St. Clair Hospital HouseCall Vol VI Issue 2
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HouseCallVOLUME V ISSUE 2
HouseCallVOLUME VI ISSUE 260
YEARS | 1954 - 2014CELEBRAT ING
Carpe NoctemHOUSECALL FOLLOWS
ST. CLAIR HOSPITAL'S
YVONNE R. CHAN, M.D.
AS SHE AND A TEAM OF
FELLOW CLINICIANS CARE
FOR PATIENTS ON THE
Minimally Invasive Parathyroid Surgery I The Heart Of A Hero I Ask The Doctor History Minute I Summer Swinginside
2 I HouseCall I Volume VI Issue 22 I HouseCall I Volume VI Issue 2
Yvonne R. Chan, M.D.
There is acTive healThcare
aT sT. clair.
YVONNE R. CHAN, M.D.INTENSIVIST AND HOSPITALIST
Meeting patients needsaround the clock
Volume VI Issue 2 I HouseCall I 3
F or most of us, working after midnight is exhausting justthinking about it, let alone actually doing it on a regularbasis. But for Dr. Chan, working when most everyone elseis asleep is something she learned and mastered back in the
early 1990s while she was an undergraduate majoring in biology
at the Massachusetts Institute of Technology (MIT) in Boston.
Do you remember the Robin Williams movie, Dead Poets
Society, in which he told his students, Carpe Diem, which is Latin
for Seize the day? asked Dr. Chan as she began her shift on a
recent weeknight this spring where the weather transitioned
quickly from sunny to gently falling snowflakes to bone cold at
nightfall. Well, when I was at MIT, the saying was Carpe Noctem,
Seize the night. We had a
t-shirt with this imprinted
in midnight blue on black
with the subtitle I do my
best work after 2 a.m.
Dr. Chan, who went
on to earn her medical
degree at Harvard Medical
School, says that she has
always been nocturnal and relishes the extra challenges and
responsibilities she has as one of the Hospitals Intensivists and
Hospitalists after the sun goes down.
EDITORS NOTE: THE HIGH QUALITY, COMPREHENSIVE, AND COMPASSIONATE CARE that St. Clair Hospitalis well known for doesnt stop when the sun starts to dip in the western sky and visitors kiss their hospitalized
loved ones good night before heading home to their own beds. The Lab continues to do blood work and other tests,
Medical Imaging continues to do X-rays and other scans, Emergency Room physicians and specially trained staff
continue to treat patients who have been whisked to St. Clair by ambulance or walked in under their own power,
pediatric hospitalists continue caring for their young patients, obstetricians continue to deliver babies in the Family
Birth Center, nurses continue monitoring and tending to their patients, Hospital pharmacists continue to fill life-
sustaining prescriptions, and Nutritional Services continues to prepare healthful meals for hungry patients. Just
as importantly, acutely ill patients throughout the Hospital continue to be cared for by experienced, highly trained
physicians. One of those elite physicians is Yvonne R. Chan, M.D., a Critical Care Intensivist and Hospitalist who
has been caring for patients during the evening/overnight shift since 2005.
HouseCall followed Dr. Chan who splits evening/overnight duties with fellow Critical Care Intensivist and Hospitalist
Maxim V. Bocharov, M.D. through a recent evening/overnight shift to see what she does in the proverbial still
of the night. Her shift started at approximately 5:30 p.m. on a Tuesday and concluded just after 7 a.m. Wednesday.
The following photo essay captures the spirit of one particular overnight shift as Dr. Chan and other clinicians
continued caring for patients while most of us were fast asleep.
Continued on page 4
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In search of:ICU Nurse Amy Carbonarasearches online for relativesof a critically ill patient.
The transition from day to evening/overnight shift:Yvonne R. Chan, M.D. is thoroughly briefed on each Intensive Care Unit (ICU) patient by Co-Director of Critical CareGregory Fino, M.D.
Critical care:She treats a patient
in the ICU.
On the move: The evening/overnight duties
are often fast paced forher and the clinical staff.
