Wednesday, August 30, 2006

Inside and Outside of the ICU



Inside the ICU cath lab at LRMC



I found these two articles while hunting around for links to put on my posts for Landstuhl. Funny thing how differently the 'official spin' looks from the inside of the the ICU. I've linked here a 'media' page from Landstuhl Regional Medical Center. The source is the media officer for LMRC and the military newspaper the Stars and Stripes. The two stories (8-17-06, 7-31-06 respectively), one about a visiting trauma doctor and the second about a 'doctor and wife team' at LRMC are the most interesting only because I met all of the people in the stories and it looks much different through an anti-war observers eyes. I had the good fortune to be married to a visiting doctor and being former military myself, I was seen as 'one of them', so to speak. I had access someone would normally not recieve on a tightly secured military facility. And I know what really happens in the LRMC ICU. Read the posts, then come back here and I'll tell you some secrets.

Visiting-Trauma-God-Story:

News from the United States Army, Europe & 7th Army

LANDSTUHL, Germany -- If contractors can come to Landstuhl Regional Medical Center and work, then why can’t civilian surgeons? Thanks largely in part to trauma guru Dr. Ernest Moore, they now can via the Distinguished Visiting Surgeon Program.

Dubbed by many as the “Godfather of Trauma”, the celebrated surgeon, researcher and teacher arrived recently at LRMC for a two-week volunteer session. On Monday, he lectured to a large group of docs and nurses on multiple organ failure, a leading killer of patients suffering from trauma.

“This man is the godfather of trauma,” said Sgt. Anil Shandil, a nurse in the LRMC Intensive Care Unit. “In the civilian world, you’d pay money to hear him speak. Why do you think I’m here? This was my day off.”
-read full story


Husband and Wife Doctor Team:

Husband, wife doctors at Landstuhl give troops their all
Surgeon, pulmonologist put patients' well-being before personal time together

LANDSTUHL, Germany — Apparently, Air Force Dr. (Lt. Col.) Warren Dorlac needs neither food nor rest to fuel his boundless energy and frenetic pace.

Dorlac glanced up while completing paperwork following an operation to amputate an Army specialist’s left arm.

“We gotta get lunch because I missed breakfast, lunch and dinner yesterday,” said the Landstuhl Regional Medical Center surgeon and chief of trauma services.

(...)

The married couple of 17 years spent a rare free moment together at lunch recently, munching down salads. Once or twice a week, they’ll have lunch together. Even then, their time together is usually interrupted by phone calls.

“Sometimes that’s the only times we see each other,” said Gina Dorlac. “This week has been a bad week. The night before last, he didn’t come home at all. Last night, he came home late and went to sleep...


Now on to my observations. The first story about Dr. Moore is fawning and differential and while he seems to be a 'nice guy' it was appparent to me that he loves the sound of his own voice. During rounds in the ICU, he talked and talked and talked. He did no hands-on or procedures. The ICU is really busy and it seems to me that no matter how important you are or how high you've risen in your field, that when it's busy and care is emergent, you pitch-in. Apparently there is a different 'ethic' for Dr. Moore. I have never understood the hierarchical nature of medicine. On another day, on my way up the hill to Landstuhl, about 1:30 in the afternoon, I saw Dr. Moore coming down the hill. We both stopped and chatted briefly. I asked, "Anyone new?". He responded, "Yep, always, 3 new guys". Have a nice day.

Walking up the hill to LRMC


What I don't understand is how he can come to Europe, with his family, on the government's dime and not 'work'. Has he paid his dues, earned a certain level of respect? No doubt he has, but is his mere 'presence'in the hospital enough to justify not getting 'his hands dirty' with the task of healing our devasted soldiers?
Others may disagree with me but I think he should pitch-in. Just my opinion.

Now the Drs. Dorlac, is another story entirely. I spent time with Dr. Gina Dorlac who runs the ICU at Landstuhl. I met her husband only once but his dedication is also apparent. Gina is amazing, smart, hands-on, committed. I liked her very much. I watched her do absolutely dazzling work. During rounds, which is when patients status is described and updated for all the doctors on the unit, she gives lucid, clear, detailing of their condition, leaving nothing to 'interpretation' which greatly diminishes the possibility of medical mistakes. Doctors don't like to appear that they don't know, so the more detailed an intro to a patient is the less likely they are to make assumptions.

I observed Dr. D. do difficult procedures effortlessly. The patient was a 32 year old soldier with extensive burns, a broken foot and internal injuries. He was intubated and in distress, he was shivering from pain and cold alternately. I watched one doctor have a difficult time putting in a subclavian line (a catheter below the clavicle), unable to find the hidden vein several times. The succlavian is a difficult line to put in because the vein is not visible as it lies beneath the bone, not to mention this young man was moving around. Dr. D. came in and spoke soothingly to him, "Sweetie I know this hurts, just give me a second." She was able to get the line instantly. Her experience and compassionate bedside manner were inspiring to watch.

To watch the difference between these two medical professionals, Dr. Moore and Dr. Dorlac was an eye-opening experience. Dr. Moore is older, with more 'time' under his belt and while I do not doubt his expertise and professionalism, I do take him to task for not giving what I percieve to be his all. Dr. Dorlac was always available and was always working. Granted it is her ICU, and he was a visitor, but he was there to work. I think he saw himself as too important to get his hands dirty in the actual duty of caring for patients beyond intellectually.

This approach to me is what is mostly wrong with not only medicine but the general public at large. How many of us do 'all that we can' instead of 'what we can get away with'? I experience a high percentage of people in daily life willing to do only the 'bare minimum' at their jobs and even in their lives, to 'get by'. Viewed in the context of our country and its stature in the rest of the world, is it any wonder we are called "Ugly Americans" and are universally despised? People in the rest of the world think we are rude, lazy. greedy and stupid. And considering who runs the country, who can blame them?

2 comments:

lotus said...

Thanks for this, swim.

You know, I'm just about certain I've read about Gina Dorlac somewhere before (WaPo, NYT, LAT? I'm not sure, but one of the three). Between the older, more acclaimed Dr. Moore and her, I'd want Dr. Dorlac on my case every time. And you took us right there to watch her -- Brava!

(You know what I think you're also documenting here? The toxicity of the Y chromosome. My salute to the many carriers of it who don't exhibit its effects a la Ernest Moore.)

Leilani said...

Swimdeep, YOU'RE MARRIED?

Swim, really. The PR pages for these hospitals put a "positive spin," a bright shine if you will, on the day to day goings on (and nongoings on) at each hospital. One day you should visit the PR website for the infamous DGMC. It's about as accurate as McDonald's commercial depictions of their Mc-nasty heartcloggers. There are good doctors, bad doctors, and great doctors. None should rest on their laurels and none should forget that it's a person that is being administered to. Each patient comes with a different set of expectations and fears. One has to be fluid enough to adapt. And it's harder than you think.

There's always some jackass passing him/herself off as the lastest idol to worship. Walk quietly and carry a big scalpel I say. I'd rather be known as the slightly goofy yet skillful chick who treated her coworkers well, and not a world reknowned B**** on wheels. We'll see how it plays out in the end.