In this spotlight, Bhavika Shah, co-associate chief CRNA, shares more about the decision to build her career at Mass General, the challenges and rewards that she values in her work and her vision for the future of the CRNA profession.
Jerome Crowley, MD, MPH, is a critical care physician and anesthesiologist at the Massachusetts General Hospital Department of Anesthesia, Critical Care and Pain Medicine. After completing his residency and Intensive Care Unit (ICU) fellowship at the University of California, San Francisco, Dr. Crowley joined Mass General as an attending anesthesiologist and intensivist in the surgical ICU. He expanded his expertise by becoming a fellow in the Mass General Adult Cardiothoracic Anesthesia Fellowship. In July 2019, he resumed his position as Mass General attending, well-prepared and better equipped with a more specialized knowledge of the field.
To Dr. Crowley, pursuing dual fellowship training allowed him to grow as a provider and educator. This path, he says, is one that he encourages for all trainees and faculty who are interested in it.
“Many people ask me if multiple fellowships are worth the time and effort. I tell them to ask themselves what they want to be doing in 10 years,” says Dr. Crowley. “If additional training is what it will take to achieve it, then you will be thankful you took the time to gain the skills.”
Dr. Crowley shares more about his day-to-day in an intensive care setting, the lessons he has learned throughout his career and how he stays motivated in his work.
Q. Why did you choose anesthesiology?
I went into anesthesiology because of my passion for critical care. Anesthesia establishes an excellent background in physiology and acute pathology, which is very applicable to the ICU setting.
When I was a medical student, I was unsure if I wanted to work in a surgical or medical ICU, and anesthesia training prepared me for both units. It also allowed me to experience addressing a large variety of clinical needs in a hands-on way and alongside experts across all fields like surgeons and respiratory therapists.
Q. What lesson have you applied to your practice that you’d like to share with others?
One of the biggest benefits of working at an institution like Mass General is the availability of high-quality mentors who are always willing to offer advice and help. Here at Mass General, many people have been strong influences on my development as a physician, and I’ve learned many lessons.
When approaching conversations with patients and their loved ones in the ICU, I have learned that it is important to couple honesty with optimism. I listen to and acknowledge the hopes and wishes of the patient and their family, but also ensure that I only make promises that I can deliver on. Ultimately, it is up to the medical team to determine the best course of treatment while considering the goals and wishes of the patient and their family.
The ICU can be a very emotional place, so it is important for providers to always stay grounded and remain professional and collegial. As doctors, we have many difficult conversations with patients and families—conversations that are likely unfamiliar to them and emotionally complex. We can pause, take a step back and try to identify the feelings of everyone involved, as feelings extend beyond the organic causes and treatments of illness itself. Maybe someone feels guilty, or like they have failed the patient. As doctors, we always need to be supportive, empathetic and understanding.
Lastly, remember that all of us, even doctors, have good days and bad days. Take stock of good outcomes and experiences and let go of the bad. Particularly as a new attending, it is normal to feel like you need to know everything; however, knowledge only comes from experience and asking for help. When you see that a situation is not going well, reach out for help. It is not a sign of weakness—delivering care in the ICU is a team sport.
At Mass General, our team is really good at listening, actively building each other up and lending support when needed. We know that one individual’s attitude, be it positive or negative, can cause a trickle-down effect and impact everyone else on the team.
Q. What motivated you to return to Mass General as a fellow?
I think dual fellowship training is a more viable option in anesthesia as the field continues to become more specialized. After working as staff for several years, I was ready to add to my practice, and there is simply no substitute for the dedicated time and resources provided in fellowship training, especially at Mass General. Cardiac anesthesia seemed like a logical next step, as it was a specialty practiced by my mentors at Mass General, Kenneth Shelton, MD, and Gaston Cudemus, MD. I saw their practice pathways and skillsets and knew that I wanted to follow a similar path. I also wanted more experience taking care of patients with mechanical circulatory support as well as developing my echocardiography skills.
I can confidently say that I am a significantly better provider because of my fellowship experience.
Q. What does your day-to-day look like?
On days in the operating room, I arrive in the morning, set up for my cases, talk to my patients and then customize the best possible anesthesia care plan for them. In the ICU, the day depends on which shift I am covering. Usually, it involves talking to the prior intensivist as well as with patients and bedside providers, rounding with the team, discussing care with consultants and responding to emergencies. Other days, I am mostly doing academic work, working on projects and lending a hand to the resident and fellow education program.
Q. What areas of your field are you curious about today? Are you working on any notable projects?
Some of the projects that I am focused on today include developing a mobile extracorporeal membrane oxygenation (ECMO) team to support the teams at our affiliate institutions, North Shore Medical Center and Newton-Wellesley Hospital. Additionally, I am currently working with the education team to develop a collaboration model that include training for residents in anesthesia, infection control, pulmonary internal medicine and surgery. This type of effort is particularly important in anesthesia because it expands the role of critical care anesthesia.
Q. What do you love most about your work?
The best parts of work for me are both the colleagues I work with as well as the patients I get to take care of. There is such a strong team dynamic at Mass General where everyone pulls together to help take care of patients. It is this team-focused approach that I think is one of the most rewarding parts of working at Mass General.
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