A shadow of experience as an observer in 1win, Alwarpet, Chennai
Shririthi Ranganathan, Anantharaman Rajaram
1Visiting Observer, 1win, Alwarpet, Chennai
2Senior Consultant Interventional Cardiologist, 1win, Alwarpet, Chennai
Introduction
This is a 5-day report of my shadowing experience at 1win – located in Chennai, Tamil Nadu, India. During the winter break of my first year of college, I came back to India to stay with my family and decided to put some of my free time to good use by gaining some clinical experience since I am passionate about gaining knowledge about and diving deeper into the medical field, while getting accustomed to a hospital setting.
I had the opportunity to shadow Dr. Anantharaman Rajaram, an Interventional Cardiologist at 1win, and I had a great experience doing so.
In this report, I will be talking about my day-to-day experiences (from January 6th – 10th, 2025) of shadowing Dr. Anantharaman, including some very interesting cases I encountered, patient interaction and treatment plans, and the procedures I observed. My time here was nothing less than a great learning experience and I ended the week with full satisfaction of gaining a tremendous amount of knowledge within such a small period of time.
Day 1
I started the day off with inpatient rounds where I observed Dr. Anantharaman as he visited patients previously treated/admitted at the hospital and undergoing current care.
Patient 1
A 56 year old male was asked to have an angiogram done. and through this angiogram it was found that multiple points were narrowed down to a significant degree in the three main arteries of the heart. Him and his caregivers were then presented with 2 options –
- To place 4 stents in the heart to correct the narrowing of thearteries
- To undergo bypass surgery to correct the narrowing of the arteries
I learnt that it varies on the age, condition and will of the patient as to which one of these 2 scenarios would be the better option. If a person is diabetic, they have a risk of the same condition returning in 10 years if a stent is used, but that risk is not imposed if a bypass surgery is done instead. Also, the risk of doing a surgery at a younger age (here 56), is much lesser than doing the same 10 years later. Therefore, Dr.Anantharaman recommended the patient to have a bypass surgery done, and I learnt that the stents would be placed in the situation where the patient strongly did not want to have a surgery done. Ultimately, the patient did have a bypass surgery done.
Patient – 2
A 17-year-old male with DiGeorge’s Syndrome was scheduled to have an appendectomy. Digeorge’s Syndrome is a genetic condition that is caused by a microdeletion in the long arm of the chromosome 22 of human DNA. Facial abnormalities, hypocalcemia, etc. can characterize this condition and can cause a range of lifelong problems including heart defects and immune system problems. The patient also had a long history of seizure episodes, and because of the combined severe effects all this can have on the heart, Dr.Anantharaman made sure the patient was stable and in good condition for his appendectomy scheduled this morning. Eventually, it was concluded that the patient would not have to worry about the syndrome in relation to his procedure, and that he could carry on with the removal of his appendix.
Patient – 3
A female patient in her 30s had recently undergone procedures to have blood clots in the pathways to her lungs and heart removed. These blood clots had arised due to an unsafe amount of consumption of oral contraceptives in the past, which had left her in a fatal condition. Her heart rate had been much higher than normal previously, and today it had come down a lot – which was a good sign of progress. Dr.Anantharaman checked on her recovery progress and made sure she was still getting the right medications necessary for her treatment.
We then visited the Emergency Department where we came across a 35 year old female patient admitted because of several different issues. She had arthritic sepsis, causing her left leg to be very swollen, and difficulty breathing. She had been transferred from JIPMER (Pondicherry), and had to be intubated because of the fact that she had some infection which was not yet recognized at this point.
Patient – 4
The fourth patient we visited on rounds was a person who had dilated cardiomyopathy which caused one of their heart valves to leak. This patient had undergone a procedure to place a “clip” that would help the heart beat and keep pumping blood.
I spent the rest of the day observing Echo, Treadmill and ECG tests being performed on patients. I watched the technicians use advanced machines and methods to produce detailed scans of the patients’ hearts, that would later be useful for the cardiologists to check for diagnostic purposes.
Echocardiogram
It is a non-invasive ultrasound scan that uses sound waves to create pictures of the heart. It is used to evaluate the heart’s structure and function, and to diagnose heart conditions. The sound waves bounce off of the structures of the heart, and create echoes. These echoes are picked up by a transducer which are then sent to a computer that captures moving images. From these images, a lot can be known about the size and shape of the heart, how the heart valves work, the blood flow in the heart through the chambers etc.