Sporting blue scrubs, black clogs, and a
white lab coat, the self-described nocturnist
bounds from one unit of the Hospital to the
next as she explains that it is important for
families of hospitalized patients to know that
their loved ones are well cared for during the
night. There is active healthcare manage-
ment happening 24/7 at St. Clair, she says,
adding it is a superior level of care usually
offered at only the countrys best academic
Drs. Chan and Bocharov are full-time
nocturnists, a rare breed of physicians who
work exclusive nights. Nocturnists are quickly
becoming high in demand as peer-reviewed
medical journals, including the New England
Journal of Medicine, say that night and week-
end coverage by attending physicians greatly
enhances patient care.
THE COMPREHENSIVE HANDOVEROF PATIENT CARE
The 40-year-old Boise, Idaho, natives
shift begins in the Hospitals Intensive Care
Unit where she is thoroughly briefed on
each patient by Co-Director of Critical Care
Gregory Fino, M.D., who, along with specially
trained critical care nurses, has been treating
patients there throughout the day.
Continued from page 3
T H E E V E N I N G B E G I N S
Volume VI Issue 2 I HouseCall I 5
Administering critical care:Dr. Chan places
a central line in a patient in the ICU.
A caring mom checks in:A quick call home to say good nightto her two young children.
Each patient in ICU needs to be individually
discussed because they are so critically ill,
explains Dr. Chan, as she examines a 38-year-
old man who was rushed to St. Clair after
being found unresponsive by his roommate.
The patients initial caregivers first suspected
bacterial meningitis, but tests soon ruled out
that potentially fatal disease in which a person
suffers from acute inflammation of the protective
membranes covering the brain and spinal cord.
His breathing assisted by a ventilator, the
unconscious patient is suffering multiple-
organ failure. Attempts to locate the patients
next-of-kin have proven unsuccessful so far,
as all phone calls have gone straight to voice-
mail. ICU nurse Amy Carbonara begins
researching various addresses on her desk-
top computer to try and find close relatives of
the patient to notify them about his condition.
ALWAYS CLOSELY MONITORING PATIENTS IN RECOVERY
In a flash, Dr. Chan is down the hall, then
the stairs, to the Cardiovascular Surgical Unit
(CVSU) on the Third Floor to check on patients
who had undergone open heart surgery
earlier that day. Like her patients in ICU, the
patients in CVSU are in need of very intensive,
individualized care following surgery.
Suiting up:In preparation forplacing a centralline, she creates asterile environment.
Staying nourished:Mindful of colleaguesneeds too, Dr. Chanorders in food for the ICU staff.
Continued on page 6
Cardiology conference:Cardiologist John Girod, D.O., who practices withSouth Hills Cardiology Associates, part of St. ClairMedical Services, confers with Dr. Chan about a90-year-old female patient who was transportedto the ER after suffering a heart attack and wasabout to undergo a cardiac catheterization.
Cardiac catheterization team:Left to right, Leah Pence, R.N., and Cardiovascular Technologists Nicole Antle and Rachel Zeh arrive in the ER to prepare a patient for a catheterization in the nearby Cath Lab, just after midnight.
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A CALL TO THE ER Dr. Chan also serves as the Hospitals admitting
physician throughout the evening/night, which
means frequent trips to the Emergency Room to
consult with ER physicians. Together, they will
decide which tests to run before patients are
assigned to a unit in the Hospital.
One of her trips to the ER this evening is to
examine a 39-year-old patient who attempted
suicide. Intubated to maintain an open airway,
he is later transported to the ICU.
There, Dr. Chan consults Micromedex, one
of the many medical knowledge databases the
Hospital provides to augment physicians practice,
to determine the toxicology of the medication he
had ingested in large quantities.
Around midnight, Dr. Chan is back in the ER,
conferring with Cardiologist John Girod, D.O.,
who was called in from home to perform a heart
catheterization on a 90-year-old female patient
who had suffered a heart attack and was rushed
to St. Clair. Dr. Girod is a member of St. Clairs
door-to-balloon team interventional cardiol-
ogists who respond to heart-related emergencies
throughout the night. Door-to-balloon refers to
the time between when a suspected heart attack
victim arrives in the ER and when a tiny balloon
is inflated in his or her heart artery to clear
blockages that led to the attack. Studies have
shown that shorter door-to-balloon time leads
to a better recovery. St. Clair cardiologists have
long had some of the best door-to-balloon times
in the country.
Quick change:ER physician Jason Biggs, M.D.,and Dr. Chan discuss a patienthe is tre