Yesterday marked a big day for Stanford and the local community: Ground was broken for the new Stanford Hospital & Clinics. As Ruth Schechter reports in our online story:

Scheduled to open to patients in 2018, the new building will optimize the hospital’s services and infrastructure, adding more beds, private rooms, state-of-the-art operating suites, expanded emergency services and the flexibility the hospital needs to adapt to advancing technologies and more streamlined services.

The new 824,000-square-foot hospital will increase patient capacity to 600 beds and feature 368 individual patient rooms, an enlarged level-1 trauma center and an emergency department nearly three times the size of the current capacity. Designed by the internationally recognized firm Rafael Viñoly Architects, the project will feature amenities intended to enhance both physical and emotional healing with the latest in medical, surgical and diagnostic technology. The new building will be connected to the current hospital by a bridge and tunnel.

The new hospital will feature individual patient rooms centered on health and well-being, with expansive windows that provide natural light and integrated accommodations for family members to visit and spend the night. Patient rooms will be modular, allowing them to accommodate any level of acuity. A roof garden setting will create a quiet retreat for patients and families, and landscaping will feature native and drought-tolerant plants. The building also incorporates the latest innovations in green technology to reduce the hospital’s environmental impact.

About 400 community members, donors, and administrators, including Amir Dan Rubin, the hospital’s president and CEO, and Lloyd Minor, MD, dean of the School of Medicine, were on hand late yesterday to watch as “shiny red shovels were put to ceremonial dirt.”

Previously: Growing up: The expansion of Lucile Packard Children’s Hospital, Hospital mock-ups help refine plans before construction begins and City of Palo Alto approves rebuilding and expansion of Stanford Hospital and Lucile Packard Children’s Hospital
Rendering of new hospital from Rafael Viñoly Architects

Getting through medical school and raising a child are two activities that on their own can each be challenging - not to mention exhausting. But what’s it like to do them simultaneously? In a candid piece on Mothers in Medicine (a blog that I consider a must-read for doctor-moms), a writer shares the less-positive aspect of her juggle:

I judge myself constantly. If I were not a medical student mom, I could have given my child a more even-keel life filled with playgroups, museum activities, more reading and less TV. Should I be doing those things despite needing to study and handle school and fatigue? Should I have done more anyway? Maybe sucked it up, because darn it – medical school moms are supposed to be smart and manage the house and family? Having it all and doing it all, right?

Now I’m looking backwards. I am less than two weeks from graduation as I write this, and I still judge myself for decisions I made in medical school. We did survive the away rotations despite living in a 350-sq ft apartment for one of them. We survived each of the Step exams and third year. We even survived a crazy interview season that involved many flights, and I matched somewhere that is perfect for my family. However, did I do enough of the right things to balance out the wrong ones? Should I just be thankful Sesame Street and Super Why! have taught my toddler all his letters and numbers? (Thanks PBS!) I don’t really know, but I console myself that he is a loving, sweet toddler who seems to somehow really love me…

Blogger-physician Aaron Neinstein, MD, offers today a nice, brief reminder of how small things in health care can make such a big difference. Noting that he received a thick, comfortable cloth robe instead of the “humiliating, cold, and uncomfortable paper gown” at a recent dermatology appointment, he writes:

Small touches like this robe can make a dramatic difference in the patient experience. This does not mean that “luxury” can or should replace high-level medical care. However, thoughtful touches like this robe can enhance and augment high quality medical care to make it even better, and we should not ignore these opportunities to make our patients feel more comfortable.

The CommonHealth blog drew my attention today to the story of a group of students who jumped into action after the Boston Marathon bombings. As one of the pre-med students explains in the Times Higher Education piece, the incident - as horrific as it was - solidified her decision to go into medicine:

Near the marathon’s finish line, 50 Boston University pre-med undergraduates had been volunteering in the medical tent, filling out record forms and carrying supplies, when the bombs went off.

…

Some of the Boston University volunteers worked to clear the aisles as the floor of the tent ran red with blood. They saw the wounded, including children, arrive with missing limbs, and physicians fashion tourniquets from belts and shirts. One was ordered to set up a morgue.

“There was nothing in a classroom that could have prepared us for this,” [Yeon Woo Lee] said. “Some of the students in my group were barely 18. People stayed calm. Nobody panicked. It was scary, but I’m glad that I was there to help out and very proud.”

The experience for her and the others, she said, was horrifying and inspiring. “It was a terrible, terrible, terrible week with a lot of pain and suffering, but at the same time there’s nothing else in the world I would rather do now than go into the field that I chose to dedicate my life to,” Ms Lee added.

Previously: “We are not innocents:” What prepared medical professionals to treat Boston bombing victims

My now-husband and I were together when I learned I had a chronic illness - a rare blood disorder - 13 years ago. (I’ll never forget how hard he held my hand as we sat in the waiting room before my bone marrow aspiration, or how he went out and bought me a pair of flannel pajama bottoms to lounge around in on those days when I was waiting for the results and feeling weepy and scared.) I never had to deal with telling a potential mate that I had a disease, but I can’t imagine it would be easy. Which is why I found this first-person piece on the The Global Gene Projects’ website of interest. There, a guest blogger shares her own experience and offers advice from an expert:

One of the biggest questions in regard to this topic, at least for me, was how long into the relationship should a rare disease patient approach the topic of disease and diagnosis? (I had a feeling that [the therapist's] answer wouldn’t be “well just ambush them with it on the first date and see how it goes.”)

