Tales from my residency

Learning about the power of team-based health care, one patient at a time

Caring for a patient who’d had a cardiac arrest taught Leslie Tamura, DO, about the value of teamwork in medicine.


Joseph Pagone crumpled to his garage floor, unresponsive, barely breathing. Within seconds, his daughter’s boyfriend initiated cardiopulmonary resuscitation. Within minutes, emergency medical services arrived, bringing him to the hospital. Later, cardiologists targeted atherosclerotic plaques blocking flow to vital areas of his heart. Afterward, he came to the medical intensive care unit, intubated, sedated with two new coronary artery stents.

Barely a doctor for four months, I met Pagone, a 58-year-old husband, father, business manager and golfer on my very first day in the medical intensive care unit (MICU) at Advocate Lutheran General Hospital in Park Ridge, Illinois.

Like many patients I had met before and those that I continue to meet, Pagone had a team of physicians and other health care professionals caring for him.

Today’s patient-centered system

Unlike the hierarchical practice in which a doctor made a decision for ancillary staff to follow, today’s patient-centered system promotes interdisciplinary collaboration. Although the responsibilities of the medical team may become more complex with the presence of students, residents, and other professionals, interdisciplinary work often benefits patients and health care professionals.

I arrived to work extra-early on my first MICU day to get an overview of Pagone’s hospitalization from the overnight resident. I spoke with the nurse who supported him and his family throughout the night. Then I met Pagone.

The room was dim. I heard the sounds of the balloon pump, the ventilator, the flowing intravenous fluids. His wife was at the bedside, watching me examine her high-school sweetheart. We talked quietly about the course of events, the uncertain plan.

I would later talk with the cardiology and neurology teams to review their recommendations. Throughout his hospitalization, Pagone’s interdisciplinary team collaborated. The MICU team reviewed his condition and the strategies of the pulmonologists, cardiologists, neurologists and pharmacists, as well as any nursing concerns. Our plans remained flexible, changing as Pagone changed.

A few days after Pagone entered the MICU, he experienced a life-threatening arrhythmia. Immediately, his nurse called for help. The MICU and cardiology teams rushed to initiate CPR. Given the constant communication that had occurred throughout Pagone’s hospitalization, everyone knew his medical story.

Pagone returned to the catheterization lab, where the cardiologist found that his stented arteries had thrombosed. Per cardiology and pharmacy, he required a more potent form of dual anti-platelet therapy. He returned to the MICU still intubated, sedated, now with an intra-aortic balloon pump.

‘One link in that chain’

Pagone’s interdisciplinary team also addressed the Pagone family’s concerns. Peder Lindberg, MD, the emergency physician who had initially triaged Pagone, even visited the family.

“I’m glad that I could have been one link in that chain that pulled him back to safety and to his family,” Dr. Lindberg said.

As Pagone’s sedation was weaned, and the team challenged him to breathe, Pagone awoke.

“I was standing at the bedside, and the nurse told me, ‘He’s looking at you,’” said Frankie Pagone, the patient’s son. “It was the turning point.”

The day after Pagone was extubated, he told his medical team he was ready to go home. It would take a few more inpatient days, but he eventually returned to his everyday life.

“I want to get back in action,” Pagone said. “Sitting around is not my style.”

As I continue to learn as a new physician, I find that medical practice is becoming more interdisciplinary, less solitary. The increasing complexity of modern health care makes it potentially harmful to practice in isolation without information and advice from members of the patient’s team. Recognizing everyone’s respective areas of expertise and limits, Pagone’s care team worked toward one common goal: to provide the best possible care for the patient.

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