This weekly series follows six interns over the course of their first year as they step into their roles as practicing physicians.
They are pursuing internal medicine, general surgery, primary care, family medicine, and emergency medicine in hospitals across the country.
, was drawn to practicing in the intensive care unit (ICU) since before she began her internal medicine residency at Harbor-UCLA Medical Center in Los Angeles.
She found that taking care of critically ill patients engaged her intellect and empathy. "It's everything that's interesting about medicine," she said. "You have to know physiology so well, and you can fix it. There are a lot of social issues with families, and ethical ones too."
Over the course of intern year she has gotten more comfortable with caring for very sick patients. "Seeing critical patients has helped me become a better judge of how sick someone is, if they need to be in the ICU," she said. "A lot of it is having confidence in your management capabilities. Knowing when you need to call for help or whether it's something you can deal with yourself. Being able to anticipate events."
In addition to improving her own clinical skills, Yang wants to improve ICU care. Through her reading and her experience, she realized how much variation existed in the care that patients received and how that care had long-term effects. "People get so debilitated in the ICU," she said. "They're completely weakened. It's very dramatic."
When she started working in the ICU, she knew that delirium was a major medical issue and linked to increased time spent on a ventilator and overall ICU length of stay. But she knew less about how to prevent it or treat it. "People know about it ... but I haven't really heard anyone say, 'This is how you deal with it,'" she said.
Critical care societies have released their own recommendations. "The guidelines are very well-written. The evidence is there," she said. "But comparing [the guidelines] to what is in practice, there's definitely a huge gap," she added. "There's just very little standardized in the way that we deal with delirium in the ICU."
Yang wants to help streamline that care. For the past month she has been laying the foundation for a research project to standardize delirium prevention and detection for her hospital and for others nationwide.
"The strongest recommendations are very basic," she said. They include screening for delirium and letting patients ambulate sooner rather than later.
But perceptions pose a challenge to those recommendations. "When you're critically ill, it's thought that you're not safe to ambulate," Yang said. "Part of it is changing the perception that critically ill patients are too weak. Keeping them in bed for weeks on the ventilator, not moving, is what's really detrimental."
Practicalities also prevent early mobility efforts. It takes a lot of staff and coordination to get sick patients up and walking, Yang said.
Screening for delirium could be logistically easier to carry out but would require a change in thought process. "Just recognizing it is half the battle ... I think it would be good if there were a formalized way to discuss it on rounds and brought up as part of a problem list," Yang said. "Then it wouldn't go days without going noticed."
Again, perception plays a role in underdetection. "I think there's a misperception from doctors that if we're giving sedation and changing consciousness and altering thinking, it's not bad because we're doing it. But that's not necessarily okay," Yang said. "It doesn't matter what the cause of delirium is ... It still leads to bad outcomes."
"More and more people are surviving ICU stays," she said. "Now it's about having good quality of life after that."
Previous installments for Yang: