Doctor-in-charge

Patient A, female, age 3 and recently diagnosed with Spinal Muscular Atrophy type 3a," Dr. Felix said. "She has no breathing problem at the moment, but developing severe signs and symptoms of her scoliosis has become the top priority."

"Dr. Felix Lee has worked for us for two years, " Dr. Cha whispered to Amy. "He studied in NYU Grossman School of Medicine and was at the top of his class" Amy leaned in a bit closer. "After graduating, he jumped from hospital to hospital to study and practice as a pediatric neurosurgeon. Two years ago, I was approached by a friend asking me if a position was open because apparently, Dr. Lee has been expressing interest in working here."

"Your two years his work senior, but you might be on the same age." Dr. Cha continued whispering. "He is outstanding."

"But wouldn't it be impractical to consider a surgery for a client who, pardon my bluntness, has 3 or 4 years to live?" A doctor from the back corner voiced his opinion. "The patient has no breathing problem and has been responding to medications. Should we focus on palliative care instead?"

"I second Dr. Tan," another doctor from the other side of the auditorium spoke. "Not only is the surgery impractical; it can also cause surgery-related complications, such as infection."

Dr. Amy focused his gaze on the doctors. Her arms crossed over her chest, and her face was unreadable. Dr. Cha wiggled his chair as if anticipating a rough exchange among doctors.

"As the doctor-in-charge of the case, getting the client surgery to fix the debilitating effect of scoliosis is the best approach," Felix responded, stern and immovable. "It may cause surgery-related complications, yes, but the odds of her benefiting from the surgery is more than the statistics of surgery-related complications occurring. If you come to my office with a case study proving your point, I will gladly read it and take a second look at my approach." Dr. Felix Lee looked at both men with confidence.

"If so, shouldn't you be as doctor-in-charge, not put your patient at risk and focus on palliative care? SMA has no cure. Why be impractical and illogical?" The first Dr. spoke.

Felix opened his mouth as if to say something, then closed it to breathe. "If impracticality is your concern, I can assure you that the surgery is the most ideal approach," Felix said, his voice annoyed.

It went quiet for some time when Dr. Cha elbowed Amy, encouraging her to talk.

Amy stood up and said, "Dr. Lee, who's your assistant?"

"I'm working on the study alone as of the moment, Dr. Fitzgerald. I was hoping to find one after the finalized treatment plan."

Amy looked at the second doctor who spoke, "can you perhaps tell me examples of complications that can occur for clients having scoliosis?"

"Breathing problems, persistent pain if wearing and tearing of the bones are present, and spine and nerve damage," the doctor replied like a textbook.

"And you, Dr. Tan?" Amy addressed the first doctor. "Yes, Chief," he replied.

"What signs and symptoms should we, as health care professionals, watch out for in clients with SMA type 3a?"

"Deterioration of muscular strength, and muscle atrophy"

"How about breathing problems? Would there be no concern about that?" Amy's face is indiscernible.

"Breathing problems for clients with SMA type 3a are uncommon," Dr. Tan replied

"What would you think if a 3year old with SMA develops breathing problems?

"Then severe complications can occur since the body's respiratory muscles are weakened."

"Severe Aaahlications such as what?" Amy directed her gaze at the other doctor.

"Confusion, lethargy, impaired cognition, and atelectasis."

"Atelectasis, aaah!!!" Amy exclaimed, shaking her head. "The complete or partial collapse of a lung or a section of a lung," Amy said, describing the definition of atelectasis.

Amy then stopped and looked at all the doctors in the auditorium.

"So does that imply that for a client who is experiencing severe muscle weakness, one of our priorities would be preventing breathing such as atelectasis?" No one dared answer.

"What if that client is 3 years old, has severe spinal muscular atrophy, has no breathing problems but is experiencing severe progression of scoliosis? What would we prioritize? Dr. Tan? Anyone?" The crowd was silent.

"We should prioritize correction of scoliosis since it can result in lung disease with a multifactorial decrease in lung volumes; displacing the intrathoracic organs that impede the movement of ribs and affects the mechanics of the respiratory muscle." Dr. Felix Lee broke the silence as he spoke softly but confidently at the microphone.

"Bingo!" Amy was pleased. Boldly, Amy looked at the crowd and said, "Now, will Dr. Tan, present, Dr. Lee detailed research of palliative care specific to our client with SMA type 3a. And Dr…???" Amy paused, thinking if the other doctor had mentioned his name.

"Dr. Jeon," Dr. Cha whispered

"Dr. Jeon?" Amy looked at the other doctor. The doctor stiffened.

"Please present a detailed study of complications and preventative measures regarding spinal fusion to Dr. Lee as soon as possible."

"As the doctor in charge, I expect you to choose your partner and present to me the treatment plan of your patient," Dr. Amy directed at Dr. Felix Lee, who is now meeting Amy's gaze. "I want updates regarding this."

"Yes, Dr. Fitzgerald," said Felix Lee, astounded.

Amy sat back down while Dr. Cha stood up and spoke. "Like I always say, three brains are better than one brain," succeeding in making everyone chuckle. "I think that's all the time we have for now. As usual, other department heads are welcome to stay for the next case study. Everyone, go back to your stations" Dr. Cha dismissed everyone.

When Dr. Amy got up, Dr. Cha stood next to her and said, "I think you just made your colleagues' knee tremble" Dr. Cha laughed loudly.

"It was you who encouraged me to speak" Dr.Amy smiled and left the room.

"Dr. Fitzgerald," a voice called, making Amy look back. "Dr. Lee"

"Please call me Felix," he insisted.

"Dr. Felix," said Amy authoritatively.

"Thank you for helping me out there today" Felix scratched his head as if embarrassed by his lack of response during the heated conversation.

"I read your case study Dr. Felix, and it was well put. I think your care plan for this case was theoretically and practically well thought out."

"Thank you, Dr. Fitzgerald. I will update you from time to time. I hope you help me along the way."

"Of course" Amy smiled and excused herself.

Felix stood there frozen, never had he felt so stunned at a woman like Amy. She was astute, confident, and beautiful. Felix's ears turned red, his heart beating loud.

Back in her office, Amy was greeted by So Min, who gave her info about all the doctors she deliberately and meticulously sectioned per station. "3 and 4 should start their afternoon rounds in 15 minutes," she said.

Amy looked at her watch. It's 2:15pm. "I should return in less than an hour; please have the documents among newly admitted patients and their treatment ready. Also, I want the statistics of treatment given for the last 6 months in my department."

"Noted, Dr. Amy," So Min nodded. "Will that be all?"

"Yes. If I'm not back in an hour, please alert me. I need to finish reading the documents before the day ends".