“On Call With RK.md” is a podcast dedicated to all aspects of medical training and practice. From admissions and clinical pearls to philosophies about medicine and team-based, patient-centered care, Dr. Rishi Kumar uses his experience as a board-certified cardiothoracic anesthesiologist and critical care physician to delve into the realities of life as an academic clinician.
Organ donation after the circulatory death (DCD) or clinical diagnosis of brain death is a highly coordinated process primarily driven by organ procurement organizations (OPOs). I’m fortunate to be involved with a streamlined process whereby organ donors from our hospital are cared for in a dedicated “donor specialty care unit” while finding potential recipient matches at hospitals all over the country.
Just inside this ICU is a commemoration that reads:
Here we stand… At the threshold of this new beginning. We bless the intention, vision, and labor of those who brought this space from mere possibility into solid reality.
May we honor and bless the patients and families Whose generous but broken hearts Have made the difficult decision In offering the most precious gift of all To those they’ve never met.
May those who serve here Be continually renewed in their spirit As they, too, give of themselves With wisdom and compassion. May their lives be bountiful with love and blessings.
Through all of these gifts The sacred speaks and smiles From behind those giving eyes. May we all be givers As we rise together in this new beginning.
I was pulled from my clinical duties as a cardiothoracic anesthesiologist to start my time as a critical care attending a bit early in light of COVID-19’s rampant spread throughout the greater Houston area. After completing my first week on service, I’ve come to realize how devastating this disease is from a medical and social standpoint. Families who have to be updated solely over the phone/video conference about their loved one dying from hypoxia and acidosis. Previously healthy patients succumbing to multisystem organ failure. Feeling like we just don’t know enough about COVID-19 or “good” therapies because… we don’t.
All isn’t bad though. I’ve seen many patients pull through. Many who have left the ICU are well on their way to returning to their loved ones — many who initially lost hope but slowly recovered. And many who continue to fight within the walls of the ICU.
The way multidisciplinary teams have come together during these times is truly remarkable. Nurses have assignments that have stretched them to the extreme. Respiratory therapists are constantly having to adjust ventilatory devices. Physical and occupational therapists continue to work tirelessly to make sure these patients stay conditioned and can perform their activities of daily living. It’s this team aspect of medicine that drew me to critical care initially, and this pandemic has only strengthened my love.
Episode 013 – Tips For Intern Physicians
Jun 15, 2020
With July right around the corner, I wanted to go over some tips for soon-to-be interns as they embark on their graduate medical education! Please check out the full post I wrote at the end of my intern year for more tips.
Episode 012 – Flexibility As An Attending In Academics
May 03, 2020
Of all characteristics, I think flexibility is perhaps the most desired attribute of an attending in academic medicine. Knowing how to balance trainee autonomy with protecting the patient, being a good educator, and providing timely feedback are all promoted by having a flexible approach to one’s practice.
Drop me a comment with your thoughts on this podcast!
Episode 011 – My First Six Months As An Attending
Apr 27, 2020
It’s been over six months since I’ve been an attending cardiothoracic anesthesiologist and intensivist! Listen to this episode where I discuss what I learned in that time as new faculty and things I did to be successful.
Special shout out to my wonderful colleagues who were not only accepting of me but have consistently provided opportunities and encouragement to spread my proverbial wings as I mature into my practice.
Episode 010 – How I Studied During Training
Feb 19, 2020
Throughout the course of my collegiate and medical training, the manner in which I’ve studied has evolved tremendously. In this podcast, I’ll share this process and outline how I study these days. Check out this post with book references too!
Learning is a highly individualized process, and as a result, study habits vary from person-to-person, the material at hand, and even around one’s work schedule. The last of these is important because in undergrad and even med school, students have so much more time dedicated to learning their trade and coursework. As a resident, balancing a full workload (60-80 hours per week) while ALSO attempting to study for in-training exams and boards can be a daunting task. Here are some study tips which have served me well over the course of my training.
QUALITY OVER QUANTITY
“How many hours do you study?” I never understood the point of this question. With all the distractions we have in the modern era, the sheer volume of “hours spent studying” probably has little to do with actual comprehension and retention.
I study in very short bursts (no greater than 30 minutes) with distractions between sessions, but I’m extremely focused when I read. It’s also why I have to take my exams very quickly, because I can’t sustain that degree of concentration for very long. Naturally, the overall time commitment ramps up just before exams and falls off immediately after an exam. And that’s okay. Just focus on how much material you were able to get through (and retain) rather than the number of hours.
SACRIFICE
“Burnout” is an incredibly important concept in healthcare training, but individuals have different thresholds where they cross the proverbial line. Know yourself and the circumstances surrounding your work schedule and personal life. Don’t feel guilty if you find yourself choosing sleep or recreation over studying from time to time.
That being said, sacrifices must be made to truly commit oneself to healthcare. I can’t tell you how many times I chose studying over celebrating special occasions, hanging with colleagues, vacation, etc. Fortunately, I’ve found studying with the goal of teaching to be a very zen-like experience which brings me a great deal of happiness. Find your motivation and resilience to stay afloat amidst a life of sacrifice. Learning will become a natural extension of your daily pursuits, and you’ll feel like studying is less of a chore and more of a hobby.
