Behind The Scenes

5 a.m. Preparation for the Shift

Minutes away from UC Health’s UC Medical Center is Evanston, Ohio, where you can find the Irankunda residence. Edmond (Eddie) Irankunda, MD, is a third-year resident physician in the University of Cincinnati Emergency Medicine Program. Dr. Irankunda lives near the Clifton, Ohio Campus with his wife, Victoria, and young son, Kimani. While Victoria and Kimani are fast asleep, Dr. Irankunda is preparing to start his day.

He turns his alarm off and gets ready for his 7 a.m. shift in UC Medical Center’s Emergency Department. With each passing workday, he is one step closer to completing his residency and starting his dream career as an attending emergency medicine physician.

Born in Rwanda, Dr. Irankunda moved to the U.S. with his family in 2003 after living in various parts of Africa. As he grew, he became more and more interested in the field of medicine. He finished his undergraduate education on the South Bend Campus of Indiana University, before moving on to the Indiana University School of Medicine.

Early in his undergraduate experience, Dr. Irankunda planned to pursue nursing, but after working as a scribe in a local emergency room, he found his true passion. He built close relationships with the physicians he worked with.

After completing a rotation at UC Medical Center during medical school, the decision to return to Cincinnati was a no-brainer. Dr. Irankunda loved the exposure he could have to many specialties of medicine, equipping him to care for the sickest patients. As the original and first emergency medicine program in the country, UC offered him the best education and experience opportunities.

“I fell in love with the program the moment I arrived,” he says. “I really wanted to have that exposure so I could develop my clinical skills so that I’d be ready to care for any patient I encounter.”

Dr. Irankunda matched into UC’s emergency medicine program in 2018. The Match is a system used to place medical students into residency and fellowship programs across the country. Residency is a stage in training after medical school where physicians get hands-on experience with patients in a hospital setting.

When Match Day arrived, Dr. Irankunda hoped he would have the chance to call Cincinnati home. As it turns out, he matched into the program that was his No. 1 choice.

“I was ecstatic! It was one of my happiest moments for sure,” Dr. Irankunda says. “After doing all of the hard work in medical school, I was very fortunate and blessed to match at an amazing place.”

In his two and a half years as a resident, Dr. Irankunda has been exposed to many clinical areas that UC Health offers, including Air Care and Cincinnati SWAT training in partnership with Cincinnati Police Department. He also cares for patients in some of UC Medical Center’s intensive care units.

Dr. Irankunda walks downstairs, turns the lights on, brews coffee and cooks breakfast. As he sits down with his breakfast and black “UC Emergency Medicine Program” coffee mug, he thinks about what may happen during his shift. He knows that anything is possible. He may walk in to a packed shock resuscitation unit (SRU) and full waiting room, or things may start slowly before the day gets busy later on.

After breakfast, he changes into his scrubs, grabs his badge and vest, and goes to Kimani’s room to embrace him one last time before he leaves for the day. He locks up the house, hops in the car and makes the four-minute commute to UC Medical Center.

7 a.m. Patient “Sign-Out”

Once he makes his way through the underground tunnels of UC Medical Center, Dr. Irankunda arrives in the Emergency Department, where he finds other residents, physicians and nurses busy at work, wrapping up their overnight shifts.

He walks over to A-Pod and meets with the current third-year resident on duty. UC Medical Center is split into “pods”, which include beds and a main care station where staff can monitor each patient. A-Pod houses the third-year resident, attending physician (the doctor who supervises residents and interns) and a charge nurse. The third-year resident desk is located near the ambulance bay, so he or she can easily see paramedics and emergency medical services (EMS) arrive.

Each time a physician or resident begins a shift, they must “sign-out” with their colleagues and transfer their patients to ensure a seamless transition of care. Third-year residents manage the care of eight beds in A-Pod and oversee patients who come to the SRU. The SRU receives patients in need of critical, lifesaving care.

Once the sign-out process is complete, Dr. Irankunda takes over and officially begins his shift.

7:30 a.m. Education — A Critical Part of Residency

Before starting his rounds, Dr. Irankunda heads to his daily morning report. Every day between 7:30 and 8 a.m., one of the attending physicians presents a hypothetical, but possible real-life, medical scenario to interns, second- and third-year residents. This is in preparation for their board certification after residency, which must be completed in order to practice medicine.

On this morning, Edward J. Otten, MD, professor in the Department of Emergency Medicine at the UC College of Medicine and a UC Health physician, leads the group through a toxicology case.

Once education ends, Dr. Irankunda returns to A-Pod and walks through each bed to check on his patients. He listens carefully to their concerns and discusses their treatment plans. Throughout this time, he communicates back and forth with the nurses and the attending physician. Being in the Emergency Department, patients need his full attention and every bit of experience he has.

By 11:30 a.m., Dr. Irankunda returns to his desk for a quick break and snack. No matter how busy the day is, he tries to squeeze in enough time to recharge.

“These days can be hectic and wear you out, especially during COVID-19,” he says. “Sometimes, it’s hard to remember to take a break.”

12:30 p.m. Teamwork and Lifesaving Care

Dr. Irankunda’s shift has been steady so far, but that changes quickly. One of the phones he carries on him rings. EMS providers from around the region call our Emergency Department to give a “heads up” that they are bringing a trauma or very sick patient.

