Not THAT Kind of Catheter

As I mentioned in my last post, I was scheduled to start my preceptorship with the pediatric cardiologist this last week . Ideally, I am supposed to spend every Thursday working with her in the clinic. As it turns out, her schedule is somewhat variable from week to week, so there are going to be certain days where that just won't work. Last Thursday was one of those days--she wasn't working in clinic that afternoon, so I wasn't able to go in. To make up for it, she invited me in on Friday afternoon instead to observe her in the cath (catheterization) lab, which turned out to be a lot of fun. I'd seen some similar procedures in the past (while shadowing a cardiologist during college), but I felt like I learned/understood a lot more this time around. My preceptor seems very kind and easy to work with. She was also very willing to teach, and she tried to keep me informed about what she was doing.

The procedure was interesting: she was working with a really young patient who was born with a heart defect (called tetralogy of flow) that caused extreme hypoxia (not enough oxygen). The procedure was largely exploratory, making sure that the patient was ready for surgery, but the doctor did some intervention herself as well. I left after the procedure, which only took two and a half hours, so unfortunately I wasn't able to completely make up for missing Thursday.

For those wondering, cardiac catheterization (much different that the catheterization you're probably imagining) invovles the use of fluoroscopy, a technique that uses x-rays to get real-time images of internal structures (in this case, the heart and surrounding vessels). The doctors put tubes (catheters) up through arteries/veins and into the heart either for investigation or intervention (fixing defects). Radioactive dye can be injected for investigative purposes, yielding really cool looking images of the cardiac structures that show how well blood is flowing. On the other hand, I'm sure many of you, my avid readers, have heard of doctors placing a stent--this is an example of intervention. A stent is basically a metal tube used to expand a narrowed vessel. They can also use balloons to expand a narrowed vessel, which is what my preceptor did on Friday.

I was pretty disappointed when I first found out about my preceptor's schedule. It's rather unfortunate that I won't have a set schedule from week to week like I'm supposed to. On the other hand, it will allow me to observe the doctor in multiple avenues, such as in the clinic, on hospital rounds, during procedures, etc. So it isn't all bad, I suppose. Plus I really liked the doctor, so I'm very much looking forward to working with her.

It seems like this preceptorship is going to involve a lot more observing that actually contributing (although that is sort of the nature of the specialty preceptorship, as opposed to the primary care one). It will be interesting to see what working with her in clinic will be like. It's possible that I might get to contribute (actually see patients on my own, taking histories and vitals, etc.), which would be really exciting. At first I was pretty worried about seeing patients on my own so soon, but now I'm really looking forward to it. So now I'm a little disappointed that I didn't get assigned a primary care preceptorship for the first year. Then again, having it next year certainly has some advantages: I'll be much more knowledgeable and prepared as a second year. Hopefully I'll get to work with patients this year as well; that way I'd get the best of both worlds. I'll just have to wait until the 23rd (she's unavailable next week) to find out. And you'll be the first ones to hear!

Well...back to studying. GIE exam 1 on Monday. Eek!