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The Best in FOAM Education

  • Writer's pictureElizabeth Dalchand, MD

HERstory Highlight: Dr. Karalynn Otterness

Dr. Karalynn Otterness joined our Emergency Medicine department in 2015. She graduated from Drexel University College of Medicine in 2011 and completed a residency in Emergency Medicine at NYU/Bellevue. Dr. Otterness has been involved with resident education and is one of our assistant program directors. In addition to being an APD, she has an adorable family that she enjoys spending her free time with. We had the opportunity sit down and dive deeper into her life.

I just have to get this off of my chest right off of the bat– it just amazes me that you were pregnant and working in the ED during the brunt of COVID. What was going through your head during that time?

On one hand, I was obviously scared because everything is more panic-inducing during pregnancy since you’re not only thinking of yourself but of your baby as well. But on the other hand, I felt very supported. I wasn’t scheduled in critical care during those months, so I wasn’t doing high risk procedures, like intubations. My colleagues were more than happy to help me out in that regard. I definitely took more precautions than I would have if I weren't pregnant. I was wiping everything off and taking everything off in the garage…I wonder if I would’ve been that safe if I were not pregnant. The one slightly disappointing thing is that I’ve always been a white cloud as a resident and even now as an attending, so during this time it would’ve been a good opportunity to do some intubations myself had my situation been different. Part of me struggled with feeling a little disconnected from really being down in the trenches with you guys who were doing all of these procedures and taking care of the sickest COVID patients, but I’m glad I played it safe.

I’m glad you chose to be safe too. Congratulations on your third child – I remember you mentioning that your first pregnancy was as a resident…or was that during your first year as an attending?

[laughs] Thank you! Third and last! My husband and I wanted to have our first child during my last year in residency, but I had two miscarriages during that year and so it didn’t work out. I started my first attending job 16 weeks pregnant, and it was a little scary and awkward trying to figure out when I should tell people and who to tell first. Part of me felt guilty even asking for maternity leave just 6 months after starting my first job. One of my best friends from residency was actually in the same position as I was – her first child is actually only 2 weeks younger than mine – and we banded together and supported each other through this time. All three of my kids were born while I’ve been at Stony Brook.

Being pregnant and the months after pregnancy, how did this affect you clinically?

Due to my miscarriages, I was on a whole bunch of medications to sustain my pregnancies and I had to go to frequent doctor appointments. During the last several weeks of my pregnancies, I would have to see my doctors twice each week, while still working full-time. Often, I’d have to go after an overnight shift or before an evening shift, so it made for very long days. With pumping I do have to take extra breaks, but being at Stony Brook and having amazing colleagues, residents, and NP/PAs, it just makes it so much easier to do.

You mentioned that you had two miscarriages. It’s so common yet no one really talks about it. How did you get through dealing with two of them?

So it was very hard – much harder than I thought it would be. It truly does feel like a loss and it’s the kind of thing that you don’t realize how devastating it is until you’ve gone through it yourself. I actually found myself reaching out to some friends of mine who had had miscarriages and telling them that I was so sorry that I wasn’t even more sympathetic when they went through this because I didn’t know until I went through it too. You know, you get through it. My husband was an amazing support person. But you’re right – it’s something that is rarely talked about but for that reason, it makes it even harder to talk about. Women tend to struggle to talk about it because they can feel guilt or shame, and really it’s nothing to feel ashamed about. If more people were willing to open up about their struggles, it would be so much easier to cope with and appreciate just how common it is.

I completely agree and I am so happy you’re candidly speaking about this.

It’s actually changed the way I’ve approached patients who are coming in with vaginal bleeding during pregnancy too. I try to take the time to sit down with them and really be present. I take the extra time to explain that it isn’t their fault and nothing they did caused this. A lot of women perseverate and blame themselves, so I try to give them the reassurance they need. I definitely spend more time with these patients than I did before my own miscarriages. There have even been a few times where I’ve opened up about my own struggles with miscarriages.

I am so sorry that you had to go through that experience but I’m glad that you’re able to get through it and use it as a way to relate and comfort patients – and sharing that with the people reading this too.

Yeah – and I want anyone reading this to feel comfortable reaching out to me if they’re going through something similar and they’d like to talk about it. It’s unfortunate how no one really talks about it.

Despite going through two miscarriages, you now have three beautiful children. Do you find that you have a lot of time to spend with them?

Aww, thank you! I think we’re lucky in emergency medicine that when you’re an attending you have a good amount of time off. But it does get exhausting working overnights and evening shifts, and it’s like two full time jobs- work, and then my other full-time job doing all of the things for three small humans!

How did you and your husband meet?

[laughs] It was random, we actually met through mutual friends on a ski trip. I went to undergrad at the University of Illinois in Urbana-Champaign and he went to high school in town since his parents are professors at that university. One of his best friends was a friend of one of my best friends, so we all went on a ski trip during the winter of my junior year. He was a year ahead of me and he moved back home during the following summer before moving to NY for law school. We started dating that summer and spent the next 6 years long distance. It worked out since he was in law school and I was in medical school, so whenever we would see each other it would be a nice vacation from our academic pursuits.

Does your husband do medical malpractice [laughs]?

[Laughs] No, thank goodness. He does corporate/commercial litigation. It’s nice to not be in the same profession. My stories are way more exciting than his.

What was the most interesting case that you’ve had?

I was at Bellevue and we had a patient, a 60-year-old male, coming in with altered mental status. He was a smoker but had no other medical problems. He left a restaurant to smoke but he was then seen stumbling, almost like a syncopal episode. Per EMS he was agitated and combative and had to be intubated to facilitate medical care. We got tox labs and other labs which showed a very elevated lactate and initially thought it could have been a seizure, but decided to just pan scan him to see where that lactate was coming from. It turns out he had a Type A dissection. His family arrived and they told us that he had no chest pain or other symptoms preceding this –so this was a painless dissection that we were lucky to catch.