Instead [Dawn Wiggins, a licensed family and marriage therapist] replied, “When to discuss your health diagnosis and related issues with someone you are dating depends on what the expectations are for the relationship. If it is a casual dating relationship there is less burden or urgency to disclose early in the relationship. If there is a risk that your disease and symptoms could impact the time you are spending together, you may need to disclose. If your relationship is more serious and there is an expectation of a longer term commitment, it is important to be honest sooner than later.”

Previously: Broken: A poem about coming to grips with chronic disease

Those of you who have ever waited for hours (or what feels like hours) in an emergency room might appreciate this statistic: In the last eight months, the median door-to-doctor time for patients visiting Stanford’s emergency department dropped from 45 minutes to 18. So what happened? Credit the implementation of two new programs, Team Triage and Fast Track, that were “designed to provide speedier, more efficient service” in the ED. The current issue of Stanford Medicine News has more details:

First came Team Triage, inaugurated a year ago. In the same area as the waiting room, big bronze-colored letters that spell “triage nurse” are affixed to a dividing wall, behind which patients are evaluated by a team of doctors, nurses and ED technicians. Apart from trauma patients brought in by ambulance to receive the highest-priority care, everyone who comes into the ED passes through the Team Triage area. Minor injuries are classified as 4 or 5, the most critical as 1. “Most patients are 3s,” said Patrice Callagy, RN, patient care manager in the ED. “They might have abdominal pain or broken bones.” Team Triage also allows for earlier diagnosis of time-sensitive conditions, such as stroke.

An analysis found that 40 percent of the hospital’s patients were sick enough to have been admitted through the ED. It also showed that 12 to 13 percent of the ED’s patients were 4s and 5s, who did not require hospitalization. Yet their relatively minor medical issues meant that they were waiting the longest, starting with how long it took for them to see a doctor.

…

Enter Fast Track, a dedicated team composed of doctors, nurses and ED technicians whose job is to treat patients with less-severe health problems as rapidly as possible. “We treat you and let you get on with your life,” said [Grant Lipman, MD], Fast Track’s medical director. “You’re the least sick, so we’ll treat you the fastest.” The median length of stay for Fast Track patients is 65 minutes, well under the original goal of 90 minutes.

Previously: Decreasing demand on emergency department resources with “ankle hotline” and Windows ER?

Did you see yesterday’s Well blog entry on the growing number of older adults seeking therapy? Abby Ellin reported:

“We’ve been seeing more people in their 80s and older over the past five years, many who have never done therapy before,” said Dolores Gallagher-Thompson, a professor of research in the department of psychiatry at Stanford. “Usually, they’ve tried other resources like their church, or talked to family. They’re realizing that they’re living longer, and if you’ve got another 10 or 15 years, why be miserable if there’s something that can help you?”

Some of these older patients are clinically depressed. The National Alliance on Mental Illness reports that more than 6.5 million Americans over age 65 suffer from depression. But many are grappling with mental health issues unaddressed for decades, as well as contemporary concerns about new living arrangements, finances, chronic health problems, the loss of loved ones and their own mortality.

…

That members of the Greatest Generation would feel comfortable talking to a therapist, or acknowledging psychological distress, is a significant change. Many grew up in an era when only “crazy” people sought psychiatric help. They would never admit to themselves — and certainly not others — that anything might be wrong.

“For people in their 80s and 90s now, depression was considered almost a moral weakness,” said Dr. Gallagher-Thompson. “Fifty years ago, when they were in their 20s and 30s, people were locked up and someone threw away the key. They had a terrible fear that if they said they were depressed, they were going to end up in an institution. So they learned to look good and cover their problems as best they could.”

Previously: The importance of combating loneliness among older adults and Elderly adults turn to social media to stay connected, stave off loneliness

Every year on a Friday in spring, Stanford Medicine opens its doors to area high-schoolers, who take courses at the medical school on a wide range of medical and scientific topics. This photo from earlier in the week shows three participants of our popular “Brain Lab” session.

Previously: Image of the Week: Med School 101, Med school: Up close and personal, A quick primer on getting into medical school, Teens interested in medicine encouraged to “think beyond the obvious” and High-school students get a taste of med school
Photo by Norbert von der Groeben

My daughters spent their first few days of life in the neonatal intensive care unit, and I won’t soon forget padding down the long hospital hallways, decked out in my flimsy gown and fluffy blue slippers, every two hours to go visit and feed them. As emotional as this time was for me and my husband, I recognize it would have been even more so if I wasn’t able to see my baby - which is why I think a new program at a Los Angeles hospital is so cool. Called BabyTime, the Cedars-Sinai program uses iPads to connect parents with their premature or ill newborns.

readwrite’s Brian S. Hall reported yesterday:

Mothers who are confined to recovery rooms following delivery, typically because of a cesarean section or other complications, often can’t see their newborns in the intensive care unit for 2-3 days. “With BabyTime, the new mother can now see their baby in about 2-3 hours,” Yvonne Kidder, a clinical nurse in the hospital’s Neonatal Intensive Care Unit (NICU), told me:

“BabyTime’s been wonderful. For mothers, to see their baby, this absolutely lessens their anxiety. For the fathers, who can become overwhelmed with all the information they are receiving, BabyTime bridges the gap and allows for a direct line between mother and caregivers.”

Previously: The emotional struggles of parents of preemies

Much has been written about the tragic events in Boston on Monday, but I have to draw attention to a New Yorker piece detailing how the doctors and nurses at area hospitals leapt into action to treat victims’ war-like injuries. Atul Gawande, MD, describes what happened at the hospitals that afternoon, and his take on why people there worked with such “grim efficiency”- and why, in turn, so many victims survived - is compelling:

…Something more significant occurred than professionals merely adhering to smart policies and procedures. What we saw unfold was the cultural legacy of the September 11th attacks and all that has followed in the decade-plus since. We are not innocents anymore.