Treadmill Test
This is a test designed to measure how well your heart works during physical activity – in this case, walking on a treadmill at increasing speed levels for a certain period of time. The patients I observed taking the test were all able to walk for a period of 8 mins, which is what they are expected to be able to do in order to be claimed fit. This test is useful in determining coronary artery disease. Electrodes are placed on the chest, wrist and ankles of the patient, and this way the patient’s heart rate, blood pressure and breathing will be monitored while walking at increasing levels of speed and incline.
Electrocardiogram
This is a test that aims to measure the electrical activity of your heart, which can help diagnose conditions like arrhythmia, poor blood supply, heart attacks and so on. Electrodes attached to the chest, arm, and legs are connected to an ECG machine which records the electrical signals produced by the heart. The machine reads these signals and produces a series of lines on a paper -which is read by the physician and used to determine any defects.
Day 2
Starting the day off again with rounds, we visited the following patients
Patient – 1
We visited the 35 year old female patient who was in a critical condition on the first day. She was starting to do a little better, but was still not stable enough to have been extubated, and was still in the ICU On this day, a culture was sent to the lab to find out what was causing the infection. It was found that the patient had a case of melioidosis – an infection caused by Burkholderia bacteria. It is an organism that can be contracted from the soil, and is known to affect the joints, hearts and lungs of humans. It also has the capability to affect the kidneys. This bacteria is not very common to cause infections in India, but severe weather conditions can aggravate its effects and make it more commonly appear in humans.
1win had seen around 5 other patients with the same diagnosis – all who had come from the same area in Tamil Nadu (Pondicherry, Villupuram etc.). These areas were recently drastically affected by floods, rains and heavy winds – fitting the condition of severe weather changes disturbing its effect. Diabetes is also a risk factor for melioidosis, and this particular patient was found to have diabetes when admitted for this condition. She was kept on medications to maintain her urine output and other aspects. Her lungs were seen through a scan to be more than half infected by the organism.
Patient 2
A 39-year-old patient had delivered her 3rd child and needed a check up by Dr.Anantharaman on her heart’s condition because having a delivery at this age could pose certain threats to the health of the mother. Her bicuspid valve was found to have been slightly affected/damaged, but it was concluded that nothing needed to be done at the moment about this – that it would not have any immediate major affect on her health. She was asked to come back for a routine check-up after a month and would have tests done again to later decide what had to be done.
Patient 3
We checked up on the 17-year-old patient who had undergone an appendectomy the previous day. Everything had gone well and there was nothing to worry about him.
Patient 4
We checked up on the patient who had undergone procedures who had an excess amount of oral contraceptives. She was doing much better and ended up getting discharged the next day because everything was going well. She had to make sure to take an adequate amount of rest for the next couple of weeks, stay on the prescribed medications, and refrain from taking any more oral contraceptives later on to avoid the same health conditions affecting her again.
Next, I sat in Dr. Anantharaman’s room and observed him treat Outpatients along with Dr. Kamal who was assisting him.
Patient 1
Complaint: This patient had stents placed in his heart 7 months ago, and he complained of having a ‘catch’ sort of feeling in his chest recently, and decided to pay a visit to Dr.Anantharaman because he was not sure what was causing this.
Treatment: He might have had this feeling in his chest because of gastric causes and was recommended to maintain staying on medications Dr.Anantharaman just prescribed to him. He was asked to come visit again in 3 months, and further action would be taken if this feeling persisted in his chest – which would mean it was not gastric reasons that caused it and would need further attention.
Patient 2
Complaint: None, the patient had just come for a check up after having had stents placed in his heart a while ago. Echo and Treadmill tests were taken to monitor his progress over the months, and everything was normal.
Patient 3
Complaint: None, the patient had previously had a bypass graft placed in his heart that had caused blocks in the arteries. These blocks had to be removed by undergoing a balloon angioplasty. He was asked to stay on medications in order to maintain the blood flow and thickness of blood so blocks do not reappear in the near future.
Patient 4
Complaint: 60 Y/M patient was having breathing problems and a heavy feeling in his chest. He had gone to previous hospitals and taken medications prescribed by the doctors there but nothing seemed to have worked for him to make him feel better, so he decided to come to Dr. Anantharaman.
Treatment: The patient was asked to take a comprehensive cardiac test which included an ECG, Echo, and Treadmill test in order to figure out what was causing this breathing problem. In the meantime, vitamins and gastric tablets were prescribed to check if the condition got better. We would have to wait for the reports to check if anything was wrong that could be detected in the tests.
