Dr. Adham Osman '15 on Intensivist Position at AdventHealth Orlando

Dr. Adham Osman ’15 is currently working as an intensivist in the Advanced Cardiac Surgery unit at Advent Health Orlando in FL. As an intensivist, he specializes in critical care and deals with the sickest patients in the hospital. His work involves responding to “code blue” situations and resuscitating patients who are dying. In his specialized ICU, they focus on patients with primary cardiac and pulmonary problems, as well as those who require extracorporeal membrane oxygenation (ECMO) devices. They aim to stabilize and reverse any reversible causes to get the patients back to health. In cases where the patient's heart and lungs are too sick to recover, they also perform heart and lung transplants.

Dr. Osman emphasizes the importance of teamwork in his work and advises current and prospective medical students to enjoy the journey and find a good study group. He also expresses his interest in reconnecting with UMHS alumni and being available to help students with any questions they may have. The UMHS Endeavour caught up with Dr. Osman—a native of Honolulu, HI who mostly grew up in Boston—on a late winter day to talk about his career, his medical education at UMHS, his undergraduate days at the University of Massachusetts at Amherst, how growing up with a father who was a doctor influenced him, and more.

Working as an intensivist in the Advanced Cardiac Surgery unit

UMHS Endeavour: Dr. Osman, it’s a pleasure to speak with you today. Can you please tell us a little bit about where you're currently working?

Dr. Adham Osman: Hey, Scott. Sure. So I'm working at Advent Health Orlando. I'm working in the Advanced Cardiac Surgery unit there as an intensivist.

And for the people out there that don't know what exactly is an intensivist?

Great question. So an intensivist, it's basically a specialist in critical care. We are tasked with dealing with the sickest patients in the hospital. Patients that are classically considered to be crashing. If you've ever seen movies or TV shows when they call it “code blue “overhead and somebody's heart or lungs have stopped working, they typically call the ICU team. We respond to those calls and try to revive and resuscitate patients who are otherwise dying and we try to stabilize them and reverse any causes that we can to get them back to health, if possible.

That sounds like a really important job. What would a typical workday be like for you? A day in the life of your job?

I kind of describe what life is as a kind of general intensivist. General intensivists take all comers in terms of very sick patients. I work in a specialized ICU called the Advanced Cardiac Surgery Unit. In that ICU, we typically specialize in patients who have primary cardiac problems, pulmonary problems, and patients who are so sick that they require devices called ECMO or what we call extracorporeal membrane oxygenation. It’s a device that pulls blood out of the body, oxygenates, and pumps blood back into the body to take over the role of the heart and lungs when their own heart and lungs are too weak to do so.

We place some of these patients on these devices to try to keep them alive to reverse any potential reversible causes and support them in the meantime. Hopefully in those cases, if we can reverse those causes, we can take them off the machines and hopefully get them back to health. Now there are some scenarios where these patients, their hearts and lungs are so sick they're unable to recover effectively. And in those cases, the unit, the department that I work in also does heart and lung transplants. So we work in conjunction with our cardiothoracic surgery colleagues. We work with our heart failure cardiology specialists as well.

Together as a team, we work to try to get transplants for some of these patients as well. So we have kind of a diverse patient population. I would say the sickest of the sick typically come to our ICU. We get referrals from all over the state of Florida and actually we get referrals from other places in the southeastern United States as well. But it's definitely an exciting place to be. Love working there and I love the people I work with. There's definitely a huge emphasis on teamwork there.

Oh yeah, definitely. And it sounds like it. So, the ECMO, in layman's terms, is that like a ventilator basically?

In some ways. It is different than a ventilator. A ventilator is a kind of breathing tube that helps oxygenate lungs and we use that in a lot of different ICUs. There are some situations where the lungs are so sick, so damaged that even a ventilator person—in that case, we would use ECMO where we physically take the blood out of the body, oxygenate it outside of the body, and then return it back into the patient.

These patients are very sick then. So that gets really into life-or-death situations, it sounds like.

They really toe the line, I would say.

On a lighter note, can you please tell us why you chose UMHS for a med school?

 Absolutely. I was originally studying philosophy as an undergraduate; I wasn't sure what I wanted to do when I finished everything. So I ended up doing my last year abroad in Europe. When I was in Spain, I met professors who did research in neuroscience, worked with them, and really enjoyed it. I love learning about the body, but I figured I enjoy learning about the body but want to be able to work with others more often and work with people more closely. So, I figured medicine would be the way to go.

I went back, did my post-bac pre-med classes and my MCAT and I was really looking for a school that would really have a lot of accessibility of the professors and would also have good reviews in terms of patient experience. I had a friend who was going to the Ross Vet School, the veterinary school. He was my best friend from college and he had heard about UMHS and actually was friends with several people there. They told him and gave him real feedback about good support from the professors, the great student population, and the heavy emphasis on teamwork. A lot of the students would stay after the classes, they would study together; they had their study groups and it really seemed like an environment that was my values and what I was looking for and it turned out to work for me.

