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Endless Challenges: 48 Remarkable Hours with 8 Pittsburgh Doctors

Follow eight physicians over two days as they perform surgeries, consult on end-of-life care, treat accident victims, discuss hospital programs –– and then reset and do it all over again.



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PHOTOS BY MARTHA RIAL

    

 

Over two days in February, Pittsburgh Magazine embedded a team at four Pittsburgh-area hospitals to observe eight doctors at work. We saw early-morning operations, sat in on heavy afternoon conversations about end-of-life care and heard about late-night accidents. We were humbled that patients so freely opened their rooms and lives to us. They told us about their illnesses and recoveries. They permitted us to watch surgeries; we saw their pulsing brains through open skulls, their lung-cancer operations, their CAT scans.
 

   

In the midst of frigid temperatures and snow, the hospitals never stopped moving; one of our visits took place on Ash Wednesday, when nurses with dark, smudged crosses on their foreheads cared for patients who couldn’t breathe from the flu and surgical teams came together to excise lung tumors.

This is our record of 48 hours — and the countless moments of care patients receive by the hour, shift and day — at Allegheny General Hospital, Children’s Hospital of Pittsburgh of UPMC, Ohio Valley Hospital and UPMC Presbyterian.
 

Wednesday,
February 18

 

7:30AM Dr. Robert Kormos, Director of the Artificial Heart Program and Co-Director of the Heart Transplantation Program at UPMC Presbyterian in Oakland, starts his first surgery of the day. One of his patients had a small heart pump implanted about a year ago to help his weakened heart push blood to the rest of his body; now, the line that comes through the skin from the pump and connects to an external battery and controller repeatedly has become infected. Dr. Kormos and a team of plastic surgeons clean out the area and insert drains, staving off the need to change the heart pump itself.
 

8:13AM Members of the trauma team at Allegheny General Hospital in the North Side gather around an octagonal table in a room outside of the Intensive Care Unit to discuss their patients: new arrivals, who’s getting better, who’s getting worse, who’s leaving that day. Dr. Allan Philp, Trauma Program Medical Director for Allegheny Health Network, sips a bottle of pink Gatorade and leafs through the two-page list of patients. They have a full docket — car-crash victims, elderly patients recovering from falls and a few people who suffered injuries while committing crimes and will face prosecution when they’ve recovered. Considering that the team sees 3,200 trauma cases a year, it always has a full docket. “If we do our jobs well,” Dr. Philp says, “nothing exciting will happen.”
 

9:10AM On the seventh floor of Children’s Hospital of Pittsburgh of UPMC in Lawrenceville, Dr. Brian Feingold, the Medical Director of the Heart Failure and Transplant Program, is doing rounds with his residents; they visit the room of a child who, after two months in the hospital following a heart transplant, finally is starting to feel better. The boy also has regained his mischievousness — he grabs a syringe of water and sprays it onto Dr. Feingold’s shirt and pants.
 

9:15AM Back at AGH, Dr. Philp is doing rounds, including visiting with an older man who had fallen and a man who broke a few ribs and suffered a concussion while skiing. Dr. Philp’s pager buzzes; another man who took a fall is headed to the hospital via ambulance. As one of only three Level 1 — that is, equipped and prepared for any situation, and able to provide long-term and rehabilitative care after an injury — adult trauma centers in the region (the other two are UPMC Mercy and UPMC Presbyterian), AGH frequently is tapped to treat serious injuries — the results of bad car crashes and falls, shootings or assaults, industrial accidents. Philp has been at AGH since yesterday morning, cycling through patients. “It’s a little bit like NASCAR,” he says. “You spend your day just doing laps.”
 

9:40AM Dr. Rodney Landreneau, Division Director of General Thoracic Surgery at Allegheny General Hospital and Co-Director of the Esophageal and Lung Institute at Allegheny Health Network, is walking Dr. Mark Crye, his medical resident, through a diaphragmatic hernia surgery; both are in full medical gowns and masks. This procedure aims to treat a serious complication that occurs when the diaphragm pushes its way up into the esophagus, causing respiratory problems, acid reflux and abdominal pain. Using a minimally invasive laparoscopic technique, the pair is able to reach into the patient’s body cavity with tools, roughly the size of kitchen skewers, inserted through small ports. Using video cameras, they repair the hernia.
 

10:00AM Dr. Jean Tersak has been working since 6:30 a.m. — reviewing files and doing her own pre-rounds with patients — before she begins teaching rounds with her team at Children’s Hospital, where she is the Principal Investigator for the Children’s Oncology Group. Her medical residents recite the facts of a case, and Dr. Tersak gently asks questions, prodding them to make recommendations on treatment. They stop in the room of a preteen girl who has just been diagnosed with acute lymphoblastic leukemia, which will require more than two years of treatment. The girl is concerned about losing her hair and her ability to take part in physical activity during the course of the treatment. They agree to a plan to start chemotherapy later that day.
 

10:27AM Dr. Gary Sauer, a family doctor who in the past has served as the President of Ohio Valley Hospital’s Medical Staff, walks to the emergency room of the facility in Kennedy Township. A patient he’s known for 25 years has been admitted with gastrointestinal bleeding. The patient also is living with mesothelioma, a rare type of cancer which usually is incurable. In pain, he lies on his side, a thin blanket covering him. Two members of his family wait at the foot of his bed. Dr. Sauer puts his hand gently on the patient’s shoulder. “Hi, it’s Dr. Sauer. How are you doing today?” During a thorough exam, the doctor presses on the patient’s stomach and asks the man to squeeze his hand. He pulls back the blanket to see the patient’s pale, swollen feet. More friends arrive in the room to check on the man, and they are blunt: “What is your prognosis?” “I’m not being sarcastic,” Dr. Sauer replies gently. “But my crystal ball doesn’t work any better than yours.” They ask if they should call a priest; Dr. Sauer says yes. The patient has asked to discontinue additional transfusions, so Dr. Sauer orders only medications that help to make him comfortable. He walks out from the curtained room and behind the center pod of desks to dictate. At the end, he takes a minute to wipe his eyes — a rare occasion on which his calm, unflappable demeanor is shaken. Later, he shares his worry that this would be his patient’s terminal event. A short time later, that would prove to be the case.
 

10:30AM Dr. Robert Friedlander, Head of Neurological Surgery at UPMC and the University of Pittsburgh, meets with a middle-aged patient for a preoperative evaluation. She is scheduled to undergo surgery to treat an aneurysm tomorrow; the aneurysm was discovered after she came to the hospital complaining of a headache, which turned out to be unrelated. One of her brain’s blood vessels has a swollen bulge — akin to a bike tire with a spot that has thinned and swells out with air. Her aneurysm has developed in a very unusual place, nestled between the hemispheres of the brain. There is only a 1 to 3 percent chance of it rupturing in a given year, her doctors assess — but if it does, she has a 50 percent chance of dying. Dr. Friedlander plans to find the aneurysm in her brain and clip it with a tiny metal pincher, essentially making the blood vessel back into the stronger bike tire that it once was. The patient looks at the clips in his hands, and she asks if she can opt for the purple clips. He tells her yes.
 

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