LRMC - Sean's job

After writing the Christmas letter I realized that there is just so much that I wanted to share and I didn’t.  We have tried to keep the blog about the travels, but I also realize that there is a lot more to our lives than traveling, despite my best efforts.

Last year we shared a little about the kid’s school, so this time I thought I would let you know a little more about Sean and I and the work that we are doing here at Landstuhl Regional Medical Center a.k.a LRMC.

Sean, as you know, is a critical care medicine doctor and that translates into he works in the ICU.  Most of the patients he cares for will never actually get to know him as they are on ventilators and extremely sick or injured.  When we first arrived the unit was very busy; however, in the past 6 months it has slowed down tremendously.  A very good thing for our soldiers down range.  The first year Sean was very blessed to have Dr. Silvey stay for an extra year to provide much appreciated mentoring.  Dr. Silvey had been here for 6 years and was able to provide the institutional memory plus hand over responsibilities more slowly than normally happens.  Most transitions are about 2 weeks leaving the new physician feeling very overwhelmed and under-equipped. 

This ICU is different from typical units – it is a Trauma service for 90% of the patients which means it is dominantly surgical cases and then 10% medicine – think pneumonia type stuff.  So, the team rounds with surgeons and medicine physicians and in many cases each patient has 3-4 physicians providing input to their care.  The biggest concern with units like this one is physician and nurse burnout.  With the decrease in patients and the number of physicians we have here the physicians are rarely on more than 7 days in a row with 2 nights of call.  Sometimes due to vacations or training the schedule can be up to 14 days, but that is very rare.  Last spring we were fortunate enough to have it be 7 days on in the unit and 14 days from the unit.  So, the first question that normally comes to mind is 14 days off, really?  No, not really.  Those 14 days are filled with military training and then administrative work to keep the hospital going. 

Sean serves on a number of committees and has taken on the role of education coordinator for the Trauma service; that means that when trainees are in the hospital he is responsible for their scheduling and educational activities and then providing feedback at the end of the rotation.  He is also responsible for scheduling all of the physicians, when they are on-call during their assigned weeks in the unit.   This fall he also took on the job of being the project manager for replacing all of the defibrillators in the hospital and clinics affiliated with LRMC that was more than 200 machines and lots of red tape!  Now, his administrative time will be filled with helping to update the notification systems for when there are different staffing needs.  With the military cutting back on soldiers downrange they will also be cutting back on staffing for LRMC making it so that physicians will be able to be on-call from home instead of in-house because they will be on-call more often. 

In January, Sean will head back to the states for 2 weeks to cover the ICU at Ft. Bragg – this will be an on for 6 days, off for 1 deal with coverage extending into the night.  Bragg does have a family practice residency so there will be a resident there to make the initial assessments and then they will call him for advice and guidance.  

When he returns he will start covering the hospitalist service at night to keep his skills up there, that is general medicine inpatient services, think kidney failure and other reasons people spend a few days in the hospital.  Then he will also start to train for special flight missions.  He is part of the lung team; that means he flies to pick-up a patient that is in respiratory distress and can’t fly without mechanical assistance.  2-3 physicians plus nurses and other trained professionals are all part of the team and they are normally gone for 24+hours.  Sometimes longer if that patient is not stable enough to fly, but never shorter – it just takes that long to fly.  Once he gets additional training he will be provide greater support for those soldiers.  There are a lot of very unique and special opportunities for his professional growth here and while we go for some extended times with him being at work, this has actually been the most relaxed schedule and work environment since before medical school.  It doesn’t hurt that when he is off, we can take off for something interesting or different.