Vascular Medicine

Although many of the projects the interns are working on this summer are related to heart health and disease, some of the interns are working on research related to vascular medicine, which offers comprehensive care to all the vasculature throughout the body, excluding the heart. Dr. Skeik gave us great insight into the world of vascular diseases this week by giving the interns an opportunity to shadow him in the wound clinic. Let’s hear from Meng Tong, who can tell us more about her experience learning about vascular medicine.

“I was super excited to visit the wound clinic. In my mind, it is an eventful place busy with purposeful activities. However, I was pretty surprised when I arrived at the wound clinic. It looked very homely! I don’t know why I imagined it to be a cold, stark white room filled with rooms full of moaning people. Too much sensational TV shows I guess. In any case, I really enjoyed the tour. Dr. Skeik showed us the three single-person hyperbaric chambers (monoplace) that the clinic has. I was pretty fascinated by how the chamber can be pressurized up to three times the atmospheric pressure and releases pure oxygen to the person in it. It is very useful too; hyperbaric oxygen therapy can be used for treating a variety of problems, ranging from decompression sickness (“the bends”), carbon monoxide poisoning, soft tissue and radiation injuries, and even bone infections. However, Dr. Skeik also told that the chambers have to be used with extreme caution, because it is a fire hazard. Flammables ignite very easily in such highly oxygenated environment. […] Of course, any medical equipment carries an inherent level of risk, and it is up to healthcare providers to use the service with caution and care.”

Dr. Skeik also happens to be a physician mentor for the intern program! This summer he is working with one of my fellow interns, Sarah Soo-Hoo. This week she had an incredible experience, but I’ll let her tell you the story!

This week I shadowed in H4200 with an incredibly kind RN of 23 years. […] This shadowing opportunity proved to be the most meaningful experience of this internship so far. One of the patients the nurse was responsible for was a middle aged gentleman who presented with antiphospholipid syndrome (APLS), a rare form of thrombophilia. This immediately grabbed my attention because I happened to be studying APLS as one of the variables for my project. Theresa gave a quite extensive background on him; he was an engineer and avid skier who had a loving wife and two kids. He had originally come in for surgery a number of days earlier, but was too sick to tolerate the procedure. In addition, his condition had just been deteriorating over the last couple of days. It was a surreal experience to walk into the room and see this fairly young man jaundiced and weak, having difficulty swallowing his food […] The following day, while I was meeting with Dr. Skeik, a nurse practioner walked into his office to give him background information on a patient he was asked to consult on. She began to describe a man who had originally come in for intolerable chest pain and surgery for his cholangitis. Later CT scans showed he had aneurysms in his renal arteries. His surgery was postponed too because his platelets were too low, and instead was given a cholecystectomy tube. I immediately began to think the patient who I had seen earlier. Next, she mentioned he had a history of PE’s, DVT’s, and APLS and portions of his liver and kidney were infarcted. That’s the moment I knew it in fact was him. It turns out that later in the day (after I shadowed), the patient went into TWO pulseless electrical activities (code blues). He had to be intubated, put on dialysis, have his right renal artery coiled, and hooked up to what appeared to be endless medications. After expressing my interest in the patient, Dr. Skeik let me accompany him and visit the patient. As a vascular doctor, he informed me all he could do was simply recommend potential underlying vascular diseases such as segmental arterial mediolysis or Ehlers-Danlos (a disease I happen to be writing a case report on).

It felt unreal to walk into the patient’s room. Just 30 hours earlier, this same gentleman was joking about how quiet and seemingly “useless” I was as I stood in the corner watchin the nurse perform all her duties. Now, he was comatose, hooked on a vent and had more IV’s coming out of him than I could count. […] There was a brief moment when everyone- the PA, the NP, Dr. Skeik, and me- stood in the room in silence. The slowly, rhythmic beeps of the heart monitor were the only signs of life in the patient. […] Dr. Skeik performed an evaluation for indications of vascular diseases. After agreeing with the PA that nothing could be done, Dr. Skeik signaled for me to leave the room and I briskly followed. He informed me that the patient was facing an endless amount of issues, making his journey to recovery incredibly slim. He told me, “He’s dying and there’s not much we can do about it.”

I felt my heart drop. Just the day before, the patient was deciding whether he wanted strawberry or blueberry pancakes for breakfast. Now, by the looks of it, his time was almost up. Even though I had no personal relationship with this patient, I remained frustrated for the remainder of the day. I realized I felt this way because I was completely helpless. A man was facing the brink of death and all I could do was watch him deteriorate. This particular experience simply fuels my desire and passion to become a physician in the future. I’m driven not by the scientific aspects of medicine, but by the personal aspects of medicine. Given the opportunity, I would have done anything to give the patient a second chance at life and help relieve his wife of those burdensome feelings. Being a physician will empower me with the skills and expertise required to help such patients in the future.”

I don’t know if there’s any way to explain how lucky we are to have the opportunity to experience health care in a holistic sense—other than to say that we are all extremely grateful! Stay tuned to hear about our field trip to Boston Scientific!