J-Term Diaries: Lauren Shirocky

Today is my last day at Bon Secours. Michael is away on business for the next several days, so I am coming in today just to kind of wrap everything up. I am writing my final report to hand in to Dr. Turney, who is overseeing my internship. I also need to finish writing my ethics paper, so that I can email that to Michael and Dr. Turney.

I do have some exciting news that I haven't been able to share until now. Michael has offered for me to continue working for him through a paid internship in the spring!! I am very excited, since I need experience in the health care industry since I am planning on completing a master program in health administration. This is such a great opportunity and am so lucky to have been able to intern with such a helpful and accomplished professional.

I hope you have enjoyed reading my journal over the past several weeks! Have a great spring!

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Today was a typical day of work. I did some reading in the morning on current ethical issues and read two articles for the ethics night class that I have been attending with Michael every other week from 6-8pm on Tuesdays. Th articles dealt with the current  major problems in health care and focused mainly on economic issues. There are many reasons why there is an on going economic crisis in health care and the articles outlined all of them and also included some potential solutions to the problem. The articles were interesting but also disturbing, stating that Medicare coverage  funds are expected to be exhausted by 2019. Last night's class discussion was interesting and the various attendees made it even more insightful. A physician, nurse, mission employee, ethicist, and a compliance officer made up the group. It was interesting to hear the different perspectives related to their their position within the hospital.

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Today Michael, my supervisor had a conference call at 11 am concerning some compliance issues. I was able to listen to the meeting that lasted until or so. In the afternoon after grabbing lunch with Michael, I did some more reading and writing for my ethics paper. Today wasn't very eventful overall, but I did enjoy as always getting to ask Michael questions about his job.

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This morning I attended a law class at the University of Richmond on bioethics, primarily dealing with the relationship between law, medicine, and ethics. Mr. Michael Goodman and Mrs. Kathleen McCauley are the professors, who were kind enough to let me sit in on the class. Class discussion centered on what exactly it means to be a professional and what requirements and standards they should uphold versus a non-professional. Defining the difference between a non-professional and a professional was also being debated. There was approximately one hundred pages of reading for the day's class and I had read most of it. The reading dealt primarily with distinguishing patients, subjects, and citizens from each other and defining responsibility based on one's position within society. The reading and court cases were interesting. The discussion in class was also very interesting and enjoyed listening to what students had to say concerning the reading. In addition to the chapter of reading, we also were supposed to take a look at an article from the Cleveland Clinic Foundation. That article's main argument was that with people having so many different cultures with their own ethical codes, it is important for us to be aware of this to ensure as physicians the we are sensitive to patient's beliefs and ethics. We need to recognize that our ethical values may not be the same as the patients we are treating. The overall question posed within the article was whose ethics should we adopt with so many different ones? There of course is no answer to this question, but the article raised a very important question.

At the end of the class I thanked both professors for letting me attend their class. I thoroughly enjoyed it and it has made me even more excited about attending law school.

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I apologize for not writing in awhile! I have been extremely busy and have not had much of a chance to check in.  Lynn Clark, the Director of the Institutional Review Board (IRB) invited me to attend a meeting scheduled for 7:30 am today. Thus, I woke up pretty early this morning and headed to St. Mary's hospital for the meeting. It was interesting to hear about the various cases of research conducted at Bon Secours hospitals recently.

In addition to the early meeting, back at Windsor (the business complex in which I work) today was Bon Secours Recognition Day. Around 11 am employees were invited to attend a worship service during work if they would like. In addition Bon Secours calendars and buttons were handed out to every employee. The best part of the day was the dessert line that was available in the afternoon. Petit fours and various other small pastries were displayed on a large table as employees went through the line to grab some of the delicacies. Michael, my supervisor was out of the office today as well as the past two days due to an engagement in Augusta, Georgia. Thus I spent some time reading and continuing an ethics paper that I am working on.

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I began my morning at regular time and arrived at work at 8:30 am. I worked on my ethics paper in the morning and then around 11 am drove to St. Mary's Hospital to meet David Belde, the ethicist for Bon Secours to learn more about what his job entails.

Soon after arriving at St. Mary's David informed me that he had an ethics consult in a few minutes concerning a patient with Locked-In syndrome. Not familiar with what this condition is, David filled me in on exactly what this means. A patient with Locked-In syndrome (LIS) is essentially fully alert with all mental capabilities but completely paralyzed and unable to communicate with others in any way except with eye movements. The patient that he was about to meet with, was in this current state as a result of complications of a spinal chord surgery. I observed at David met with both the patient's family, the treating neurologist, various nurses in the cardiac intensive care unit (ICU), and myself. It appeared that the big question was the patient wanted in her current state, since LIS' prognosis is grim and the chance of recovery even small muscle functions is rare. After meeting with the various health care staff for almost two hours, no conclusion had been reached. Since the patient was alert, it would ultimately be her decision to decide whether she wanted to continue her life. She would need to be asked questions in a way so that through blinking her eyes (one blink being yes and two being no) she could convey her wishes.

Observing the LIS consult was very interesting but knowing the reality that the outcome of this situation would determine whether a person would live or die was difficult. I was very glad to get to observe this case and see what David does as an ethicist. I pray that what is best for the patient ultimately becomes the outcome for this patient. As one can see there are many ethical issues present in this particular case.

After the consult, David and I went to a Vietnamese Restaurant for lunch. The food was similar to Chinese restaurants, but a little different. David informed me that Vietnamese food is similar to Chinese food but the main difference between the two is that Vietnamese food is less greasy with less oil used in cooking. I was pleased with this, because I try for the most part to be a healthy eater. I enjoyed the lunch and discussed with David my plans for the future. He informed me on how he decided on becoming an ethicist and a great deal about himself. After lunch, I headed back to the office and did some reading for the rest of the day.

