So I started working with liver transplants at the start of November 2018. Before that I had six weeks of orientation with all of the different organ groups. And I work with liver transplants, with their inpatient service for two weeks. Every two weeks. So every other two weeks I’m doing night and weekend calls.
My Orientation to the Transplant Service
So I started off and I spent a week with each organ group. So I did kidney firsts. And I really spent a lot of time just trying to figure out how each service works and just the logistics behind it because you’d be surprised that’s one of the most difficult things to figure out just how they do their medicine. But then, there’s also the medical side of things that you need to figure out for every group. And from kidney I went to lung transplant and that UHN lung transplant team is one of the world leaders. So that was pretty special to be a part of and see kind of the transformation that they are able to achieve with lung transplant. And then a heart transplant after, there’s not as many heart transplant patients, but it was still very, very interesting. And I worked with some very, very smart people and then also liver transplant.
I spent a lot of time with liver transplant just because that was going to be the team that I was going to be with. And I mean I learned a lot in that in that orientation week, but even to this day of learning, learning more, just not only about the medicine around it, but also the logistics and kind of how, how things kind of work in the realm of liver transplant.
A Typical Week in Transplant Medicine
So the way my schedule works is, it’s a four week rotation. Where I do two weeks with liver transplant and that’s working 10 to 6 and then I get the weekend off, but then I do the nights and weekend calls, where I do Monday, Tuesday from 7 to 7 and work at the weekend from 2 to midnight.
And then next Wednesday, Thursday, Friday 7 to 7, and then I restart the two weeks with liver. So to me, I actually really do appreciate the rotation because it kind of changes things up. And I see, for instance, when I am on call, I’ll get to see patients from all of the organ groups as well. That’s where some of the more exciting medicine comes. Code blues will happen. More kind of serious of events will happen at night and they always happen at night for some reason.
And then, but then getting back to the liver team, it’s nice to kind of be part of a team working. We have three nurse practitioners on our team that have been super helpful with me kind of entering the team. And then we have fellows and then our staff position every week.
A Typical Day in Transplant Medicine
The liver transplant team gets to the hospital at around 7:00 AM and they do their round on all the patients. At 7, they finish their rounds by the time I get their pen and we meet as a team and they basically give a quick run through as to what happened over night, if there were any changes.
And from there as a team, we essentially map out our day what we need to do for our patients. From there we round on our patients at night, so I typically will have 8 to 10 inpatient liver transplant patients on mine roster, not all I’ll manage and then we’ll meet back up at 3. And then at 3 we’ll do our whole team round again. And then from there we’ll just kind of clean up anything we need to do before I go home at 10 or before I go home at 6.
My Overnight Shifts 7pm to 7 am
So I get there, I’ll get there a bit early and kind of just review the patients that we have in the acute care units because those are the patients that are typically going to be more active over night. They’re on continuous monitoring and they, they are in the acute care unit because they do have a bit more of a concern with their stability. So I round on those patients first and just make sure I’m familiar with them. In case anything does come up, and then I’ll kind of round on every floor. Right now we have about four floors that have patients on them. So I’ll just go check in with the nurses, make sure everything is all right, and then at this time I’m carrying a pager, so by then, the pager is going off – managing blood sugars, Managing high blood pressure’s low blood pressures, ordering different medications, going to assess patients. It’s every, every shift. It’s always something new. So it’s always kind of exciting and it keeps you on your toes.
Consults to the Transplant Service
So we’ll do consults, for instance if there’s say, can you transplant patient that’s all of a sudden, kind of needs assessment for liver transplant. We’ll kind of do consults in that regard as well as if any, any transplant patient comes to the emergency at TGH, they’ll give us a call, we’ll completely assessed them in emergency. So at nights, typically the fellow will be down in emergency taking the new consults. But if I’m having the quiet night though, generally send me a message and asked me to get down there to give him some help. Cause typically we have a lot of patients coming in through the ER. But we don’t, I don’t really work in the note patient setting. No. Mainly inpatient stuff.
What I enjoy about transplant medicine
Well for me the most amazing thing is really the transformation that you see in these patients, specifically in liver transplant. And we have these patients that will come into hospital and they really don’t look that great.
“They’re bleeding, they’re swollen they are jaudiced, their stomach is distended and if we’re able to get them a liver transplant, all of these things change and they all of a sudden you get to see this amazing transformation. So it’s pretty amazing to witness this change and also help facilitate it.”
That’s what been one of the greatest things about being in transplants and then also to work at UHN and seeing all of the work they’re doing and all the research that they’re coming out with, I’m very fortunate for that.
Challenges in Transplant Medicine
Well, these patients are quite complex. So I think for me, just as a recent graduate and just starting out, with the job, the biggest challenge I’ve had is really making sure I’m a pro, I’m managing the patient as a whole. So I’m making sure I’m not missing anything on patients and just being overly prudent, and if they’re really managing these complex patients. So really just developing a kind of step-wise approach to make sure I’m kind of covering all my bases for these patients has kind of been the challenge. But I think right now I’m starting to get a lot more comfortable and more confident
How I often I see the Patients and Physicians in Transplant Medicine
So I will see the physician at 10:00 AM, and I start with liver transplant that would be the staff physician. But typically the physician I work with most often is a fellow on the service and the fellow and I, we’re always in contact and whether it be like David did and they’ll contact me if we need to do a paracentesis and right now they’re kind of in the process of establishing a medical directives to just do Paracentesis and then other things. So with him in the relationship I’m able to spend a lot of time kind of working on my own, which is nice. Getting that autonomy, but then also working closely with the fellow physicians. They come from around the world. They have a lot to teach. So it’s been awesome.
Interacting with Nurses and the Allied Health Team on the Floor
So when I’m working with the liver transplant team, we do have the three nurse practitioners. So, we work together as a team. We all have our region rosters. They’ve been nothing but helpful for me, kind of showing me the ropes in liver transplant. On the floors the nurses will page me if they have any concerns about their patients and I can come in, assess them or if it’s just kind of nothing too big and I’ll just kind of give them a hand. And then for a lot of these patients, because these surgeries are so significant. I’m working with a physio therapy, occupational therapy, speech language pathology. Just to ensure that these patients are completely managed from all aspects of patient care.
Referring Patients to Transplant
So for individuals where their livers are looking like they’re not going to get better. Typically we’ll get the referrals and we do have the pre liver assessment clinic, where some staff physician and fellows will assess them. From there they can afford it or they can just be admitted to liver transplant as pre liver for assessment, and then afterwards, once they’ve been transplanted, anytime they come to Toronto General and they will be admitted with us regardless of what it is. So they can come for a heart related problem. But because we’re on liver transplant, they’ll stay with liver transplant and then cardiology will just follow them. So we see a lot, that’s why we see such a range of patients because some of these patients are so far out from their liver transplants. So you get to see a lot of different things.