Medical mission volunteer & critical care research experience – Part 2

I backtrack a little bit before I continue from my Part 1: previous post….

Before I joined the research position in 2013, in December 2012 I went to India to volunteer my time with Amar Seva Sangam. The organization is located in Tamil Nadu, India and provides food, housing, education, physiotherapy and medical care to children and adults with disabilities. I was extremely happy to be involved on so many levels! I volunteered my time for several months teaching English, math, learning various methods of physiotherapy and also assisting the physician in providing medical care to the children, adults, and families from nearby villages!

In addition to this, I met some occupational therapy students from Quebec and we became extremely good friends! To this date, we continue to keep in touch! One of them even came to India to attend my wedding! ❤

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Gotta have coconut water when in the South!

All the kids seen above are probably all grown up now! It was an unforgettable experience that touched me so deeply. Once I am an independently practicing physician, I will go to India for a few months every year and volunteer my time serving under privileged communities.

Fast forward to Sept 2013….continuing from Part 1: previous post….

I traveled 170 km total to volunteer at the allergy clinic 5 days a week. This went on for several months and I was starting to become physically and financially drained. I came back after work and spent hours looking for research positions closer to my home. I sent out another hundred or so emails and finally…FINALLY, in March 2014 I received an unexpected response from the head of research at a hospital about a ten-minute drive away from home!

I met with the head of critical care Dr.W who told me that he was looking for a clinical research coordinator for his sepsis study as his previous study coordinator matched into family medicine at the University of British Columbia. In addition to this, Dr. W took me on a tour of the medical simulation lab in the hospital and asked me whether I was interested in volunteering as a medical simulation specialist! At this point, my eyeballs almost popped out of my head and I said YES! I had never worked with simulators before and it excited me!

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Let’s talk about the research study. It was called EUPHRATES: Evaluating the Use of Polymyxin B Hemoperfusion in a Randomized controlled trial of Adults Treated for Endotoxemia and Septic Shock. To explain it simply,  first, we found adult patients who were septic. (Septic patients are those who have an infection that had spread through their blood to the whole body to shut down major organs like the kidney, heart, brain etc.) If the infection was severe and the doctors were unable to control it with their initial ways of handling it (fluids, antibiotics, pressors to increase BP etc.) this study was an option. We were researching whether the antibiotic Polymyxin B would help these very sick patients.

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I would be in charge of roaming the CrCU floor, communicating with the critical care doctors and nurses to find and enroll severely septic patients into the research study. It was difficult because:

1) very few patients got that sick because the staff were so well trained at managing septic patients, so they got better even before I got to review their chart for the study

2) if I did find a patient they would have to fit into some pretty strict inclusion and exclusion criteria to be a part of the study

3) If they met ALL criteria then I would have an OMG moment and then a holy SH*T moment because now the clock starts ticking. I get 28 hours from the time they started their vasopressors to the first dose of antibiotic (abx)….so all of the following had to be done within this span of time! I had to review the pt’s information, calculate their MODS (multiple organ dysfunction syndrome) score, inform my PI (Dr. W) and give a heads up to the nephrologists (you will see why in point 4), track down the patient’s family members (because the patient is usually intubated and sedated because they are really sick), explain the study to the family,  they need time to think about it, read like a 50-page consent, get their signatures, draw the patient’s blood, test it myself in the lab for the level of endotoxin in their blood….if it was high enough then another holy SH*T moment happens because that means the patient can actually start receiving the abx.

4) I won’t go into too much of the nitty gritty details but the antibiotic is not an abx that we give by iv. I would need nephrologists for this because the abx is a cartridge that we stick into the dialysis machine. So a line has to be started on the patient to receive the abx via the dialysis machine…

Oh goodness gracious. It was difficult enrolling a patient for various reasons….I have to find the patient in time, the patient could have been admitted in the middle of the night and already started their vasopressors so many hours could have passed by, the family does not agree to the study because it sounded too dangerous, the endotoxin level in the blood was not high enough…and the list goes on 🙂

It definitely made my adrenaline pump on many occasions, but it FELT GOOD to be around physicians, nurses, critical care, in a hospital working on a really cool study!

I just didn’t like the amount of paper work that came with being a clinical research coordinator 😉

Will continue with part 3 next…

If you are interested in volunteering with Amar Seva Sangam: https://www.amarseva.org/get-involved/volunteer

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