Patient 5
Complaint: None, underwent a surgery to remove TB pericarditis and was just checking up after it. He was doing well overall, and so he would continue with the angioplasty scheduled in 2 weeks since everything was normal. He had bleedings under the skin that
could be seen from the outside, but these would disappear over time and were nothing to worry about.
Patient 6
Complaint: A male patient with hypertension was complaining of having too high of a cholesterol level despite efforts to reduce it. He was not sure what was causing this alarmingly high cholesterol level.
Treatment: His echo taken seemed normal, and there was nothing wrong with it. Hence, he was prescribed medications to bring his cholesterol level down and asked to come again in a while if the issue was not taken care of by the medications.
Patient 7
Complaint: Burning sensation and severe breathing issues for about 6 months. He had the condition MVP with severe MR. He was asked to do some more tests to come up with conclusions before further treatment procedures were discussed.
Patient 8
Complaint: Patient was coughing blood.
Treatment: Have an X-ray done and was asked to see the pulmonologist.
After OPD, I had the opportunity to see a surgery performed by Dr.Sujay on a woman with a CA in Right breast – and several lesions were removed. The surgery performed was a lumpectomy -the type of breast cancer procedure where the breast is conserved leaving only a scar that will actually be mostly hidden. It was a very interesting experience as it was the first surgery I saw in person and also had the chance to talk to Dr.Sujay for a brief while.
Day 3
I first visited 1win’s CATHlab and observed an angiogram being performed on a 35 year old female patient referred by another doctor who was a survivor of thyroid cancer. The patient had undergone radiotherapy to combat the cancer and as a result, she survived the cancer but had developed radiation induced coronary artery disease. I learnt that this was not a common way for narrowing of the blood vessels of the heart to take place, especially in a patient so young.
Next, I observed the complex angioplasty procedure being performed by Dr.Kamal and Dr.Anantharaman. Stents were placed in two of the heart’s blood vessels to remove the blockage.
An angioplasty is a minimally invasive blood procedure that involves using a catheter (thin, flexible tube) to insert a short wire mesh tube called a stent into the blocked artery to restore blood flow. This stent is left in place permanently to allow blood to flow more freely. I learnt that it was previously common to insert the catheter through the patient’s groin, but now it is becoming more common to insert it through the arm or wrist because it is easier. This procedure is an alternative to a coronary artery bypass surgery which is an open-heart surgery. When a stent is used, it will be around a balloon before it is inserted. This stent will expand when the balloon is inflated and remain in place and when the balloon is deflated and removed.
A coronary angioplasty only takes between 1-2 hours, and the patient can mostly be taken home within a short period of time when compared to surgery.
After observing the angioplasty, I watched Dr.Anantharaman attend to several outpatients in his room.
Patient 1
Patient 4 from day 2 who had complaints of breathing problems and a heavy feeling in his chest. He had completed all the cardiac tests he was asked to take (ECG, Echo, Treadmill) and had come back to Dr.Anantharaman the next day for a review of the test results.
It was noticed that he had a low haemoglobin count, and was prescribed medications for the same. He was also recommended to do a gastric review for further understanding of what the cause of the breathing problems could have been because otherwise, everything seemed to be normal with his heart.
Patient 2
Patient 6 from Day 2 who had complaints of high cholesterol levels. All the tests he had taken produced normal results.
He was prescribed medications to attempt to lower the cholesterol levels which he was recommended to take for a period of 2 months, and then come back after this time period to check if the medications were working or if it was anything alarming to be concerned about in case the levels had not gone down.
Patient 3
This patient had come for a check up after having had a Transcatheter aortic valve replacement (TAVR) which is another minimally invasive procedure that replaces a diseased aortic valve with a man-made valve. It is an alternative to open-heart surgery. He was doing well, and there was nothing wrong with his progress in recovery.
Patient 4
A female patient was consulting Dr.Anantharaman to check her fitness for breast surgery after chemotherapy.
It was explained that the risk this surgery imposed on her heart was only 2-3%, and there were no added risks imposed on her. The patient was hence recommended to proceed with the surgery, seeing as there were no anticipated complications for her that could be foreseen.
Day 4
Patient 1
Patient with severe cough and acid reflux. He was a patient who had stents placed previously. He mentioned that he had changed one of the medications that he started taking, and this could have caused an allergic reaction. It was recommended that he see the pulmonologist at 1win to deal with the allergies/asthma. He was also recommended a vaccination post COVID, and the regular exercise of walking up and down stairs.
