A Physician in Our CTICU Answers Questions About His Role at Children's Hospital
How Do You Like Your Job?
"I really enjoy what I do and know that the people that I work with feel the same. It is a special privilege to take care of other parents' children.
"Being a father myself, I do appreciate the stress and anxiety that comes with having a child admitted to the hospital, let alone the Intensive Care Unit (ICU), for any reason.
What is your daily routine on days you work?
I work in the Cardiothoracic ICU and I am an attending pediatric intensivist. In this particular ICU, we take are of children with heart defects that they were born with. We also take care of children that have received heart and lung transplants. It is mainly a surgical ICU, in that a vast majority of the children have undergone some kind of heart surgery.
We are responsible for the medical management of these children and I do not perform surgery. We take care of the children before and after the surgeries. The age range of the chilren range from newborn infants weighing as little as 4 pounds to "children" in their early 20s, weighing much more.
7:30 a.m.
We start our daily rounds at 7:30 am. Our "rounds" consist of visiting each child in the 15-bed ICU. It is a multidisciplinary group consisting of the:
- Bedside nurse
- Respiratory therapist (who manages the mechanical ventilator)
- ICU nurse practitioner
- Pharmacist (somtimes)
- ICU fellow (in subspecialty training to be an attending physician, like myself)
- Attending physician
During rounds, we discuss each patient and spend anywhere from 5-20 minutes discussing the child's medical issues and creating the medical plan for the day. We examine the child and talk with the parents, if they are at the bedside. The bedside rounds usually last until 10:30 - 11:30 am, depending on how critically ill the children are and how many children are in the ICU at that time. Our usual census ranges anywhere between 11 - 15 children at any one time.
Sometimes, I can see about 18 - 20 children per day because some children are transferred out of the ICU to the regular ward and new children arrive. The new children are usually admitted from the operating room after heart surgery.
The first 24-48 hours after the heart surgery is the most critical. We take care of about 3-4 new postoperative cases per day. It is one of the busier cardiothoracic ICUs in the country.
10:30 a.m.
Usually, around 10:30 am, the postoperative cases start returning from the operating room. We spend most of the afternoon stabilizing them and monitoring them closely. I circulate around the ICU making sure that all the children are stable. I touch base with the parents and see if they have any questions.
There are official family conferences led by the ICU social worker for some of the sicker children. We deal with life and death issues frequently. While only about 1-2% of children die in the cardiothoracic ICU, any loss is difficult for the ICU. We invest a lot of time and energy into caring for these fragile children and it can take its toll. We do have an ICU clergy person as well. He is invaluable, not only for the families, but also the staff. It is a very emotionally draining job sometimes. Our afternoon is very busy with patient care issues and there is always something happening. No one has ever been bored in our ICU.
5:00 p.m.
At around 5 pm, we usually make rounds again with the surgical team to update them on the status of the children's condition and they give additional ideas for plans of care.
7:00 p.m.
Usually around 7 pm, I start dictating my daily progress notes for all of the children in the ICU and work on finishing my paperwork for the day.
What Is Your Approach to Your Job?
I like the following statement:
As a physician, it is my duty to, "...cure sometimes, relieve often, and comfort always."
What is the best thing that has happened to you with your patients?
Well, I was carring for a 12-year old who had a bone marrow transplant for leukemia. She had a severe infection and her body had almost given up. I arrived at the hospital at about 8 am on a Thursday and didn't get home until 7 pm on Friday. I was practically at her bedside the whole time trying to keep her alive. I got a call just about 1 or 2 am on Saturday and was able to manage her condition on a two-way interactive robot that he have set up at the other hospital from home.
But, I was on the computer interacting with the staff through the robot from about 2 am to 8 am when the next attending came on to relieve me. Her heart was failing, her kidneys were failing, and she had no white blood cells to fight the infection that she had.
We got her through it and I saw her in the oncology clinic a couple months later. She walked in and it was like nothing happened. I was amazed...these are the things that keep us going...the victories and the saves.
What Amount of Schooling Do You Need to be Your Doctor?
- 5 years for undergraduate
- 1 year graduate program
- 4 years of medical school
- 3 years of pediatric residency training
- 3 years of pediatric critical care medicine training
Do You Have a Team?
ICU medicine is all about team. I am part of a physician group and we work together to cover the Intensive Care Units at the hospital. We watch out for each other and cover for each other when emergencies or important things come up.
Also, in the ICU our team consists of many individuals...nurses, respiratory therapists, nurse practitioners, social workers, clergy, pharmacists, child life specialists, physical therapists, and different types of physicians.
The care of children in the ICU is too complex for any one person to manage the care by themselves. The reason that I like ICU so much is because of the team environment.
An example is during a code ("code blue")...on TV they show chaos and yelling, but in an ICU with good teamwork it is actually very quiet and organized.
Everyone is focused on their particular job and while everyone may be anxious, you would never know it . . . it is like a well oiled machine with all of the parts working in complete harmony. The teamwork is really something special.
What is your favorite part of working at Children's Hospital Los Angeles?
The work environment, the teamwork, the complex care, the intellectual challenges, the patient and family care are but a few of the reasons that I like working at Children's Hospital Los Angeles. It is a great patient population to serve. Everyone is very appreciative of their care, regardless of the outcome.
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