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| Dr. Joao Lucas O'Connell |
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| Hospital Madrecor |
Dr. Joao Lucas is a cardiologist and he works in three hospitals in Uberlandia. THREE! What's more is that Dr. Joao Lucas also has a practice of his own which he works in three afternoons per week, and he is a professor at the federal university in Uberlandia. He told me when we met, "My goal for your experience here is to make you want to be a cardiologist." Though I am not so sure about that, I will say that I learned an immense amount and that cardiology is not crossed off of my list of possible areas of specialization.
Hospital de Clinicas
Hospital Santa Clara
Madrecor
Private Office
Professor
?!?!
I do not know how he survives! I am all the more grateful that he was willing to have me because he really is busy! On Tuesday we went to all three hospitals in one day. On Wednesday, he only went to two hospitals but he had an emergency at one which caused a large delay in the rest of his afternoon. I asked him about this choice to work at so many locations and the logistics of it. Clearly, one has to be driven to do this, a characteristic in which Dr. Joao Lucas is not lacking. Two of the three hospitals, Madrecor and Santa Clara, are private hospitals, meaning they only serve people who are able to purchase health insurance. They do not serve people with the government's public health plan called SUS. Therefore, at these two hospitals Dr. Joao Lucas is paid more and in a way has to give preference to these patients when one of the hospitals calls with an emergency for him there. Of course he cannot just stop in the middle of a surgery at the public hospital for the SUS patients, Hospital de Clinicas, to go there, but he may have to delay a surgery or do it on a different day if he is called for a private patient. Similarly, if he has patients scheduled in his office for the afternoon but is called to an emergency in the private hospital, then he has to reschedule all of his patients in his office. This poses a big challenge for him because, he said, right now if you call his office to make an appointment, you will not be able to be seen until November. I suppose that is a testament to the kind of doctor he is, since everyone wants to be under his care! But, so too it is a testament to the ill distribution of health care in Brazil.
Here is a little bit about the time I spent with Dr. Joao Lucas.
Tuesday:
First thing on Tuesday morning, I met Dr. Joao Lucas in Hospital Santa Clara. I was given a quick tour while we waited for his patient to be prepped for surgery. The hospital was old but many parts, including the maternity ward, have just been remodeled. It was interesting and almost disheartening to see how much nicer the maternity ward here was than in Maternidade Nascer Cidadao where I began my trip in May. It seriously was a whole other world! That is representative of the public (Maternidade Nascer Cidadao)/private (Santa Clara) divide in the health care here once again. Once the patient was ready for surgery, Dr. Joao Lucas and I suited up in X-ray protection and I watched him perform a catheterization through the right arm to check the blood vessels of the heart for blockages. Right after, he performed a second catheterization for a similar purpose and it was very interesting for me to see the differences in the patients during the surgery and the differences in the images of their hearts. One thing I really appreciated about my time with Dr. Joao Lucas was that he was excellent at explaining everything he was doing for me (in a mix of English and Portuguese) and why he was doing it. After lunch at his home with his wife, two daughters, his sister, and his parents, Dr. Joao Lucas and I went to the public hospital, Hospital de Clinicas, to write a prescription for a patient he would be seeing the next day for an Angioplasty. Then we went to the other private hospital where he works, Madrecor, to attend a few patients that would be getting imaging exams that are similar to a catheterization but with an MRI scanner. It really was a cool process and the software used produces a colorized 3D image that can be used to analyze the health of a person's heart. Dr. Joao Lucas also gave me a tour of the hospital which was very nice and modern in between seeing patients. After the scans were completed, he had to take some time to see a few patients who called him for office visits and demanded to be seen today because they were afraid that they needed immediate attention. Dr. Joao Lucas did not brush them off or tell them to call his office, but he made time to see them at Madrecor, in a break room for some of the nurses because all of the consultation rooms were already in use. I am not sure how Dr. Joao Lucas manages to do all of the things he does.
Wednesday:
Today I met Dr. Joao Lucas at the Hospital de Clinicas and we got right to work. He was doing more catheterizations today and so we again suited up in the X-ray protection gear. It is really interesting for me to see this because although there is a standard for human heart anatomy, there are so many variations that can be detected with a catheterization! It is interesting to see them as Dr. Joao Lucas points them out for me and says, "Do you remember that other heart we looked at yesterday (or this morning) that did not look like this?," and then goes on to explain what is different and why. While Dr. Joao Lucas was doing some paperwork, he left me in the care of a fellow cardiologist to watch two ECGs she was performing. This was interesting to see how the valves of the heart were functioning. One patient had a prosthetic valve that was not functioning properly but was letting blood go back into the atrium after being pumped into the ventricle. After a brief lunch in the quad of the federal university to which this hospital was connected, Dr. Joao Lucas had to run an errand and then make a stop at Madrecor before returning to Hospital de Clinicas. I, however, stayed at Hospital de Clinicas to watch a procedure that a neurologist was performing similar to a catheterization for the heart but was to detect if there was any blood flow to the brain of a patient who was in a coma. If when the dye was injected through the catheter it was detected in the brain, then the patient would not be brain dead. If when the dye was injected it was not detected, then the patient would be brain dead. This patent only had a little bit of brain activity and so was not declared brain dead by this test. However, the doctor said that the activity would probably diminish over the coming days. Moreover, his prognosis was still not good. Though it was a difficult thing to hear and a difficult procedure for me to watch, it was very educational and a good reminder that medicine is not perfect and doctors are not always bearers of good news. Next was a tour of Hospital de Clinicas by two of Dr. Joao Lucas' students. They were in their third year of medical school and had not yet done all of their internships. It was interesting when they showed me the maternity ward to learn that they had not yet seen a birth and there I was having seen twenty-five in one month! They took me to many areas of the hospital, including the neonatal intensive care unit, the maternity ward, the emergency room, the urgent care, the surgical center, and the in-patient ward. I think the best part though was getting to talk to them and hear about their thoughts of the hospital and the things they are looking forward to doing when they do have their internships. After, they also showed me the anatomy lab of the Federal University of Uberlandia where they study because the hospital is on the campus. Having returned to the surgery center where Dr. Joao Lucas had returned to perform more catheterizations, I suited up in the X-ray protection once again and watched the rest of his surgeries.
As a sort of aside, I would like to point out a few things that occurred during the past few days that I think are important to note.
#1. It was announced by the Brazilian federal government that medical students will now need to devote eight years to their degree rather than six. Students will complete the six years as they do now, but after, each will be required to work in the public health care system for two years before they can receive their diploma. This is mandatory public service for all students.
#2. I received an education in Chagas disease today. Chagas disease is a disease prominent in Brazil and other areas in Central and South America (though it has now been diagnosed in Europe and Southern United States) which is transmitted by a beetle that lives in mud. Therefore, it is common in poor areas because houses are often built with mud in which the beetles reside. It attacks the cardiac, intestinal, and esophageal muscles but can go undetected for long periods of time and can cause weakening over time. Dr. Joao Lucas said that I was not allowed to leave Brazil without an education in Chagas disease. Fun fact: Chagas disease is named after the Brazilian who discovered the parasite that was causing the disease.
