November 4, 2024 • 26 mins
In this episode of “Covering Your Health,” host Evelyn Erives sits down with Dr. Valentina Amaral, a renowned critical care medicine specialist at St. Bernadine Medical Center and Community Hospital of San Bernardino. They discuss the inner workings of the Intensive Care Unit (ICU), exploring the vital role it plays in patient care.
Dr. Amaral shares her insights on the complexities of ICU care, the latest advancements in critical care medicine, and the emotional and psychological support provided to both patients and their families.
Whether you’re a healthcare professional, a patient, or simply curious about the inner workings of the ICU, this episode offers a comprehensive and compassionate look at one of the most critical areas of healthcare.
For more information on this show's topic visit IEHP.org or (800) 440-IEHP.
Reach out to Evelyn via Instagram @evelynerives or email her at EvelynErives@iHeartMedia.com
Dr. Amaral shares her insights on the complexities of ICU care, the latest advancements in critical care medicine, and the emotional and psychological support provided to both patients and their families.
Whether you’re a healthcare professional, a patient, or simply curious about the inner workings of the ICU, this episode offers a comprehensive and compassionate look at one of the most critical areas of healthcare.
For more information on this show's topic visit IEHP.org or (800) 440-IEHP.
Reach out to Evelyn via Instagram @evelynerives or email her at EvelynErives@iHeartMedia.com
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
Hi there, Welcome back to another episode of Covering Your
Health with Evely and Erieves, presented by i EhP Oh.
I'm so happy to be here with you. I'm a
little extra raspy today. I spent a couple of weeks
getting over a cold and know all kinds of things.
You know, this is a health podcast, so we figured
you'd be okay with a little bit of extra rasp
(00:21):
understanding that sometimes that's the process. It takes a little
extra time to get rid of that. So but I'm
so glad that you're here. As always, we're always looking
for topics that not only I find interesting, but we
hope that you will find interesting. And today I really
think you will. I think this is going to be
something special, especially because I don't think everybody has had
(00:46):
the experience of an ICU, the intensive care unit in
partnership with Dignity Health. We would love to welcome doctor
Valentina Emerald to the podcast to talk about that topic.
I icee you what to expect when receiving Karen and ICU,
what to expect from the ICU team, how family plays
(01:09):
a very very important role in the road to recovery
and really in the entire process. Doctor Emerl is a
critical care medicine specialist at Saint Bernardine Medical Center and
Community Hospital of San Bernardino, serving a diverse population of
people and their variety of needs. Most importantly, doctor Emerl
(01:29):
is a all about education, which is super cool and
is very eager to help us navigate the healthcare system
so that you and your loved ones get the best
care possible. I think you're going to enjoy this.
Speaker 2 (01:45):
Welcome to Covering your Health, a wellness podcast dedicated to
covering all areas of living a healthy and happy lifestyle,
from healthy hearts to understanding health plans and everything in between.
Each episode will provide you with a better understanding of
managing your health, preventative care, and staying on the right
path for your family's wellness journey. The Covering Your Health
(02:06):
podcast is presented by i EhP. Now your host Evelina Revez.
Speaker 1 (02:13):
I am so excited to have you here. Thank you
so much for joining us, Doctor Amile.
Speaker 3 (02:17):
How are you God, thank you for having me.
Speaker 1 (02:21):
Oh, thank you for being here. So let's get started. Obviously,
you are a doctor, you are prestigious in your career.
I want to know how that all started for you.
Was this something that was a lifelong passion, something that
you knew when you were a child you would be
a doctor one day? Or how did you find this path?
Speaker 3 (02:39):
Yeah? So it's it's kind of interesting because I knew
from way way early that I wanted to be a doctor,
even though I had no doctors in my family. I
just felt like, I like that and I need it
to go into that. I have a younger brother, she
was twelve years younger, and he would get hurt and
(03:02):
he would like defer to me and he would be like, no, mom,
you don't take care of me. It's my sister and
so and that brought.
Speaker 1 (03:11):
Me a lot of traol.
Speaker 3 (03:13):
So it started off with that, and then it obviously
grew into a love for science, a love for how
the human human body works. And then here we are.
Speaker 1 (03:26):
So that is so amazing. So it's like your brother
saw something in you even at a young age. What
is your age difference again.
Speaker 3 (03:33):
Or twelve years apart?
Speaker 1 (03:34):
Twelve years so that could be part of that, right
and our oldest in your family? Yes, yeah, oh yeah,
so that's so so cool. Now you're from Brazil, I understand, right, yes,
And what age did you come here to the United
States and find that this was going to be your
medical path here. I mean, did you start that there
(03:55):
or here?
Speaker 3 (03:57):
Yes? So I did my medical school there. I actice
there in emergency medicine for about five years prior to
coming here, and I came here in twenty fifteen to
do interi medicine residency in Baltimore. So I came here
pretty late. I was already practicing there.
Speaker 1 (04:19):
Wow, that's cool. I can't even hear your accent that. Hey,
you have a very strong American accent. It sounds like
you would never know that you actually spend so much
time there.
Speaker 3 (04:29):
Thank you.
Speaker 1 (04:30):
Yeah, I'm sure you work hard to do that. I mean,
I know that that's like a whole nother thing, But
that is so special. What did your family think about
you wanting to go on this path.