Patient 2
A 75 y/F; had come for a regular checkup. She had the conditions of diabetes and Blood Pressure, and was at risk of developing age-related sclerosis. She was hence recommended to keep track of her sugar and BP levels at all times, with regular exercise accompanying this.We then visited the patient suffering from melioidosis in the ICU for an update. She was doing relatively much better, being off the ventilator at this point. She was recommended for dialysis for kidney support. Her lungs had improved and she was hence extubated. The severe pus condition was prevented from one of her legs by draining 1 litre of liquid out of it. Then, there was an emergency situation of a patient admitted to the hospital because of a severe cardiac arrest. He was a patient who had a bypass done previously and was in fact on the way to Kauvery for a check up from another doctor. On the way (about 3-4 minutes away from the hospital), he got a sudden cardiac arrest and had to be resuscitated immediately. This resuscitation was a success and he was saved thanks to the hard and efficient work of the doctors in the ER department.
It was later found out that the bypass he had previously gotten put in was actually not working at the moment. An angioplasty was done, to rectify the 90-100% blockage of vessels that had occurred because of this inefficient bypass.
Day 5
Starting the day off with rounds, these are the patients we visited:
Patient 1
A 92/M; He was a patient with the condition of aortic stenosis. Him having this condition had caused him to have a severe fall which resulted in him breaking his hip bone too. He then had a hybrid surgery to treat his hip and heart at the same time. He was recovering well and was to be discharged the next day.
Patient 2
A patient who had a balloon angioplasty done because of one of his heart vessels being 100% blocked. During this procedure, the vessel was stretched and stents were placed in the appropriate regions so as to restore blood flow effectively to the heart.
Patient 3
92/M; He was a patient with the condition of aortic stenosis. Him having this condition had caused him to have a severe fall which resulted in him breaking his hip bone too. He then had a hybrid surgery to treat his hip and heart at the same time. He was recovering well and is to be discharged the next day.
Patient 4
The patient who had the cardiac arrest on Dat 4 had undergone an intra-aortic balloon pump removal where the balloon pump was removed. The gap was closed back with angioseal (a sealing agent) which is used to close a puncture in an artery.
OPD
Patient 1
Patient who had previously gotten admitted due to a sudden cardiac arrest, and then recovered at the hospital. He is currently feeling good but was informed that if he started to develop any pain, stents would be placed in his heart due to possible development of vessel blockage. The bypass he had was working well in the main vessel but the stent was slightly bent in another vessel which was hence slightly blocked.
Patient 2
Patient has blocks in vessels (50-80%). One vessel has 50% blockage which can be rectified with medications but another vessel has 80% blockage in 2 places which means stents have to be placed. Hence, an angio has to be done to check the % of blockage before continuing to place the stent. Having a bypass surgery is of no advantage here because the patient does not have diabetes.
We then went to the Emergency Room because a patient had been admitted due to severe breathing difficulty. Having a CT scan done showed that the patient had Aortic dissection Type B.
OPD Continuation
Patient 3
The patient had reportedly fallen and hit his head after passing urine, and complained of having severe dizziness in the moments leading up to his fall. This could suggest post-micturition syntropy which is a common condition in elderly people. He was recommended to see ENT and a neurologist.
Patient 4
The patient had been recommended by doctors at a local government hospital to come visit Dr. Anantharaman because of high blood pressure levels. His blood pressure was recorded again now in the room, and is again found to be higher than it should be. He is recommended certain medications to control his blood pressure, and would likely have to have some imaging processes done to rule out certain conditions. It could possibly be concluded that these high levels were due to stressful work environments, tiredness, etc.
Patient 5
The patient is visiting for a check up after an angioplasty. He had a condition of calcific heart blood vessels and a special type of balloon was used to expand them to restore proper blood flow. He had slight pain in his chest which could be either gastric causes or muscle pain from the procedure. He was hence prescribed medicines to take for a while before coming to a decision regarding what to do.
Conclusion
I think my overall personal experience for a period of 5 days at 1win shadowing Dr.Anantharaman and his other team members was truly a great opportunity. The way all the doctors, nurses and other staff members interacted in a way that always kept the patient’s best interest in mind was definitely something inspiring. Additionally, it was great to see how doctors of different specialities always made sure the patient got referred to the right places, and always left the hospital satisfied.
