siobhan. Never failed to miss a single video from you. Can’t wait to see you advance in this field in July!

  46. Hey love your videos but I was hoping I can suggest a video. There was this video going around a few years ago it was guy drank 20 red bull and vodka and it looked like his heart was going to pop out was wondering if you could do one of your case deep dives on it

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