Speaker 3 (04:42):
It's I'm not sure. I thought they initially thought it
was crazy. It was like, really, do you really want
to study for that long and then go to the
US and then study more and so. But then they
realized there was a bit of a method to the madness,
and they they were on board with it. They're still there,
they still live in Brazil. It's just me and my
(05:03):
husband here.
Speaker 1 (05:04):
Yeah, amazing. I'm sure they're so proud of you now.
Speaker 3 (05:10):
They are.
Speaker 1 (05:11):
That's great, Okay, So let's talk about an ic you
the basics of an intensive care unit. What is an
ICU for those who have maybe only heard the acronym
and like have no idea what it actually is and
what type of care does an ic you provide?
Speaker 3 (05:29):
Right? So, and I see you as the name says,
intensive care unit. It's where the sickest patients in the
hospital go to. So if they require support for very
low blood pressure, if they require support for breathing, or
you know, if they have something like a cardiac or
(05:49):
rest things like that, they come to the ICU. So
it's basically the sickest patients. We have more nurses is
a sign. So each nurse has only two patients so
that they can pay a lot of attention and take,
you know, close care of that patient. And then we
(06:12):
are trained in basically resuscitation, So resuscitating the patient, making
sure that their blood pressure is okay, that their oxygen
levels are okay, and that you know that the initial
reason for them becoming that sick is addressed. In the ICU,
(06:35):
there's a lot of machines, and so we can do
dialysis in the ICU, we can do mechanical ventilation, which
is something that became very popular during COVID. Everyone was
talking about intubation and machines to help you breathe. The
ICU is the place where we do that.
Speaker 1 (06:53):
I see. So, now, what can someone expect if it's
like they get to the hospital, they find out they
are now going to be admitted into the ICU, what
are some of the first things that they can expect
to happen, right.
Speaker 3 (07:07):
So usually we go see them in the emergency department.
The first conversation we have obviously is what happened? What
brought you here? Or if the patient can't answer, we'll
talk to the family. But I think one of the
conversations we have that patients are usually kind of surprised
by is code status conversation. And everyone's like, what is
(07:31):
a code status? Right? So code status is something that
is determined when you come into the hospital for us
to know what the wishes of the patient are. So,
would you like to be resuscitated? Would you like to
have CPR meaning chess compressions meaning restart your heart if
it were to stop would you like to be intubated?
(07:51):
Would you like it breathing too, but machine to help
you breathe? And what are your goals in life? So
would you be okay with all these things to be
long term or would you be only okay if these
things were short term? And that is extremely important for
us because then we know where to go within the
(08:12):
care of that patient and how to honor their wishes,
their wishes not what we think needs to be done,
but what they would have want to do if they
were able to choose. And so that is one of
the first conversations we have when they walk in, even
when we don't expect any emergencies to happen, because we
don't know when an emergency is going to happen, and
(08:33):
it's never when we do right, it's never when we
plan for it. It's never, you know. And so we
have these conversations with all the patients that come in,
regardless of what they have, what age they are, or
so forth.
Speaker 1 (08:47):
Wow, okay, so you brought up family. Obviously, if a
patient is now in the ICU or is about to
be admitted into the ICU, and maybe they can't speak
for themselves, how important is the family role in that
type of situation.
Speaker 3 (09:04):
Oh, family is essential. So the family has so many
important roles in the ICU. One is to be by
the patient's side. So if you can imagine waking up
at a different place, a place where you don't know,
with a bunch of people you don't know in the bed,
(09:25):
not quite sure how you ended up there. That is terrified, right,
But if you see your family member's face right there
next to you, it makes it a lot better. It
makes it a lot more tolerable whatever you're going through.
So family, first of all, is really important to reassure
the patient, to you know, keep them calm and have
(09:48):
a familiar face in a very strange environment. And also
when the patient cannot speak, to talk for the patient
and tell us what the patient's value is are because
you know, there's a lot of things we can do
in medicine, a lot of gadgets, a lot of machines,
a lot of things, right, but I need to know
(10:10):
if that is in line with your goals and values
in life. And the only way for me to know
that for some patients that are unable to respond for
themselves is to talk to family and have a little
glimpse of what that person is when they're not unconscious.
Speaker 4 (10:26):
Right.
Speaker 1 (10:27):
Wow, Yeah, that sounds like a very that's a crucial role.
Then if you're a family member, and it sounds like
it plays a big part of the recovery process as well. Right.
Speaker 3 (10:36):
Absolutely. So you know, I always say we kind of
underestimate how much impact our mental health can have in
our physical recovery. Right. But we have all types of patients,
but the patients who are more depressed or more anxious,
(10:58):
they tend to take longer to recover. They tend to
not comply with, for instance, physical therapy, which is a
key part of recovery, right, and occupational therapy and speech therapy.
And you know, they need to buy into their treatment,
and the family is really important. That support is really
(11:20):
important to get them to buy into that.
Speaker 1 (11:23):
Yeah, Oh my goodness. We talk about communication a lot
on this podcast. A keyword that we talk about a
lot is the word advocacy and being an advocate for
yourself or for your health or for the family member
you're there with. Right, what if someone is hesitant to
talk in the ICU about important things, maybe not even
(11:48):
knowing what are the right questions to ask? Where should
they begin? Is there is there a process to begin that?