Wow, that sounds insane – and definitely a great catch. How was your training at Bellevue [NYC]?

It was unlike any other experience and Bellevue has such a special place in my heart. It is truly a safety net for NYC. The diversity is amazing and my co-residents and I are still extremely close. It’s funny, out of the 14 residents in my class 10 of us are female! We were ahead of the times and it was amazing.

[laughs] That’s awesome! Bellevue is a four-year program and now you’re an APD at a three-year program. What are your thoughts on three versus four-year programs?

I would say that when I was a resident, I always thought that four-year programs were the more academic ones and the three-year programs were somehow less so. But now coming here and seeing the caliber of residents that we graduate, seeing how amazing you all are, how you guys know your stuff, and you’re able to go off and do whatever you want after graduating in only three years – it made me to a total 180. Now it’s like … why would anyone do a four-year program [laughs].

My thoughts exactly [laughs]. Anything that you experienced at Bellevue that you’d want to see at Stony Brook?

Well, morning report is something that Bellevue was well known for, so myself and few other faculty brought this up and that’s one of the reasons we have it now. I’d like to optimize our pre-attending shifts. At Bellevue the PGY-4 has a designated spot right next to the attending, and since you were sitting next to the attending all of the presentations were going to you and you were running the list with the attending and during change of shift you would run the bedside rounds. It was truly a pre-attending role. We’re always looking for feedback and even though we have our pre-attending (PAT) shift, I think we are still learning how best to optimize it.

I actually interviewed with you and it made me excited to see a female in a leadership position as an APD. Has there ever been a time where you’ve noticed that you were being treated differently as a female than a male?

There hasn’t been one defining moment, but it’s always the same thing. It’s being called nurse even though it says doctor on my badge. Or being asked to fetch warm blankets or get water, which I don’t usually mind doing, but I’m sure our male colleagues don’t get asked to do these nurturing tasks quite as often. Then you have male patients making comments about our looks or calling me ‘honey’ or ‘sweetheart’ which they would never call a male doctor. I wish these challenges were unique to me, but they’re not and it does get frustrating at times.

Was there ever a period in your life where you had to struggle with making decisions or getting to the place where you are now?

When I was applying to medical schools I had narrowed it down to two programs- a medical school in Philadelphia and another one in New York. My husband was already a law student in New York but I liked the medical school in Philadelphia much better. My husband told me that ‘we’d make it work regardless’ and urged me to choose the Philly school. It was a testament to the support I had from my husband but it was a really difficult choice. Choosing the school that would better fit my needs over the school that would bring me geographically closer to my husband.

I think that’s also a struggle that a lot of people definitely face – a career or a relationship.

I know! Can’t we have it all? Why does it always feel like we’re sacrificing one for the other? I mean that feeling also never goes away no matter what stage in your life you’re at – career or family time. It’s such a hard balance. Even now, I struggle with wondering if I’m giving my kids enough attention or if I’m neglecting my work.

How do you deal with being a great mom and a great doctor?

I think that…you just have to be able to survive on very little sleep [laughs]. If I had to prioritize one, I would prioritize my family. When I’m with my kids I don’t have the TV on and I try my best to be very present with them. Any non-clinical work that I do from home, I stay up late to do after my kids are in bed. Which gives me a pretty narrow window most nights! I’m trying to also take time for myself so I don’t lose my own identity too.

How did you choose medicine?

I’m the first doctor in my family. When I started college I was an engineering major. I wanted a career which I could be proud of, but I didn’t want to be stuck in school for a million years. Of course that didn’t happen and I was stuck in school for a million years. As cliché as this sounds, I always wanted to help people. I also grew up with my mother, who is the most influential person in my life. She and my father divorced when I was young, and she was always career driven and actually owned her own business. She told me to pursue something where I would be able to support myself, if need be. That resonated with me so I wanted to pursue a career that was also financially stable too.

How was life with your parents being divorced?

It was the most amicable divorce possible. They still remained very good friends. My dad moved to a townhouse but it was literally a 5 minute drive. He still even had a key to my mom’s house. He would have dinners with us and come on vacations with us. Even when my sister and I went to college, he would still come over and watch Lost every Wednesday with my mother. They were much better apart. It was not a bad divorce, and they both were (and still are) very present in my life. COVID times does makes it more difficult to see them since they’re both still in Illinois. It’s hard because my husband and I don’t have any family out here.

Since both you and your husband are at work and there are no family members around, how has childcare been?

We’re completely reliant on my nanny, but because I actually enjoy spending as much time as possible with my kids, I really only schedule her for the times where both my husband and I are at work. That does mean that we have very few date nights, but that’s okay- I wouldn’t have it any other way. Raising good humans is so important!

What do you think the next stages of your life is going to look like?

I foresee myself staying at Stony Brook and living in Long Island. We’re pretty sold on staying in NY. I plan on continuing to be an APD here and involved in making changes where need be and training the best residents!

Thank you so much for answering so candidly! Any last-minute thoughts?

I think FemInEM is great! I think there are so many challenges that we face, and it is nice to really develop that relationship with each other and create this community to support one another. There are so many challenges that we face that our male colleagues don’t face, so offering up career and personal advice, being mentors, and opening up about our personal and professional experiences is so important.

Elizabeth Dalchand, MD is a PGY-2 Resident at Stony Brook Emergency Medicine. She can be found on Twitter @lizdalchand


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