Translator: Tanya Cushman Reviewer: Peter van de Ven
So I'd like you to pick a dream about some place you'd like to go,
someplace calm and relaxing like a beautiful beach.
Now imagine yourself lying there on the soft sand,
listening to the sound of the ocean
as you slowly drift off to sleep.
I will stay with while you're sleeping,
and when you wake up, you will be in the recovery room.
These are the words I'd say to my patients
as I was putting them under general anesthesia -
I'm an anesthesiologist.
This is a fascinating field of medicine.
We carefully select a mixture of medications
to put our patients into a reversible coma,
allowing them to tolerate the trauma of surgery.
This is an amazing state.
You do not feel,
you cannot move,
you will not remember,
but you're not afraid,
because the whole time, your anesthesiologist is with you,
breathing for you and controlling your vital signs.
When surgery is done, we reverse the medications
and prepare you to take control of your own body.
When I was a young girl dreaming about becoming a doctor,
I didn't even know what an anesthesiologist was.
I knew doctors cared for patients and relieved pain and suffering,
and I wanted to do that too.
As my dreams crystallized into a plan to go to medical school,
I knew this was right for me.
I loved science, I cared for patients and I wanted to be of service,
and I thought service meant
bringing health care to the poor and healing the wounded.
Service is all that,
but in medical school I learned that service is so much more:
everyone in healthcare serves.
When I completed medical school, I decided to become an anesthesiologist.
In this specialty, we care for and serve everyone, rich and poor.
We bring critical care to the wounded and pain relief to the suffering,
and during these moments,
we build precious relationships of trust with our patients -
all the aspects of service I'd dreamed of as a young student.
Now, as an anesthesiologist, I know there are many ways to serve,
and I'm going to share with you two stories about wonderful ways to serve
that emerged from everyday ideas in my specialty.
(Video) Hi, this is Doctor Oriol.
I'm in OR Room 2.
I have an emergency and need some help.
My patient is a 65-year-old man
who was undergoing exploratory surgery for severe abdominal pain.
He suddenly dropped his pressure, and his heart rate went very high.
We've stabilized him with medications and fluids,
but we don't know the cause yet.
The possibilities are he might be bleeding deep in the incision,
it might be a problem with his heart, or it could be an allergic reaction.
I've examined him - no signs of allergy,
so I want you to send over 4 units of blood, in case it is bleeding,
and also ask the cardiac anesthesia team to come ultrasound his heart.
I will let the ICU team know
when I'm ready to bring him up as soon as surgery is over.
Thanks.
(Video ends)
Where am I? What am I doing?
I am in a simulation center,
practicing how to manage medical emergencies,
but I'm practicing on a mannequin, not a real patient.
These mannequins are amazing:
they're controlled by a computer
and can be programmed to have any sort of medical problems.
My job was to figure out what is wrong and what to do about it.
Airline pilots, like anesthesiologists, must be prepared for the unexpected,
and that takes practice.
So flight simulators were invented
to allow pilots to practice without putting passengers at risk.
For the same reason,
mannequin human simulators were invented
to allow us to practice without putting patients at risk.
These mannequins are an amazing teaching tool.
The problems feel real,
and taking care of them
has all the heart-pounding action of real emergencies.
And taking care of real emergencies
is actually a value for all of us, not just healthcare providers.
What would you do if the person sitting next to you suddenly collapsed?
What would you do if a friend visiting complained of difficulty breathing?
Yes, you would call for help.
But what would you do while you wait for help to arrive?
Would you wonder what's going on?
Would you worry, What should I do?
Medical emergencies grab our attention and make us think.
And thinking about emergencies also fascinates young people.
So to motivate young people to learn science,
my colleagues and partners and I created a curriculum
that uses mannequin simulation to bring science to life.
We immerse our young students in real medical emergencies
where they take care of simulated patients,
and in doing so,
learn the science behind diseases
like asthma, infectious diseases, allergies, diabetes and more.
They also learn how to work in teams,
think logically and critically
and analyze complex situations.
This curriculum is called HMS MEDscience.
It's offered in six high schools.
It is a semester-long, credit-bearing course
that includes daily lessons in biology
and weekly visits to a simulation center where they put that knowledge to use.
Our students tell us it changes the way they think
and gives them self-confidence.
One student told us
that when her grandmother complained of feeling poorly,
she asked her probing questions as she'd learned to do in class,
and she figured it might be a stroke, so she called 9-1-1,
and she was right.
