Sharing the Air with Natasha Spottiswoode, MD
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What is the premise of Natasha Spottiswoode’s story and why does it matter for clinicians?
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Learning medicine is tough. It requires a lot of reading, understanding, memorizing. But there are other parts of medicine that we learn differently, a more body-based learning, which is grounded in feel, in instinct, in spidey senses. How do we think about that type of learning? You're listening to The Nocturnists, stories from the world of medicine. I'm Emily Silverman. Today I speak with Natasha Spottiswood, an infectious disease physician-scientist with a love of outdoor adventure. She grew up in California, studied malaria and iron metabolism in the UK, and moved to New York for medical school before coming back to UCSF for residency and now infectious disease fellowship. Outside of work, she loves to rock climb, backpack, cook new recipes, and explore new places with her partner and friends.
Before I speak with Natasha, we're going to hear the story that she told live at the Nocturnus in January 2020. Here's Natasha.
It was a dark and stormy night. I actually don't mean that literally. This is San Francisco. It's beautiful weather, usually. But that night, it was clinically dark and stormy. I was brand new to being a senior resident. My intern was new to being an intern. And I think even my third year medical student was also new to being a third year medical student. And we were in the middle of the busiest call day that we had ever had. We'd taken so many patients and they were all so sick. And I was super worried about being a senior resident and doing my job well and keeping the patients safe, but also giving everyone on the team the independence that they needed to grow. And I didn't know them very well. I knew my intern, George, well enough to know that I could trust him to take a thorough and sensitive history and to see patients as people and not just collections of illnesses.
But I didn't know how good his clinical acumen was, and I worried that in our newness we might miss the forest for the trees. So that night, we got a call from the emergency room that they had an admit for us who was a gentleman with alcohol use disorder who'd been found down. And then we hear that he has a low hemoglobin, which is bad. And then we hear that he has a fast heart rate, which is much worse, and in that context, suggested that he was bleeding somewhere. So as we're walking to the ER to get this patient, I said to George, what's the first thing we're going to look at when we go into the room? And he says, well, this man has drunk a lot of alcohol over many years. I'm worried about his brain and his memory.
We should know if he knows where we are and what year it is. And I said, yes, George, that's right. We will do that. But I'm really worried he's bleeding. So the first thing we're going to look at is how many IVs he has in case we have to give him blood. So we get to the room, and the patient does indeed look quite sick. And I said, actually, I'll take this patient. You'll take the next one. So, I got to work, and my pager was going off, and the next thing I know, we have a second patient. And this second patient has metastatic cancer and is coming in confused. And I remember hearing that and thinking, this person is sick and I don't quite know why, and that's scary. but I couldn't leave the first patient, so I said, George, can you go take a history, find out what's happening, and if they look bad or their vital signs change, just call me and I'll be there.
So he goes off, and I go back to work on my first patient, and I was trying to keep track of everything that was happening that day, and I was thinking about someone's insulin level and an anion gap and a heart rate, and things were just stacking, and my pager kept going off,
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Chapters
3 chapters
1
What is the premise of Natasha Spottiswoode’s story and why does it matter for clinicians?
0:00–9:08
2
How did the “dark and stormy night” emergency case unfold for the senior resident and his intern?
9:08–16:48
3
What critical mistakes highlighted the intern’s missed cues and how were they resolved?
16:48–35:33