Speaker 3 (11:55):
Yeah? So things get really complicated in the IC, you, right,
So we try to update the families every day, and
the nurses also update the families every day. But you know,
an update might be a brief, you know, a couple
of lines, a little bit of information, and sometimes it
(12:18):
confuses the family more than helps. Right, So whenever I
go into the room, I tell the families, I'm like,
there is no such thing as a dumb question. So
you start with all your questions. You let me know
everything you want to clarify, and I will go over
things for you. The Internet is always helpful and unhelpful
(12:39):
at the same time. Right. You can imagine, right your
Google things and sometimes a really good thing pops up
and a really bad thing pops up. So don't be
afraid to talk about what your background is in your question.
So it's like, how are they gonna do? I read
online that things these things have really poor outcome, right,
(13:00):
so I can I know where you're coming from and
what your concern is and I can address that. Or
you know, I have a family member who had something
similar and I would like to know if this is
the same so I think transparency on both sides is
key for us to improve our communication and to get
(13:21):
the family to truly understand what's going on when we're
updating them.
Speaker 1 (13:27):
So I was thinking about like being in high school
and my teacher saying there are no dumb questions, but
then you still go, yeah, I feel like there are
dumb questions, you know, because you don't get that one
teacher who's like, well, that was a dumb question. So
I think in a hospital setting there really are no
dumb questions, right, you have to ask all of the things.
Speaker 3 (13:51):
Yeah. Absolutely, So I mean again, it took us on average,
right ten years to learn the trade of the trade.
It took us so much time to learn the things
that we're trying to implement, the treatments and all of that.
So I don't expect my patients to understand that. First off,
(14:13):
oh yeah, I get this. This is pretty quick and easy.
There is no such thing. Right. Also, we're well aware
that each person is a person, and we treat each
patient as an individual. And you know, some things might
make more sense for your loved ones than it would
(14:33):
make for the patient next door. And it's important for
the family to bring up all of their concerns because
maybe their concerns are something I haven't thought about, or
some background that they have because they know the patient
and I never thought because I don't know, I don't
know that habit or you know, or that they were
(14:53):
doing something, or that they ate something, or you know.
It's just hard because we weren't with them when it
all started, just seeing them after the fact. So in
the ICU, there's definitely no such thing as a dumb question.
Speaker 1 (15:08):
I love that. I do love that. Okay, then let
me ask this, how do you navigate negative energy? I
imagine in a very crucial time, when a patient is
going through a very hard time, it's very stressful for
everyone involved. How do you navigate maybe people being upset
(15:29):
or maybe not understanding the process fully the way it
has to go, and it feels too slow, you know
those kinds of things. How you handle that well?
Speaker 3 (15:38):
I mean, having sick patients, it's it's a given right.
The family's upset. The way I see this, they're not
upset at me. They have the right to be upset.
That situation is not a situation that anyone should be right,
and so I try not to personalize it. I like
(16:02):
make it about myself. I try to make it about
the patient. And usually when families are really really upset
and and you know, sometimes things get a little bit heated,
and I always try to bring it back to the patient.
So we're all here for the patient. We're all here
to take care of the patient, and we're doing our best,
(16:23):
and so you know, we all need to work together
on their benefit.
Speaker 1 (16:29):
Yeah, that's a great way to look at it. Bring
it back to center, bring it back to one, right,
this is why we're here. You know, recovery is not
always easy. I imagine for a lot of people. If
you're in the ICU, it's going to take a certain
level for you to get back to where you were
before you even had to be at the hospital. In
(16:52):
addition to the support of your family and friends. Why
is it important And I feel like you have such
a great positive outlook on this, but why is it
import for the ICU staff to also have that same
level of care and support and positivity.
Speaker 3 (17:08):
Well, I mean, we're all here for the patient and
the patient. Again, going back to what an icy routine
for a patient is. The patient is either in pain,
it's uncomfortable, just the routine is takes a toe on
the person, right, and they have doubts, am I going
to make it out of here? Am I going to
(17:30):
make it through this? What kind of deficit I'm going
to have? What kind of issues am I going to
have after this? Right? And it's very anxiety provoking. So
I feel like if the environment, the staff around the
family keeps a positive you know, like as the environment
(17:50):
around around that patient, it just helps them be positive
about their own recovery. Right. So that's why I think
it's it's so and for the whole staff to be
on that same page.
Speaker 1 (18:03):
What's a great way to limit that stress associated with
this whole diagnosis, the care and then the recovery.
Speaker 4 (18:11):
I think focusing on on on the end goal, right,
And that's why when we were talking about code status,
I think I always focus.
Speaker 3 (18:22):
On what is your value in life? And that gives
you a big picture. So when you look at the
big picture, the little hurdles or the huddles hurdles of
right now are a little bit easier to manage.
Speaker 2 (18:36):
Right.
Speaker 3 (18:37):
So I try to ask all of them, like, what
is what is the most important thing? What is their
joy in life? And they'll say, you know, I've had
so many different answers to this, like, oh, their joint
life is eating or their joint life is gardening, and
and I'm like, okay, so picture yourself gardening or having
(18:57):
a great meal or whatever it is that you love
about life and just focus on that, right, And I
think that helps them go through it.
Speaker 2 (19:08):
Yeah.
