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Fellow Spotlight: Thomas Christanson, MD

Tuesday, November 7, 2017

The career of Neurocritical Care Fellow Thomas Christanson lies in the boundary between anesthesiology and neurocritical care--and that’s just where he wants it. In this week’s Fellow Spotlight, Christianson talks to us about his training in each of these fields, and how they complement each other. He also talks about his life outside of work and finding a work-life balance as a husband, hiking enthusiast, and father of four.

What are your responsibilities as a Neurocritical Care Fellow? What does a typical day for you look like?
The traditional neurocritical care fellowship is two years, with different responsibilities each year. During the first year, you are responsible for running rounds on the middle eight-bed section of the ICU. The team usually consists of an attending neurointensivist and either a resident (or two) or NP. The second year, you are responsible for the first 8 bed section of the ICU. Here, you also run rounds but with a team consisting of just you and the NP. After rounds, you then discuss your plans with the attending, which allows more autonomy as you get closer to graduation. I am the first one-year neurocritical care fellow at Duke, so my year is going to be a hybrid of the two years with most of the first half as a junior fellow and most of the second half as a senior fellow.

The typical day begins at 7 a.m. with an hour of sign-out from the overnight team. After sign-out, we begin rounds, which can vary from three to eight hours depending on the complexity of the patients. I also try to make it to noon conference or one of the other weekly educational opportunities, including grand rounds, journal club, the critical care lecture series and others. The rest of the afternoon is spent following up on the plans made during rounds and admitting any new patients who arrive. In the evening, we briefly round again to ensure there is a solid plan for the night team. Sign-out to the night team starts at 7 p.m.

You just completed another Duke Fellowship in Anesthesiology. How do the fields of Anesthesiology and Neurocritical Care complement each other?
The focus on physiology and pharmacology in anesthesia parlays very well into critical care. The medications used in anesthesia for blood pressure control are the same medications used in critical care. The arterial lines and central lines that are routinely placed and monitored intraoperatively are also frequently used in the ICU. I also have a unique perspective for postoperative care of neurosurgical patients, as I get to participate in the intraoperative care of the patients and know precisely what happens intraoperatively. In neuroanesthesia, one of the main focuses is on optimizing cerebral blood flow. This also correlates well with treating intracranial hypertension in the ICU; however, during this year, I will be focusing on general neurology as it relates to neurocritical care.

What’s the biggest difference between these two programs that you’ve noticed so far?
There is a much larger emphasis on research in the NICU compared to the SICU. This year, we have monthly research meetings that are attended by most of the providers in the unit. Every patient that is admitted to the NICU is screened for ongoing research studies and many of them are approached to participate and enrolled. Last year, I could count on one hand the number of patients that I took care of that were involved in ICU trials.

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 completing fellowship, my family and I will be returning to the University of Tennessee Medical Center in Knoxville. Two thirds of my job will entail of clinical time doing OR anesthesia, predominantly for cardiac and neurologic surgeries. The other one third of my time will be spent in the neuro or cardiothoracic surgical ICUs. This is exactly what I was looking for in a job, a nice mix of anesthesia. It does not hurt that it is close to our extended family and near the outdoor things that my family likes to do.

You recently celebrated the arrival of Nathan, your fourth child, this October. What’s been the biggest surprise about fatherhood personally, and how do you balance time between being a father and having a demanding career?

We are adjusting to being a family of six right now.

The most important reason that I am able to balance my family and career is my wonderful wife. She stopped working as a teacher right before our twins were born and now stays at home with our children. Without her sacrifices for our family, I would not be able to find the balance that I have. The big thing that I try to focus on while at home is to be intentional with my time. I make a point to leave work at work (when possible) until after the kids are in bed and spend time with the children as much as possible while they are awake. This includes playing sports with my boys in the backyard after work, taking the kids fishing in the neighborhood pond, having tea parties with my daughter and her baby dolls. I do work at lot, but when I am home, I want my children to know that I want to be there making memories with them. This frequently makes for late nights and/or early mornings for me to get my research and studying done, but it gives me more time with my family.

The Christansons posed as a family of five earlier this year...

...and welcomed Nathan to their ranks this October.


What passions or hobbies do you have outside of the Department?
I am an avid sports fan and enjoy being outside as much as possible. Prior to the twins, we frequently took our oldest and hiked in the Smoky Mountains while living in East Tennessee. Once the twins get a little older, we plan to more time hiking and boating again. In the meantime, we frequent parks and museums throughout the Triangle and have daily backyard soccer/football/baseball games.