HouseCallVOLUME V ISSUE 2

HouseCallVOLUME VI ISSUE 260

YEARS | 1954 - 2014CELEBRAT ING

Carpe NoctemHOUSECALL FOLLOWS

ST. CLAIR HOSPITAL'S

BOARD-CERTIFIED

INTENSIVIST

YVONNE R. CHAN, M.D.

AS SHE AND A TEAM OF

FELLOW CLINICIANS CARE

FOR PATIENTS ON THE

EVENING/OVERNIGHT SHIFT.

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

managemenT

happening 24/7

aT sT. clair.

YVONNE R. CHAN, M.D.INTENSIVIST AND HOSPITALIST

AROunD-THE-CLOCK CARE

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

4 I HouseCall I Volume VI Issue 2

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

healthcare centers.

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.

6 I HouseCall I Volume VI Issue 2

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