Speaker 1 (19:08):
I like that. Paint the picture, make it beautiful, see it,
visualize it, and know that you could be there again. Yeah, yeah,
that's beautiful. So organizations like the Inland Empire Health Plan,
which I'm just I owe so much too, and Dignity
Health as well, are working to train our next generation
(19:30):
of healthcare professionals, people just like you. What advice do
you have for those looking to go into medicine and
even more specific the type of medicine that you're in.
Speaker 3 (19:43):
So intensive care is a very new specialty, if anything
like the intense. The word intensives actually came about in
twenty twenty. It was added to the dictionary twenty twenty.
Speaker 1 (19:57):
Not really know what. Yeah, yeah, that very wild to me. Yes,
oh my god.
Speaker 3 (20:04):
We became popular because of the pandemic, so yeah, that's why,
not in a good way, but right right, So for
the subsection of critical care. I think you have to
for you to thrive in it. I think you have
to care deeply about your patients and really like a
(20:28):
fast paced, chaotic environment of work. But to go into
medicine in general and healthcare, either nursing or physical therapy
or anything that encompasses healthcare, I think you really need
to be a good team player. I am nothing without
(20:49):
my nurses, I am nothing without my physical therapist. I
am nothing without the team that we have in the ICU. Right,
So you need to be a great team player and
be able to support and empower the people that are
around you for the greater good, which is the good
of the patient. So it's usually not the answer that
(21:13):
people expect from me, but it is being a team player,
for sure.
Speaker 1 (21:17):
I think that's a I think that's great advice though.
You know, being a team player works on so many levels, right,
It really does not even just in the medical field,
It really does in general. It serves you right, It
will serve your team right, and you will look better
because of it. I always feel like the people around
you make you look good, right. You know, if you
are delegating correctly, you're going to look like you're doing
(21:40):
your job amazing and everyone wins and everybody wins, And
I feel like in the medical profession it has to
be like that because there are so many facets to
care the nurses, to the medical team, to specialists, to
the doctors, to just all of those different kinds of avenues,
even billing, you know, things like that, where that's another
(22:01):
stressful thing. You know, I've got to deal with that
avenue of all of the things that I just went
through my recovery, now I have to go through that.
And if you have a good team around you and
you have the right attitude, that's that's gonna get you
a long way. So that's good advice. I think that's
great advice. Do you I mean, do you tell people
when they're going through their programs to folk? Do you
(22:25):
tell them like, you should look at what I do?
Or do you feel like if there was one other
like you know, do you would you rather be in
private practice? Or like, what do you say? I'm curious
what your thought is on that.
Speaker 3 (22:37):
We We have trainees here and I don't I don't
necessarily tell them to look at what I do, but
I always tell them when you're picking things you know
your specialty or some specialty or whatever it is, just
just look around right and and see if the environment
is something you would like to to be in, and
(23:00):
so that makes it a little bit easier. The other
thing I tell them all the time is treat your
nurses well, because if you treat your nurse as well,
you're bold and they're going.
Speaker 1 (23:10):
To that is key. And I'll tell you this from
a best friend perspective. Both of my best friends are nurses,
and I will say the same thing. I know their feistiness,
and I know how amazing they are, and I always
think that's too and I was like, they better make
sure they're treating you well because you're going to do
them really good.
Speaker 3 (23:32):
That's the trick of the trade.
Speaker 1 (23:34):
It really is. And I love what you said about
like you know what's around you while you're training and
deciding what you're going to be specializing, and because you know,
this is the time when you decide what doesn't work
for you, right. I even say that same thing to
my oldest daughter. She's in the workforce and she's learning
what she doesn't like. I said, this is the time
(23:54):
you learn what you don't like. You know, it's not
necessarily a find what you love. It's defined what you
don't want to do, because there's going to be a
lot of things you don't want to get stuck doing
if you don't like it.
Speaker 3 (24:06):
Yeah, which is fifty percent right, Like if you find
out what you don't like when you really don't want
to do, you're halfway through.
Speaker 1 (24:12):
Yeah, yes, for sure. Before we let you go, I
know you were very busy. I know you're you got
your scrubs on. You are working girl. So I before
I let you go, I have one last question. What
are the three key takeaways that you hope people were
listening to this podcast today really truly take home with them.
Speaker 3 (24:32):
So first, talk to your family members while they're you know,
at with you and doing well. Talk to them about
what their goals in life are, what they're what they
want for themselves and in a situation like this, because
no one thinks it's going to happen, but when it does,
(24:54):
it helps a lot. If you've talked about it before
and if you have answer from their perspective, it takes
a little bit of the blame from you and the
guilt from you, and it just puts a different perspective
into all the decisions that have to be made in
the ICU. So that is one of the things. The
(25:15):
other thing is going back to what we said, there
is no such thing as a dumb question. Please ask
all your questions, write them down, and feel free to
approach us with all of those, to make sure that
you understand what we're doing for the patient and that
we're all on the same page. And then the third
(25:35):
thing is try to keep positivity even when things look grim.
I think we can still make things better for the
patient and for the person who's lying there. So keeping
a positive attitude even when things don't look great, I.
