See One, Do One, Teach One with Bobby Chiong, MD
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What is the premise of Bobby Chiong’s “see‑one, do‑one, teach‑one” story?
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Being trusted. That's what we want as doctors for our patients to feel safe, like they're in good hands with us. But sometimes the trust of our patients is overwhelming and even scary. This is The Nocturnists, stories from the world of medicine. I'm Emily Silverman. Today I speak with Bobby Chong, an interventional radiologist and chair of radiology at the St. Barnabas Hospital Health System in the Bronx. He's a native of Southern California but has long since acclimated to the New York City way of life. When not being a doctor, Bobby is usually out dancing, riding his motorcycle, or practicing jujitsu. Before we chat with Bobby, we're gonna hear the story that he told live at the Nocturnus in New York City, all the way back in December 2019.
Here's Bobby.
See one, do one, teach one. That's the time honored way that medical procedures are taught, and this is how I had to do all three on the same day. My patient was Mr. Jones. Mr. Jones had lung cancer, and he was starting to notice his face was swelling. His uh veins were popping up on his neck, and he was starting to have trouble breathing. He was having trouble eating and laying down. So he came into the hospital and he was diagnosed with SVC syndrome. So the SVC, the superior vena cava, that's the major vein that drains the blood from the head and the So his doctors called on me to see if there was anything I could do to help. So the first step is I always go and I meet the patient and I explained to him the risks and the benefits of a procedure I could do.
I could do a venogram and I could possibly get through that obstructed vein and open a channel and put in a stent. And of course there's risks and benefits and I explained to him the risks and benefits of the procedure. And he signed the consent, said he understood. And you said, Do what you gotta do, Doc. So we set up the procedure for the next day. He came to the radiology department and my patients are generally awake from my procedures. They get a little bit of sedation and I explain, Okay, we're gonna clean your neck and we're gonna prep drape the area. You'll feel sticking a burn, this local numbing. and put a needle into the vein, put a wire through that needle, put a catheter over the wire. And I'm in the jugular vein.
So now I can get to work trying to get through the S V C. I have a glide wire and the glide wire is a very slippery wire that's kind of a workhorse for this and I'm working with the glide wire. I feel a a little pop, a little give. Mr. Jones, all right, I think I think we're through this obstruction. I have to put up a balloon now. And you know, you may feel a little discomfort, just let me know. Put up the balloon. He does fine. Take down the balloon. And Mr. Jones says I don't feel so good. And he says I can't breathe. And then I haven't seen this often, but then I see him die. So he's limp, the life goes from his face. I look at the monitor, his EKG activity's still still going on. I I feel his neck. I he's got no pulse.
Shaji, call team one. Team one's the highest call for help in my hospital. So first step at a code, check your own pulse. Go back to the basics. Okay, ABCs, airway, breathing, circulation.
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Chapters
5 chapters
1
What is the premise of Bobby Chiong’s “see‑one, do‑one, teach‑one” story?
0:00–7:08
2
How did the patient with SVC syndrome present and why was a stent needed?
7:08–17:54
3
What went wrong during the first procedure and how was the code recognized?
17:54–20:05
4
What immediate steps did Dr. Chiong take to manage the pulseless electrical activity (PEA) arrest?
20:05–25:56
5
How was a pericardial tamponade identified and treated with a pericardial drain?
25:56–30:07