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Fellow Spotlight Rana Moosavi, MD

Monday, October 29, 2018
R Moosavi

For Rana Moosavi, MD, working in the neuro-intensive care unit is the best of both worlds, offering a chance to keep one eye on a patient’s nervous system and another on their overall health. For this week’s “Spotlight” interview, the neurocritical care fellow talks to us about the scheduling fluke that led her to this specialty, relates a scary moment from the first night of her fellowship, and discusses her plans for a second fellowship and a future in academic medicine.

What are your current responsibilities as a neurocritical care fellow? What does your typical day look like?
As a junior neurocritical care fellow my responsibilities include taking care of a subset of  patients in our unit. A typical day for me in 8E begins at 7 am where we receive sign out from the overnight provider. After sign out, we being rounding. The team, which includes myself, an attending, and a resident or nurse practitioner will go in each room and examine the patient. We then step outside and system by system create an assessment and plan. As a junior resident my job is to run the rounds and devise the plan with the input of the attending. After rounds, I will then perform any required procedures, do some teaching if there is a resident on our team, and help with any new admissions. As in most intensive care units (ICU), at the end of the day we have evening rounds to go over any pertinent events that happened during the day and give the overnight provider an idea of what they should be monitoring during their shift.

How did you first get interested in neurocritical care? What do you enjoy the most about the field?
Interestingly, when I first started my neurology residency I was interested in headache. Our program at the University of Arizona included an immersive preliminary year in medicine which required us to do six weeks of medical ICU. I was fortunate enough to have nine weeks. That scheduling fluke changed my entire career path. I realized after my intern year that I wanted to work in an ICU and with neurocritical care, I was able to combine both my interests in neurology and critical care. The things I enjoy most about the field is that we take a holistic view of the patient. We are not focused on just the nervous system but are able to manage every system. I also enjoy the fact that there is so much collaboration with other services.

What’s one experience from your fellowship so far that stands out as being especially memorable or useful to you?
In the couple of months that I have been here at Duke, one of the things that stands out for me the most was during my first 24-hour call in our unit. During that shift, a very sick patient was admitted to my section of the ICU. I was terrified that I would make a mistake. Our unit is designed so that there are two other providers with you at night covering the two other sections of the unit. That first night, I felt so fortunate to have two amazing nurse practitioners with me who were able to help me provide care to the patient. We really have a great system in our unit where there is always someone there to assist and support you should you need it

What plans do you have for after you complete your fellowship? If you could have any job in the world, what would it be?
After I finish my neurocritical care fellowship, I plan on doing a second fellowship in electroenchephalography (EEG). Many of our current attendings and former fellows have done the same. We use continuous EEG so often in our ICU that it would be an advantage to be able to read my own studies. After my second fellowship, I will try to look for my dream job. I would like to work for an academic institution so that I can continue to conduct research. I would like the neuro ICU in that facility to be a closed one, like the one we have here at Duke. This would allow me to have ownership of the patients and give me the ability to also manage non-neurological problems as well.

Earlier this year you delivered a grand rounds lecture for the University of Arizona College of Medicine on the relationship between stroke and seizure. What was the key message of that lecture?
At the University of Arizona, we have a large stroke population and one of things that continued to come up during some of our neurology conferences was patients that presented as a seizure but were in fact having a stroke and were not given intervention. It was a recurring theme and therefore I decided it should be my grand rounds topic. Interestingly, there is not that much data on the subject. There have been numerous studies that have focused on the risk of seizures after having a stroke but not many on seizures that will acutely precede an ischemic stroke. The key message at the end of my talk was that a seizure is not a contraindication to giving intravenous therapy if the patient meets all other criteria. My hope was that it would assist in reassuring the residents to provide treatment to acute stroke patients that do not have a typical presentation.

What other passions or hobbies do you have outside of neurology?
Outside of neurology, I love to eat at new places and try new cuisines. Over the four years that I was in residency in Tucson I believe I was able to try over 80% of the restaurants in town. I like to make a list of places that seem interesting, have good reviews, or have been recommended each week. So far Durham has not disappointed. My other biggest hobby is reading. I try to read at least 1-2 novels a month depending on my work schedule. I tend to find a topic that is interesting and will read a couple of books in that particular category. I am currently reading The Broken Ladder by Keith Payne. I chose this book because it is by a local writer and the current topic I am reading about is public health.

R Moosavi

Moosavi visits an exhibit by Yayoi Kusuma in New York City.