Speaker 1 (25:54):
Think those are great key takeaways. You're absolutely right talking
to your family, and I feel like that the first
one that you said doesn't have to happen when you're
in later life. It should happen at any moment, right,
Anything could happen at any time, and having those serious
conversations need to happen at all walks of life, right,
So wonderful. And then of course no dumb questions and
(26:16):
staying positive. Thank you so much, doctor Ammerl. This was wonderful.
I feel like we got a little bit more insight
knowledge into the very new term of intensive care that
actually blew me away. I'm very surprised by that, but
I feel like, you know, it makes it a tiny
bit less scary when you know just a little bit
(26:37):
more about what go goes behind the care specialty, why
everybody's there, and how much they're going to care for
you when you're in that situation. So, thank you so
much for joining me today.
Speaker 3 (26:49):
And thank you for having me
Hi there, Welcome back to another episode of Covering Your
Health with Evely and Erieves, presented by i EhP Oh.
I'm so happy to be here with you. I'm a
little extra raspy today. I spent a couple of weeks
getting over a cold and know all kinds of things.
You know, this is a health podcast, so we figured
you'd be okay with a little bit of extra rasp
(00:21):
understanding that sometimes that's the process. It takes a little
extra time to get rid of that. So but I'm
so glad that you're here. As always, we're always looking
for topics that not only I find interesting, but we
hope that you will find interesting. And today I really
think you will. I think this is going to be
something special, especially because I don't think everybody has had
(00:46):
the experience of an ICU, the intensive care unit in
partnership with Dignity Health. We would love to welcome doctor
Valentina Emerald to the podcast to talk about that topic.
I icee you what to expect when receiving Karen and ICU,
what to expect from the ICU team, how family plays
(01:09):
a very very important role in the road to recovery
and really in the entire process. Doctor Emerl is a
critical care medicine specialist at Saint Bernardine Medical Center and
Community Hospital of San Bernardino, serving a diverse population of
people and their variety of needs. Most importantly, doctor Emerl
(01:29):
is a all about education, which is super cool and
is very eager to help us navigate the healthcare system
so that you and your loved ones get the best
care possible. I think you're going to enjoy this.
Speaker 2 (01:45):
Welcome to Covering your Health, a wellness podcast dedicated to
covering all areas of living a healthy and happy lifestyle,
from healthy hearts to understanding health plans and everything in between.
Each episode will provide you with a better understanding of
managing your health, preventative care, and staying on the right
path for your family's wellness journey. The Covering Your Health
(02:06):
podcast is presented by i EhP. Now your host Evelina Revez.
Speaker 1 (02:13):
I am so excited to have you here. Thank you
so much for joining us, Doctor Amile.
Speaker 3 (02:17):
How are you God, thank you for having me.
Speaker 1 (02:21):
Oh, thank you for being here. So let's get started. Obviously,
you are a doctor, you are prestigious in your career.
I want to know how that all started for you.
Was this something that was a lifelong passion, something that
you knew when you were a child you would be
a doctor one day? Or how did you find this path?
Speaker 3 (02:39):
Yeah? So it's it's kind of interesting because I knew
from way way early that I wanted to be a doctor,
even though I had no doctors in my family. I
just felt like, I like that and I need it
to go into that. I have a younger brother, she
was twelve years younger, and he would get hurt and
(03:02):
he would like defer to me and he would be like, no, mom,
you don't take care of me. It's my sister and
so and that brought.
Speaker 1 (03:11):
Me a lot of traol.
Speaker 3 (03:13):
So it started off with that, and then it obviously
grew into a love for science, a love for how
the human human body works. And then here we are.
Speaker 1 (03:26):
So that is so amazing. So it's like your brother
saw something in you even at a young age. What
is your age difference again.
Speaker 3 (03:33):
Or twelve years apart?
Speaker 1 (03:34):
Twelve years so that could be part of that, right
and our oldest in your family? Yes, yeah, oh yeah,
so that's so so cool. Now you're from Brazil, I understand, right, yes,
And what age did you come here to the United
States and find that this was going to be your
medical path here. I mean, did you start that there
(03:55):
or here?
Speaker 3 (03:57):
Yes? So I did my medical school there. I actice
there in emergency medicine for about five years prior to
coming here, and I came here in twenty fifteen to
do interi medicine residency in Baltimore. So I came here
pretty late. I was already practicing there.
Speaker 1 (04:19):
Wow, that's cool. I can't even hear your accent that. Hey,
you have a very strong American accent. It sounds like
you would never know that you actually spend so much
time there.
Speaker 3 (04:29):
Thank you.
Speaker 1 (04:30):
Yeah, I'm sure you work hard to do that. I mean,
I know that that's like a whole nother thing, But
that is so special. What did your family think about
you wanting to go on this path.
Speaker 3 (04:42):
It's I'm not sure. I thought they initially thought it
was crazy. It was like, really, do you really want
to study for that long and then go to the
US and then study more and so. But then they
realized there was a bit of a method to the madness,
and they they were on board with it. They're still there,
they still live in Brazil. It's just me and my
(05:03):
husband here.
Speaker 1 (05:04):
Yeah, amazing. I'm sure they're so proud of you now.
Speaker 3 (05:10):
They are.
Speaker 1 (05:11):
That's great, Okay, So let's talk about an ic you
the basics of an intensive care unit. What is an
ICU for those who have maybe only heard the acronym
and like have no idea what it actually is and
what type of care does an ic you provide?