UC Medical Center is the online medical control for southwest Ohio, meaning that our clinicians provide EMS agencies online medical control in the event they are on the scene and need to give a patient medical intervention above their level of training, need to pronounce a patient dead after CPR or have any concerns requiring physician input before transporting them via ambulance or helicopter.

In this case, EMS phones Dr. Irankunda to inform him they are bringing a patient over who suffered a heart attack. Answering the phone is an important responsibility that comes with being a third-year resident.

“When you get that call, there’s a lot going through your head. The biggest thing is to listen to what EMS tells you — it could be anything,” he says. “Instead of overanalyzing what they say, listen to what they report and then from there, determine next steps.”

Dr. Irankunda gives EMS his unique physician identification number and asks them to give him a report. As he converses with EMS, he has a straight-line view to his charge nurse, who is also listening to the conversation from the charge desk. While the call takes place, Dr. Irankunda and his team can determine if the patient needs immediate, lifesaving care in the SRU, or needs assistance from other hospital specialists, such as the trauma team.

Just after he finishes one call, another comes in. EMS is on their way with a stroke patient. Minutes after that call, he receives yet another notification — this time from UC Health Air Care. They are flying a burn patient over to UC Medical Center in a few minutes.

In the blink of an eye, Dr. Irankunda’s leadership skills are put to the test, as three critically ill patients will be arriving almost simultaneously. He delegates roles to nurses and other residents in the unit. He also contacts the interventional cardiologist, trauma and burn unit ICUs and stroke teams, all of which are on-site. UC Medical Center, the region’s only Level I adult trauma center, has specialists available 24 hours a day, seven days a week, 365 days a year to treat patients suffering from a wide range of medical conditions and injuries.

“Those are the shifts when you craft your skills in emergency medicine, by caring for patients in the most critical condition,” he says.

UC’s emergency medicine program uses a gradual responsibility model for residents. In a resident’s first year, they learn the basics of emergency medicine. Second-year residents perform invasive procedures in the SRU. Third-year residents are the sole team resuscitation leaders while fourth-year residents take on more of a mentoring role for younger residents and serve as a backup as needed to second-year residents with procedures.

Dr. Irankunda and his teams carefully work to care for each patient. Once each is stable, they are admitted into the Cardiovascular ICU, Neuro ICU and Burn ICU, respectively. While all of this is going on, his nurse colleagues hold down the pod and alert him if a patient is critical or needs to be assessed sooner than later. Teamwork and collaboration is essential to patient care in the Emergency Department.

“One of the biggest strengths that makes us be efficient leaders is the team we work with,” he says.

3 p.m. A Clear SRU

Things finally slow down after a chaotic — though not abnormal — few hours. Dr. Irankunda returns to his desk in A-Pod and updates his notes. He takes a deep breath, satisfied to know that all of his patients are receiving the treatment they need.

Soon after, another resident walks in to relieve him. Having lost track of time, he looks at his watch: 3:07 p.m. Time to wrap up his shift and head home.

Before he leaves, Dr. Irankunda performs a sign-out and fills in the new resident on his patients, ensuring he shares every important detail. He grabs his water bottle and walks past the empty SRU to the Emergency Department’s double doors.

“If you are able to leave with a clear SRU, that is a good thing. Especially on a day like today, where there were multiple critically ill patients,” he says.

As he makes his way through the hospital’s tunnels toward an elevator to the parking garage, he reflects on his shift.

What went well?

What could have gone better?

What do I need to do in the future to improve?

Dr. Irankunda appreciates the positive interactions he has with his colleagues and patients, and he focuses on those rather than ponder any mistakes or stress from the past eight hours. It’s easy to dwell on those moments when he isn’t able to save a patient’s life, but he also knows how rewarding it is when he does make a lifesaving difference. That feeling drives him every day.

Once in the parking garage, Dr. Irankunda finds his car, turns on his favorite music and commutes back home.

Victoria welcomes him when he arrives. Before he shares about his day, he finds Kimani, gives him a big hug and spends time with him while he plays. Dr. Irankunda knows that life is about the little things away from his job. Specifically, his role as a husband and father.

“I put everything into perspective. For me, I’m grateful to have people to come home to who remind me that so much more goes on outside of those hospital walls,” he says.

After playing with Kimani, Dr. Irankunda sits down at his kitchen table with Victoria and talks about his day at work. Having worked as a scribe in an emergency room herself, Victoria understands what he goes through. During good days and bad days as a resident, and throughout his grueling days as a student, she has been his rock.

Dr. Irankunda is also appreciative to have the support of his 13 resident colleagues in the program’s 51^st graduating class, the Class of 2022. They all keep in close contact and rely on each other during the most difficult days of residency.

Before preparing dinner, Dr. Irankunda and Victoria discuss their weekend plans. While COVID-19 has limited their activities, they still try to explore Cincinnati as much as possible, whether it’s going to Ault Park or visiting the Cincinnati Zoo. They look forward to calling the Queen City home for a long time.

Dr. Irankunda knows that he can accomplish any of his career goals — whether it be pursuing academic medicine or practicing community medicine — because he has UC Emergency Medicine on his resume. “It’s an honor to be part of this program. I couldn’t imagine being anywhere else,” he says.