Rhino Rocket with Tina Munjal, MD
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What is the main topic discussed in this episode?
At the Nocturnous, we are careful to ensure that all stories comply with healthcare privacy laws. Details may have been changed to ensure patient confidentiality. All views expressed are those of the person speaking and not their employer.
This episode of The Nocturnous was made possible with the support of the California Medical Association.
This is The Nocturnous, stories from the world of medicine. I'm Emily Silverman. Tina Moonjal is comfortable outside of her comfort zone. She became a surgeon despite not fitting the stereotype of a surgeon. She became an odorhinolaryngologist despite how hard it is to say that word. She recently went back to school to do a postdoc in computational neuroscience despite having no computational background whatsoever. And she told this personal story to a big audience of strangers, which we'll hear in a minute. After the story, Tina and I will talk about the perils of getting too good at one's job.
I feel that once something is second nature, it becomes easier to tell ourselves that we're done. But first, here's Tina. It was 9 p.m. on a Tuesday, one of my first overnight calls as a newly minted odolaryngology or ENT resident. I got a frantic call from one of my attendees. Tina, how comfortable do you feel packing a nose? Packing a nose is the ENT term for stopping a nosebleed, or more officially, epistaxis. Epistaxis comes from Ancient Greek, roughly translates to to drip from above. Actually, epistaxis can range from a drip to a fire hose. And that fire hose can be life-threatening if not turned off quickly. Unfortunately, to that point, my only exposure to epistaxis had been in the form of a practice dummy, where the stakes were just as high as getting red food coloring on my clothes.
So how comfortable did I feel packing a nose? Um, I feel okay, I said back as confidently as I could. Good, because doctor Jones is on his way in to the emergency department with a really bad bleed. Whoa. Okay. Doctor Jones was not only a physician, but a powerful physician who occupied a seat at the table in very high places at the hospital where I worked. I need you to do a good job, Tina. I'm counting on you. Great. Okay. So I knew the different pathways the situation could take in theory. For a little dribble, I could squirt a generous amount of afferin and hold pressure on the nostrils. For a little worse bleeding, there were medicated powders, gels, and absorbable packing. If it were truly bad, I could go for something similar to a tampon, and if all else failed, a fully catheter designed for the bladder up the nasopharynx.
Based on the description over the phone, I decided I'd start with something called a rhino rocket. It's an inflatable balloon that exerts pressure on the bleeding vessel and also has a coating that facilitates platelet aggregation. Sounds great on paper, but I had never used it. Time was ticking. Dr. Jones was gonna get here any minute, so I had no choice but to consult the ultimate authoritative source, YouTube. YouTube is the modern savior of junior surgical residents everywhere. Okay. Based on this very legit looking video. I was gonna need to soak the balloon in sterile water for thirty seconds, aim for the floor of the nose rather than the brain, which is A known possible complication if this procedure is performed incorrectly.
Inflate the balloon with the patient awake, of course, and hope that this was sufficient to stop the bleeding. So how did I, the kid in school that would glue her hands together instead of the paper doing arts and crafts, get here? Medicine versus surgery is often the first question that medical students ask of themselves when deciding a specialty to pursue. This dichotomy comes down to thinking versus doing, brain versus hands, ambiguity versus concreteness. But to me, these opposites felt completely wrong. Odolaryngology is a specialty of the senses, hearing, speech, taste, smell. It is a surgical specialty, yes, but it's so much more than that. It's a specialty that can restore hearing to the deaf.
But is it surgical to help a patient reconcile between improved speech discrimination for severely impaired music listening when deciding to get a cochlear implant?
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Chapters
4 chapters
1
What is the main topic discussed in this episode?
0:00–5:57
2
What sparked Tina Munjal’s first emergency ENT call and how did she feel about it?
5:57–13:56
3
How does the ‘Rhino Rocket’ balloon work to stop a severe nosebleed?
13:56–22:12
4
Why did Tina choose otolaryngology over other specialties?
22:12–27:48