Speaker 3 (05:29):
Right? So, and I see you as the name says,
intensive care unit. It's where the sickest patients in the
hospital go to. So if they require support for very
low blood pressure, if they require support for breathing, or
you know, if they have something like a cardiac or
(05:49):
rest things like that, they come to the ICU. So
it's basically the sickest patients. We have more nurses is
a sign. So each nurse has only two patients so
that they can pay a lot of attention and take,
you know, close care of that patient. And then we
(06:12):
are trained in basically resuscitation, So resuscitating the patient, making
sure that their blood pressure is okay, that their oxygen
levels are okay, and that you know that the initial
reason for them becoming that sick is addressed. In the ICU,
(06:35):
there's a lot of machines, and so we can do
dialysis in the ICU, we can do mechanical ventilation, which
is something that became very popular during COVID. Everyone was
talking about intubation and machines to help you breathe. The
ICU is the place where we do that.
Speaker 1 (06:53):
I see. So, now, what can someone expect if it's
like they get to the hospital, they find out they
are now going to be admitted into the ICU, what
are some of the first things that they can expect
to happen, right.
Speaker 3 (07:07):
So usually we go see them in the emergency department.
The first conversation we have obviously is what happened? What
brought you here? Or if the patient can't answer, we'll
talk to the family. But I think one of the
conversations we have that patients are usually kind of surprised
by is code status conversation. And everyone's like, what is
(07:31):
a code status? Right? So code status is something that
is determined when you come into the hospital for us
to know what the wishes of the patient are. So,
would you like to be resuscitated? Would you like to
have CPR meaning chess compressions meaning restart your heart if
it were to stop would you like to be intubated?
(07:51):
Would you like it breathing too, but machine to help
you breathe? And what are your goals in life? So
would you be okay with all these things to be
long term or would you be only okay if these
things were short term? And that is extremely important for
us because then we know where to go within the
(08:12):
care of that patient and how to honor their wishes,
their wishes not what we think needs to be done,
but what they would have want to do if they
were able to choose. And so that is one of
the first conversations we have when they walk in, even
when we don't expect any emergencies to happen, because we
don't know when an emergency is going to happen, and
(08:33):
it's never when we do right, it's never when we
plan for it. It's never, you know. And so we
have these conversations with all the patients that come in,
regardless of what they have, what age they are, or
so forth.
Speaker 1 (08:47):
Wow, okay, so you brought up family. Obviously, if a
patient is now in the ICU or is about to
be admitted into the ICU, and maybe they can't speak
for themselves, how important is the family role in that
type of situation.
Speaker 3 (09:04):
Oh, family is essential. So the family has so many
important roles in the ICU. One is to be by
the patient's side. So if you can imagine waking up
at a different place, a place where you don't know,
with a bunch of people you don't know in the bed,
(09:25):
not quite sure how you ended up there. That is terrified, right,
But if you see your family member's face right there
next to you, it makes it a lot better. It
makes it a lot more tolerable whatever you're going through.
So family, first of all, is really important to reassure
the patient, to you know, keep them calm and have
(09:48):
a familiar face in a very strange environment. And also
when the patient cannot speak, to talk for the patient
and tell us what the patient's value is are because
you know, there's a lot of things we can do
in medicine, a lot of gadgets, a lot of machines,
a lot of things, right, but I need to know
(10:10):
if that is in line with your goals and values
in life. And the only way for me to know
that for some patients that are unable to respond for
themselves is to talk to family and have a little
glimpse of what that person is when they're not unconscious.
Speaker 4 (10:26):
Right.
Speaker 1 (10:27):
Wow, Yeah, that sounds like a very that's a crucial role.
Then if you're a family member, and it sounds like
it plays a big part of the recovery process as well. Right.
Speaker 3 (10:36):
Absolutely. So you know, I always say we kind of
underestimate how much impact our mental health can have in
our physical recovery. Right. But we have all types of patients,
but the patients who are more depressed or more anxious,
(10:58):
they tend to take longer to recover. They tend to
not comply with, for instance, physical therapy, which is a
key part of recovery, right, and occupational therapy and speech therapy.
And you know, they need to buy into their treatment,
and the family is really important. That support is really
(11:20):
important to get them to buy into that.
Speaker 1 (11:23):
Yeah, Oh my goodness. We talk about communication a lot
on this podcast. A keyword that we talk about a
lot is the word advocacy and being an advocate for
yourself or for your health or for the family member
you're there with. Right, what if someone is hesitant to
talk in the ICU about important things, maybe not even
(11:48):
knowing what are the right questions to ask? Where should
they begin? Is there is there a process to begin that?
Speaker 3 (11:55):
Yeah? So things get really complicated in the IC, you, right,
So we try to update the families every day, and
the nurses also update the families every day. But you know,
an update might be a brief, you know, a couple
of lines, a little bit of information, and sometimes it
(12:18):
confuses the family more than helps. Right, So whenever I
go into the room, I tell the families, I'm like,
there is no such thing as a dumb question. So
you start with all your questions. You let me know
everything you want to clarify, and I will go over
things for you. The Internet is always helpful and unhelpful
(12:39):
at the same time. Right. You can imagine, right your
Google things and sometimes a really good thing pops up
and a really bad thing pops up. So don't be
afraid to talk about what your background is in your question.