This student told us that before our course,
she never would have tried to figure out what was wrong
nor have the nerve to act on her own intuition.
Another student told us, and she said,
"The moment I realized I was remembering without studying,
I knew it wasn't because I had become smarter,
but because I was doing something I loved."
My second story.
After becoming an anesthesiologist,
I further specialized in obstetric anesthesia.
In this specialty, we care for patients
at the moments of greatest joys or fears or tragedies of childbirth,
and it was during one of those near tragedies
that my second story of service was born.
(Video) Hi, this is Doctor Oriol, and I'm calling from Labor & Delivery.
I am ready to give report and transfer my patient to the ICU.
My patient, Mrs. Jones, is a 30-year-old, previously healthy woman
who just had an emergency cesarean section.
She was 34 weeks pregnant, was found at home unconscious
and brought in by ambulance.
When she arrived here, the fetal heartrate was low,
and she was rushed to the operating room for an emergency cesarean.
As I put her to sleep, I noticed her blood pressure was very high,
so working diagnosis is a seizure due to pregnancy-induced hypertension.
The baby is alive but in critical condition,
and we're ready to transfer mom to the adult intensive care.
Thanks.
(Video ends)
I first met my patient
as she was being rushed down the hallway for an emergency cesarean section.
She was unconscious, the baby was in acute distress,
and I was to be her anesthesiologist.
As we crashed her into the operating room,
pretty much the only thing I knew about her were her vital signs.
Her surgeon was fast and skilled; both mother and baby survived.
But they did spend time in the intensive care unit.
A few days later, when my patient had regained consciousness,
I went to ask her what had happened.
So it seems she was from a poor family,
but she had health insurance and she had prenatal care.
But she told me that when she started having headaches -
which can be a bad sign for pregnant women -
she didn't feel that she should bother her doctor with something so trivial;
she did not want to appear stupid.
A few days later, I was listening to a report on infant mortality,
and it seems that in the poor communities of Boston,
like where my patient was from,
the infant mortality rate is as bad as many developing countries.
But infant mortality in the wealthy suburbs was as good as it gets.
And the solutions being discussed
had to do with health insurance and prenatal care.
I knew it was more than that.
I knew it was knowledge, self-confidence
and the feeling that you were worthy of care.
My patient's story made me want to go to the street
and bring knowledge and concrete proof of caring
to the women at risk for such tragedies.
To do so, I partnered with a medical student,
and we went into the community to find women who, like my patient,
did not feel they were entitled to care.
What we found was, the issues were not just infant mortality
but all the diseases of poverty.
So we partnered with the community health centers and community colleagues
and created the Family Van.
The Family Van is a mobile clinic that travels the streets of Boston,
delivering health education and prevention services
to anyone who asks, women and men.
Now, I've been asked,
Why, as an anesthesiologist,
did I dream up a program based on street-based care?
That's pretty simple.
As an anesthesiologist, we know our patients are afraid;
however, if we have a chance to meet them in advance,
to answer their questions, to listen to their stories
and help explain what's going to happen,
they're less fearful.
This is called a preoperative visit,
and when it comes to allaying fear,
a good preoperative visit is the best medicine there is.
This is the idea behind the Family Van.
When people get on the van, seeking services,
we listen to their stories, answer their questions
and demystify the healthcare system.
We've been doing this for 20 years
and have served over 80,000 patients.
And people often wonder why,
with so many great neighborhood health centers in Boston,
people come to the mobile clinic.
So in their own words,
when asked, "Why do you come to the van?
How does it make you feel?"
this is what our patients say:
[Comfortable, Good, Motivated ...]
And we are not alone.
There's 2,000 other mobile clinics across the country,
each delivering care into their community
and making their patients feel welcomed, relaxed,
motivated, empowered and unafraid.
So why do I tell you these two stories?
I believe service comes from the way you live your life.
Learn from everything you do and then share that knowledge broadly.
Dream up great ideas,
find great partners
and then make your dreams real.
Our anesthesiologist simulator
was turned into an educational program that motivates and inspires young people.
Our anesthesiologist pre-op visit was turned into a mobile clinic
that actually delivers hope and overcomes fear.
The paths to service are everywhere.
Ben Hei Hei said,
"Effort is its own reward.
We are here to do.
And through doing to learn;
and through learning to know;
and through knowing to experience wonder;
and through wonder to attain wisdom;
and through wisdom to find simplicity;
and through simplicity to give attention;
and through attention to see what needs to be done."
Thank you.
(Applause)