STANDARDIZED EXAMS – PRACTICE QUESTIONS
Programs are always looking for “well rounded” individuals, but standardized exams (USMLE, SAT, MCAT, etc.) are still way more important than applicants want to acknowledge. Think about it – they’re objective exams. For example, it doesn’t matter where you want to college, everyone takes more or less the same MCAT. In this sense, these exams are an (imperfect) assessment of one’s fund of knowledge and critical thinking which can be compared directly to other applicants. That’s just how our system works.
With that in mind, for each of these exams, find a single text to use as your primary book (i.e., First Aid for USMLE Step 1). Minimize the number of additional resources you use, annotate material from those sources into your primary book, and focus on doing thousands of practice questions.
ACTIVE ENGAGEMENT
In a world of podcasts and PowerPoint lectures, it’s very easy to rely on our auditory and visual senses to learn difficult concepts or volumes of information. I used to do this too. Sitting in the back of the lecture hall just flipping through slides as I half-heartedly retained the information… it was frustrating, ungratifying, and very routine.
Then I pursued more active engagement with the material. I put away the PowerPoint slides and wrote notes based on the lecture. Writing is a much more active process than listening (or typing, for that matter). By listening to the lecturer, I distill down the concepts into easy-to-understand phrases with the intention of sharing my notes and diagrams with others.
These days, I use an iPad Pro and Apple Pencil to actively annotate textbooks and journal articles with PDF Expert as well as doodling notes/diagrams with GoodNotes. This work flow has significantly improved my critical thinking, retention, and even spurred me to investigate these topics further. It also facilitates my interest to teach across social media.
In the end, learning how to learn is half the battle. Find something you like and stick with it! Also, drop me a comment below with any other tip(s) you recommend!
Episode 009 – Acute Mechanical Circulatory Support (MCS) Devices
Feb 05, 2020
Mechanical circulatory support (MCS) devices are becoming more prevalent and sophisticated with each passing year. In this episode, I’ll briefly cover some of the basics for intra-aortic balloon pumps (IABPs), Impella, CentriMag, ProtekDuo, TANDEMHEART, and ECMO. As always, drop me a comment with your questions and thoughts!
Episode 008 – Not Everyone Is Drug Seeking
Jan 20, 2020
Many healthcare workers become jaded by taking care of patients who regularly abuse drugs and seek more potent medications during their admissions (oftentimes saying they have an “allergy” to more traditional analgesics).
I’m not naive to this; however, as an anesthesiologist, I’m also very mindful of appropriate pain management in the OR and ICU settings. Every patient should be treated individually, and consideration must be given that we are undertreating pain based on the clinical situation, tolerance, drug metabolism, etc.
Drop me a comment with your thoughts and experiences below!
Episode 007 – Vasodilators And Venodilators
Jan 06, 2020
As a follow-up to episode 3 where I discussed inotropes and pressors I routinely use as a cardiothoracic anesthesiologist and intensivist, in this episode, I’ll discuss some of the anti-hypertensives I use in the same settings.
As always, drop me a comment below with questions!
Episode 006 – A Pair Of Pet Peeves In Patient Care
Dec 30, 2019
Working in both the ICU and OR settings, I’ve come to learn the workflow and considerations unique to each environment. However, with all the required tasks one must complete, I feel like patient care is sometimes jeopardized. Join me in this episode where I discuss two of my biggest pet peeves related to patient care.
Episode 005 – Dealing With Mistakes And Death In Healthcare
Dec 23, 2019
Despite all the positive aspects of working in healthcare, it doesn’t take long before one experiences mistakes and patient deaths. In this week’s podcast episode, I’ll delve into how I handle these two, independent situations by promoting a culture of forthcomingness, patient safety, honesty, and supporting (rather than scolding) each other.
Episode 004 – What Are Cardiopulmonary Bypass (CPB) And Cardioplegia?
Dec 16, 2019
As a cardiothoracic anesthesiologist, I have been trained extensively in cases which require cardiopulmonary bypass (“the heart-lung machine”). CPB is similar to VA-ECMO in many ways, but for the purposes of surgery, it allows the surgeons to have a motionless and bloodless field when combined with cardioplegic arrest. Listen to this week’s episode to learn […]
Episode 003 – Cardiovascular Pharmacology
Dec 09, 2019
Cardiovascular pharmacology in acute care settings involves a variety of medications ranging from vasopressors and inotropes to inodilators and inhaled pulmonary vasodilators. Listen in on this podcast as I discuss how I use agents like epinephrine, norepinephrine, vasopressin, milrinone, phenylephrine, calcium, methylene blue, and more in my practice. Keep in mind that I individualize everything […]
Episode 002 – Thank You, Surgical Techs!
Dec 02, 2019
Surgical scrub technicians (“scrub techs”) are incredibly important individuals in the course of an operation. They facilitate surgical workflow by providing instruments, positioning the patient, ensuring sterility, assisting with tissue retraction, etc. I remember when I first scrubbed in as a medical student on my ob/gyn core rotation, the entire operating room had drawn cross-hairs […]
After taking a hiatus for over a year from podcasting as a critical care fellow, I’m finished with my formal training and ready to hit the ground running as an attending physician with the rebirth of my podcast. Drop me a comment below with feedback!
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