So it's like, how are they gonna do? I read
online that things these things have really poor outcome, right,
(13:00):
so I can I know where you're coming from and
what your concern is and I can address that. Or
you know, I have a family member who had something
similar and I would like to know if this is
the same so I think transparency on both sides is
key for us to improve our communication and to get
(13:21):
the family to truly understand what's going on when we're
updating them.
Speaker 1 (13:27):
So I was thinking about like being in high school
and my teacher saying there are no dumb questions, but
then you still go, yeah, I feel like there are
dumb questions, you know, because you don't get that one
teacher who's like, well, that was a dumb question. So
I think in a hospital setting there really are no
dumb questions, right, you have to ask all of the things.
Speaker 3 (13:51):
Yeah. Absolutely, So I mean again, it took us on average,
right ten years to learn the trade of the trade.
It took us so much time to learn the things
that we're trying to implement, the treatments and all of that.
So I don't expect my patients to understand that. First off,
(14:13):
oh yeah, I get this. This is pretty quick and easy.
There is no such thing. Right. Also, we're well aware
that each person is a person, and we treat each
patient as an individual. And you know, some things might
make more sense for your loved ones than it would
(14:33):
make for the patient next door. And it's important for
the family to bring up all of their concerns because
maybe their concerns are something I haven't thought about, or
some background that they have because they know the patient
and I never thought because I don't know, I don't
know that habit or you know, or that they were
(14:53):
doing something, or that they ate something, or you know.
It's just hard because we weren't with them when it
all started, just seeing them after the fact. So in
the ICU, there's definitely no such thing as a dumb question.
Speaker 1 (15:08):
I love that. I do love that. Okay, then let
me ask this, how do you navigate negative energy? I
imagine in a very crucial time, when a patient is
going through a very hard time, it's very stressful for
everyone involved. How do you navigate maybe people being upset
(15:29):
or maybe not understanding the process fully the way it
has to go, and it feels too slow, you know
those kinds of things. How you handle that well?
Speaker 3 (15:38):
I mean, having sick patients, it's it's a given right.
The family's upset. The way I see this, they're not
upset at me. They have the right to be upset.
That situation is not a situation that anyone should be right,
and so I try not to personalize it. I like
(16:02):
make it about myself. I try to make it about
the patient. And usually when families are really really upset
and and you know, sometimes things get a little bit heated,
and I always try to bring it back to the patient.
So we're all here for the patient. We're all here
to take care of the patient, and we're doing our best,
(16:23):
and so you know, we all need to work together
on their benefit.
Speaker 1 (16:29):
Yeah, that's a great way to look at it. Bring
it back to center, bring it back to one, right,
this is why we're here. You know, recovery is not
always easy. I imagine for a lot of people. If
you're in the ICU, it's going to take a certain
level for you to get back to where you were
before you even had to be at the hospital. In
(16:52):
addition to the support of your family and friends. Why
is it important And I feel like you have such
a great positive outlook on this, but why is it
import for the ICU staff to also have that same
level of care and support and positivity.
Speaker 3 (17:08):
Well, I mean, we're all here for the patient and
the patient. Again, going back to what an icy routine
for a patient is. The patient is either in pain,
it's uncomfortable, just the routine is takes a toe on
the person, right, and they have doubts, am I going
to make it out of here? Am I going to
(17:30):
make it through this? What kind of deficit I'm going
to have? What kind of issues am I going to
have after this? Right? And it's very anxiety provoking. So
I feel like if the environment, the staff around the
family keeps a positive you know, like as the environment
(17:50):
around around that patient, it just helps them be positive
about their own recovery. Right. So that's why I think
it's it's so and for the whole staff to be
on that same page.
Speaker 1 (18:03):
What's a great way to limit that stress associated with
this whole diagnosis, the care and then the recovery.
Speaker 4 (18:11):
I think focusing on on on the end goal, right,
And that's why when we were talking about code status,
I think I always focus.
Speaker 3 (18:22):
On what is your value in life? And that gives
you a big picture. So when you look at the
big picture, the little hurdles or the huddles hurdles of
right now are a little bit easier to manage.
Speaker 2 (18:36):
Right.
Speaker 3 (18:37):
So I try to ask all of them, like, what
is what is the most important thing? What is their
joy in life? And they'll say, you know, I've had
so many different answers to this, like, oh, their joint
life is eating or their joint life is gardening, and
and I'm like, okay, so picture yourself gardening or having
(18:57):
a great meal or whatever it is that you love
about life and just focus on that, right, And I
think that helps them go through it.
Speaker 2 (19:08):
Yeah.
Speaker 1 (19:08):
I like that. Paint the picture, make it beautiful, see it,
visualize it, and know that you could be there again. Yeah, yeah,
that's beautiful. So organizations like the Inland Empire Health Plan,
which I'm just I owe so much too, and Dignity
Health as well, are working to train our next generation
(19:30):
of healthcare professionals, people just like you. What advice do
you have for those looking to go into medicine and
even more specific the type of medicine that you're in.
Speaker 3 (19:43):
So intensive care is a very new specialty, if anything
like the intense. The word intensives actually came about in
twenty twenty. It was added to the dictionary twenty twenty.
Speaker 1 (19:57):
Not really know what. Yeah, yeah, that very wild to me. Yes,
oh my god.