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Weather reports on Sunday night indicated that the roads would most likely be icy for Monday mornings commute. After hearing this and seeing the ice on the sidewalks and roads this morning, I decided it would be best for me to not go in to work. I stayed in my apartment on campus and was able to do some reading for my ethics paper and replied to several emails pertaining to work. I also took advantage of being off work by catching up on some needed errands. A fraternity on campus, Kappa Alpha and Virginia Blood Services partnered to sponsor a blood drive on Campus. Since I was off for the day I decided to donate blood, since there has been a shortage lately. Although I wasn't able to go in to work, it was a fairly productive day.

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This past Friday after beginning research for my ethics paper, I attended an open house at Virginia Commonwealth University to find out additional information on their masters in health administration program. I met two current students enrolled in the program, an admissions counselor, and three other students also seeking additional information. I was impressed with both current students and they seemed very pleased with the instruction they had so far received through the program. One student was in her first year and one was in their second. I was impressed with the opportunities available during the third year of the MHA program which is essentially doing a residency in health care administration with a hospital or medical facility. Potential residencies could be anywhere in the United States, which gives an opportunity to explore other areas of the country if desired. I was impressed with what the program offers and am seriously considering applying to the program within the next year.

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Yesterday morning I spent time with Michael getting organized and beginning research for a philosophy paper I am writing. In addition to the projects Michael has devised for me, he wanted me to come up with some projects of my own. Since my internship is being done through the philosophy department, I thought it may be good to be able to directly pinpoint how one of my majors has supported the knowledge I have gained at Bon Secours. Thus, I will write a paper about a pressing ethical issue and apply it to one or several philosophers thoughts pertaining to my chosen issue. This will be a great way to apply what I have learned as a philosophy/ethics major to current issues in health care.

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Last night I was fortunate enough to meet with Michael, my supervisor as well as the ethicist for Bon Secours to have dinner. We went to Firebird's at Short Pump Town Center where we enjoyed a leisurely dinner while discussing some of the current issues both Michael and David are dealing with. I found out a decent amount of background information on David and how he came to be the ethicist for Richmond Bon Secours. Having dinner with both David and Michael gave me a more in depth view of not only what their jobs entail but also at how their career choices impact their families. An added benefit of dinner was the leftovers I took home!

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As many college seniors I am concerned about what I will be doing after I graduate and also with the more complex question of what am I interested in pursuing as a career. Michael so far has been extremely helpful in this area! After talking a great deal with him I am pretty sure that I would like to get a masters in health administration. With this I could be some kind of hospital administrator, for example a compliance operator. There are many areas in health administration so I am still not sure exactly what my focus would be. I am also still interested as I have always been in getting a law degree. Michael has mentioned the dual program available at both Virginia Commonwealth University and the University of Richmond. If I decided to apply to these programs I could get my MHA at VCU and my JD at Richmond. By combining the two programs I would be eliminating the length of these two programs by a year. Michael gave me a great deal of information on this program, since he completed this same program. I think that this may be a great option for me to consider.

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  In addition to learning more about engaged research, I began reading numerous articles on pediatric research. I learned that there are many legal and ethical issues involved in such research, making it less common than adult research. Michael had me begin writing a policy regarding the steps that the Investigator (physician doing research) should complete as well as the steps that the Institutional Review Board (IRB) should take to ensure compliance with all regulations. Any research being conducted must seek approval from the IRB to ensure that they are completing all of the necessary steps to properly conduct their research. Thus the IRB has a very important role and is knowledgeable about all of the federal and state regulations regarding pediatric as well as all other forms of research. With help from Michael I was able to use a template to put together a policy that will highlight the steps that both physicians and the IRB should take to adhere to all regulations in such research.

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   It was great meeting many of the employees of working at the Windsor complex of Richmond Bon Secours. In addition to the many people that I met, I also was given a lot of information about Bon Secours in general and greater detail about what compliance officers do. My supervisor, who is the Director of Corporate Responsibility, informed me fairly quickly that I should call him Michael, so I will refer to him as such from this point on.

   After the first two days of getting familiar with what my role as an intern would be, I felt a bit more knowledgeable and ready to begin working. Michael had me begin by reading a number of articles concerning "engaged" research. "Engaged" research is defined as any research involving living individuals in which individually identifiable information is obtained. There are specific regulations that must be complied with for all engaged research, so it is essential to identify what constitutes research and what does not.  I was to write a one page article summarizing the main points of engaged research that would be sent to the majority of employees at Bon Secours. I struggled a bit when writing the article and Michael helped me a great deal in making changes so that the article was clear about the distinctions of research and non-research.

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Today was exciting and I definitely had no reason to be nervous. I began the day with meeting a lot of people from the various departments of Bon Secours, got a tour of the building, and also was assigned a desk where i will work. I spent most of the morning in a conference call concerning potential reforms on general compliance and ethical issues. I also spent several hours talking with Mr. Michael Spake, whom I am interning with, picking his brain about his past actions that led him to his current job as Director of Corporate Responsibility. The more I talked with Mr. Spake, the more I am thinking I would like to get a masters in Health Administration in addition to attending law school. I am really looking forward to this month because it definitely correlates with what I want with my career.

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I arrived back at school early this morning (around 9 am) to finish preparing for an early morning tomorrow. My internship at Bon Secours in Richmond will begin tomorrow at 8:30 am. I am excited about the prospect of working for the director of such an organization, because I have minored in ethics at Randolph-Macon and am interested in possibly pursuing something in this field upon graduating. I was given some reading on the of Bons Secour, general information on health care law, issues in pediatric research, and also legal issues in physician contracting. All of this information will be extremely helpful once I begin my internship. I should have a lot more to say once I begin tomorrow.

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