What advice do you have for current or prospective UMHS students thinking about going into your particular specialty or just going into specialties in general? What advice would you give them?

Make sure that you enjoy the road. The road in medicine can be long at times, but I think that it's really important to enjoy yourself in the process. We really worked hard, my classmates and I, we had a study group and we would study together every day after classes, but we always had a specific time every week when we would go to the beach and play volleyball or go out to dinner or have fun and really have that kind of balance.

And I think that definitely carried over into residency, fellowship, and even now in the ICU that I work in. It's life or death where I work, but I love the people I work with and I love the patients and the families. I think it's very rewarding. I think that it's important to enjoy what you're doing and not to lose sight of that. Also, another piece of advice, when starting school or even preparing for med school, find a good study group. It's a family, it's a group effort and I think you'll always be better when you work with others. That's what we did and I really value the time that I had at UMHS.

Dr. Adham Osman believes in teamwork. "I feel that the ICU is definitely a place where the principles of teamwork and working with others have probably heightened the most," he said. Photo: Courtesy of Dr. Osman.

Growing up in Hawaii & Boston

Dr. Osman, can you please tell us a little bit about yourself? Where did you grow up and did you always want to be a doctor?

Sure, good question. So I was originally born in Honolulu, Hawaii. I lived there until I was about three years old. I moved around a bit but mainly grew up in Boston. That was where I spent most of my time. In terms of what I wanted to do with my life, I studied philosophy as an undergraduate and really wasn't sure what path I was going to take, honestly. I did a year abroad in my last year and that was definitely a great experience. But when I was abroad, I ended up meeting professors in Cadiz, Spain— a small city in the south of Spain—and they were doing research in neuroscience. I worked with them, really enjoyed it, and loved learning about the body, but I figured that I wanted to do something where I would be able to deal with people more consistently. I love working with people and so I felt that that would be more consistent with my values rather than being in a laboratory.

So I went back to Boston, did my post-baccalaureate premed classes, took all the prerequisites, prepared for the MCAT exam, and started looking for schools. And I'm lucky to say that I was able to choose UMHS and UMHS was able to really shape my medical career.

My father was a physician at times while growing up and would mention that; I saw what he did. I was really interested and was always kind of impressed with the cases that he would talk to me about. He never really pushed me too hard, though. He really wanted me to make my own decision and I felt like the fact that I was able to make my own decision, albeit in a roundabout way, really made my choice more sincere and special for me.

What do you like the most about being an intensivist as a medical specialty? What are some of the most rewarding things?

The teamwork. I feel that the ICU is definitely a place where the principles of teamwork and working with others have probably heightened the most. I grew up playing sports, I love playing sports. I grew up playing basketball in particular. I actually ended up playing basketball for UMass. And I think that those values of working with others, trying to figure out each other's strengths, and weaknesses, trying to find out where everybody kind of fits and the team approach, and working on meaningful problems, complex life or death problems here is really rewarding for me. I love it.

Just off the top of your head, are there any medical breakthroughs or anything exciting in your particular field that you'd like to talk about?

We do heart and lung transplants in our ICU in conjunction with the cardiothoracic surgery team and the advanced heart failure cardiology team. And I think that the process of helping others who are otherwise dying and kind of going through the spectrum of this critical illness life or death, to stability, to evaluation, to decision, to transplant, to recovery, to potentially living a life again with loved ones and family.

That spectrum, which consists of highs and lows of course, is really special for me. I know that that's something that is really meaningful for me and the team that I work with and I feel that that experience really helps me appreciate things in my own life. My own health and well-being, the people that I love and care about. Being able to go home and have a good meal with my wife and being able to talk to my parents or my family or friends. It really kind of sheds a lot of light on the things that I have and the things that we all kind of share.

Dr. Adham Osman. Photo: Courtesy of Dr. Osman.

Saving lives & breaking bad news

I would imagine that you have, like I said, you try to save as many lives as possible, but there's also an element of the people that don't make it. How is that? As a doctor, how do you deal with that?

That's really difficult. That's exactly right. We try to save and help people that we can, but because we're dealing with such sick and complex patients, there are a lot of people who unfortunately don't make it or don't turn out the way that we would otherwise hope. I think again, the thing that I've learned in that process is being able to talk about it. So really talking about it. Talking about it with my colleagues, my wife, my father who's a physician, and my friends whom I really trust, being able to process these things and not keep it inside, is definitely something that I've learned in my training, but I think that it's particularly enhanced in my job now because just because of the complexity and severity of illness.

Just something to add that's kind of relevant to what you're asking. I also am on the ethics committee of our hospital and the ethics committee is composed of physicians and then our law team, like our risk team, which is composed of lawyers, social workers, nurses, and a whole different group of people from different backgrounds. And basically, the ethics committee is tasked or we're consulted when there are complex ethical cases in the hospital, not just in our ICU but all over.

