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.