Speaker 3 (20:04):
We became popular because of the pandemic, so yeah, that's why,
not in a good way, but right right, So for
the subsection of critical care. I think you have to
for you to thrive in it. I think you have
to care deeply about your patients and really like a
(20:28):
fast paced, chaotic environment of work. But to go into
medicine in general and healthcare, either nursing or physical therapy
or anything that encompasses healthcare, I think you really need
to be a good team player. I am nothing without
(20:49):
my nurses, I am nothing without my physical therapist. I
am nothing without the team that we have in the ICU. Right,
So you need to be a great team player and
be able to support and empower the people that are
around you for the greater good, which is the good
of the patient. So it's usually not the answer that
(21:13):
people expect from me, but it is being a team player,
for sure.
Speaker 1 (21:17):
I think that's a I think that's great advice though.
You know, being a team player works on so many levels, right,
It really does not even just in the medical field,
It really does in general. It serves you right, It
will serve your team right, and you will look better
because of it. I always feel like the people around
you make you look good, right. You know, if you
are delegating correctly, you're going to look like you're doing
(21:40):
your job amazing and everyone wins and everybody wins, And
I feel like in the medical profession it has to
be like that because there are so many facets to
care the nurses, to the medical team, to specialists, to
the doctors, to just all of those different kinds of avenues,
even billing, you know, things like that, where that's another
(22:01):
stressful thing. You know, I've got to deal with that
avenue of all of the things that I just went
through my recovery, now I have to go through that.
And if you have a good team around you and
you have the right attitude, that's that's gonna get you
a long way. So that's good advice. I think that's
great advice. Do you I mean, do you tell people
when they're going through their programs to folk? Do you
(22:25):
tell them like, you should look at what I do?
Or do you feel like if there was one other
like you know, do you would you rather be in
private practice? Or like, what do you say? I'm curious
what your thought is on that.
Speaker 3 (22:37):
We We have trainees here and I don't I don't
necessarily tell them to look at what I do, but
I always tell them when you're picking things you know
your specialty or some specialty or whatever it is, just
just look around right and and see if the environment
is something you would like to to be in, and
(23:00):
so that makes it a little bit easier. The other
thing I tell them all the time is treat your
nurses well, because if you treat your nurse as well,
you're bold and they're going.
Speaker 1 (23:10):
To that is key. And I'll tell you this from
a best friend perspective. Both of my best friends are nurses,
and I will say the same thing. I know their feistiness,
and I know how amazing they are, and I always
think that's too and I was like, they better make
sure they're treating you well because you're going to do
them really good.
Speaker 3 (23:32):
That's the trick of the trade.
Speaker 1 (23:34):
It really is. And I love what you said about
like you know what's around you while you're training and
deciding what you're going to be specializing, and because you know,
this is the time when you decide what doesn't work
for you, right. I even say that same thing to
my oldest daughter. She's in the workforce and she's learning
what she doesn't like. I said, this is the time
(23:54):
you learn what you don't like. You know, it's not
necessarily a find what you love. It's defined what you
don't want to do, because there's going to be a
lot of things you don't want to get stuck doing
if you don't like it.
Speaker 3 (24:06):
Yeah, which is fifty percent right, Like if you find
out what you don't like when you really don't want
to do, you're halfway through.
Speaker 1 (24:12):
Yeah, yes, for sure. Before we let you go, I
know you were very busy. I know you're you got
your scrubs on. You are working girl. So I before
I let you go, I have one last question. What
are the three key takeaways that you hope people were
listening to this podcast today really truly take home with them.
Speaker 3 (24:32):
So first, talk to your family members while they're you know,
at with you and doing well. Talk to them about
what their goals in life are, what they're what they
want for themselves and in a situation like this, because
no one thinks it's going to happen, but when it does,
(24:54):
it helps a lot. If you've talked about it before
and if you have answer from their perspective, it takes
a little bit of the blame from you and the
guilt from you, and it just puts a different perspective
into all the decisions that have to be made in
the ICU. So that is one of the things. The
(25:15):
other thing is going back to what we said, there
is no such thing as a dumb question. Please ask
all your questions, write them down, and feel free to
approach us with all of those, to make sure that
you understand what we're doing for the patient and that
we're all on the same page. And then the third
(25:35):
thing is try to keep positivity even when things look grim.
I think we can still make things better for the
patient and for the person who's lying there. So keeping
a positive attitude even when things don't look great, I.
Speaker 1 (25:54):
Think those are great key takeaways. You're absolutely right talking
to your family, and I feel like that the first
one that you said doesn't have to happen when you're
in later life. It should happen at any moment, right,
Anything could happen at any time, and having those serious
conversations need to happen at all walks of life, right,
So wonderful. And then of course no dumb questions and
(26:16):
staying positive. Thank you so much, doctor Ammerl. This was wonderful.
I feel like we got a little bit more insight
knowledge into the very new term of intensive care that
actually blew me away. I'm very surprised by that, but
I feel like, you know, it makes it a tiny
bit less scary when you know just a little bit
(26:37):
more about what go goes behind the care specialty, why
everybody's there, and how much they're going to care for
you when you're in that situation. So, thank you so
much for joining me today.
Speaker 3 (26:49):
And thank you for having me
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