We actually are, our hospital is one of the biggest hospitals in the country and we have a lot of satellite hospitals as well. So anytime there's a scenario or situation where there's a disagreement of let's say the family or the patient between them and the healthcare professionals or where it's just not clear how a particular situation should go, they'll consult us and we're able to kind of weigh in about the ethical principles of medicine and seeing how we can apply the best care and guidance for those cases.

And a lot of those cases are also life and death. We recently had a case where there was an elderly person—an elderly woman who basically lived alone, didn't have family, was an orphan herself, never married, had no children, was now in the hospital with a terrible brain infection, wasn't able to make her own medical decisions and really there was a question of, "Hey, do we put a tracheostomy tube, a feeding tube? Do we continue to take care of her? Is that really a compassionate, ethical thing to do?"

And so, they consulted us, we were able to work with the social workers who were proxies to her care. After we kind of investigated trying to talk to her friends, trying to dig up any type of will or any type of legal documents that might've specified her values, we were able as a team, again, as kind of a team approach to figure that she really wouldn't want to be on machines and be kept alive artificially. And we were able to make a decision for her on her behalf to try to do the best thing for her in the event that she wasn't able to advocate for herself. So that was rewarding and it also kind of adds another layer to the work that I do and the work that we do at the hospital.

I think that's a very important issue. We have something similar in New York State; we have a healthcare proxy and it's very important that people say what they want done. If God forbid something happens where they're on life support, do they want to be on it? And I know that's something people generally don't like to talk about, but I think it's really important for everybody to have that information ready in case the worst happens.

I couldn't agree more.

Are you ever the one that has to tell the family the bad news, somebody's not going to make it, or that sort of thing?

Absolutely, yes. Unfortunately, it's one of the hardest parts of what we do. When things are not working well, when patients are not doing well, we need to communicate that to the family. I love giving floating-sidebar good news. When things are happening, if we're able to save somebody, that's one of the best feelings in the world to be able to walk in the room and be like, "All right, your mom's coming home, Christmas is on this year,” that's awesome. But on the flip side of that, it doesn't always work out that way. Having to sit down and have meaningful discussions about end-of-life decisions, just being open and honest about the fact that a loved one is dying and is probably not going to make it is difficult.

When I was training in residency and fellowship, we always had these workshops and there are textbooks about how to break difficult information to patients and families. And through reading these things and through going through these workshops and training, the things I learned are that it's actually very simple. There are these principles and yes, I think maybe with time and work we internalize the principles, but at the end of the day, I think about it in terms of what if my mom or dad was in that bed, what would I want to hear? What if I were in that bed, what would I want to hear?

And the number one thing that I am looking for in a care team is that they care, first and foremost. And everything else after that we can talk about. But I want to know that they genuinely and truly care about me and my loved ones. And I think that that's kind of how I will walk into it.

I sit down with them and I talk to them as people and it doesn't mean that it's always easy. There are highs and lows, and there are definitely a lot of tears, but sometimes the most effective communication is nonverbal and just being there and showing them that I care about this person. "Your mother is an amazing person and we genuinely care about her so much and I know you do too" and "I'm here for you just as much as I am for her." I think that that's kind of the mentality that I use and that a lot of my partners use and that's just part of the job.

I think that's very important and I'm sure you're great at it. I'm sure that the families would also appreciate your honesty as well as caring. It's not always what they want to hear, but the truth is I think great in these situations— as hard as it is to talk about.

I appreciate that.

On a much lighter topic, is there anything that you'd like to say to the UMHS alumni out there?

I would like to say that I'm proud of all of you guys. I have worked with a lot of the alumni out there. These were my classmates and family when I was in med school, and I know that you guys are out there doing great things. One thing that I would really appreciate and that I would look to be more involved with in the future is reconnecting with a lot of my classmates. I think that we scatter and we are going to different hospitals and clinics and we have different specialties and different roles in life after med school.

A lot of my friends I keep in touch, but I'm so interested and fascinated to know where a lot of other people have ended up and if there was a network or some way that we could communicate with each other, I think it would be really great. On a personal level, because these are people that we've been through highs and lows together, we've helped each other out so much. And I want to be there to share in their success and be an advocate for them. But even professionally, I mean there are probably other UMHS alumni out there who are doing similar things that I am and oftentimes we have questions and we appreciate insight and perspective and to know that I could be able to contact some of my trusted colleagues from our school would definitely be beneficial in many ways to me.

It's nice to be able to touch base with you guys. I know that I've met a couple of your colleagues when they visited universities in the area and it was nice to be able to talk about my experience there at UMHS and how I navigated school and residency fellowship and early career. I know that that's something that I would value too as a student because when you start school when you start at med school in particular, it can be a little overwhelming at times. There's so much unknown, and there are so many steps to take, but hearing people talk about their experiences I think is very helpful.

I appreciate the opportunity to just explain my experience and how I did it and hopefully, that can help others that are coming into the classes this semester and the coming semesters.

(Top photo) UMHS 2015 graduate Dr. Adham Osman. Photo: Courtesy of Dr. Osman.

Contact Dr. Adham Osman at Adhamosman.md@yahoo.com