Inside Man
Dr. Nima Golchin returned to his hometown and brought a new specialty with him—a specialty that’s saving lives.
By Stephanie Marsau
Dr. Nima Golchin was performing a procedure in the Mary Greeley Cath Lab when a call came in from the GI unit.
A McFarland Clinic colleague called seeking Golchin. He needed help with a patient who was experiencing internal bleeding. Golchin relayed back that he would be there when he finished the procedure he was doing.
Minutes later, another call came about the same patient, this time with more urgency. Golchin was needed NOW. He finished the procedure he was doing and rushed a short way down the hall to GI. The patient’s bleed was more complex and extensive than originally thought and required a delicate procedure that involved Golchin going in intravenously with a thin wire called a catheter to the site of the bleed. The catheter transported a coil that was carefully wrapped around the area of concern, subsequently stopping the bleed.
It’s a procedure Golchin was able to do because of his highly specialized training as an interventional radiologist. Thanks to Golchin, the patient was able to be immediately treated at Mary Greeley, instead of being transferred to another hospital and facing the very real risk of not surviving the trip.
That’s a dramatic medical story, but don’t expect to hear about it from Golchin.
He’d rather not talk about himself.
Never mind that as an interventional radiologist he’s brought a specialty to central Iowa healthcare that provides a range of services to patients—many of them potentially lifesaving. To paraphrase that Liam Neeson character, Golchin possesses “a particular set of skills.” He doesn’t, however, have much of an appetite for attention.
He insists that the help he provides his patients is the same care any other physician would provide. Golchin is exceptionally personable, but when asked about himself and the people he’s helped, he finds it difficult to discuss. He deflects the attention away from himself and talks about the patients, their families, and the coordinated care he provides in conjunction with Mary Greeley staff and McFarland Clinic physicians. He seems happiest when praising other team members for the work they do and gives them more credit than he gives himself.
But, sorry Dr. Golchin, credit is unavoidable, as one of your patients is about to make crystal clear. A certified nurse midwife at McFarland Clinic, Alice May credits Dr. Golchin with saving her life.
What is Interventional Radiology?
Interventional radiology (IR) is a specialized field within radiology in which doctors use medical imaging—such as MRI, CT, x-ray, and ultrasound—to assist in minimally invasive surgical procedures that diagnose, treat, and cure many kinds of conditions.
Because most IR procedures are minimally invasive, they can be less expensive as well as less painful than a typical surgery. In some cases, they can even eliminate the need for a patient to be admitted to the hospital.
Dr. Golchin is able to perform procedures at Mary Greeley that previously would have required a patient to be transferred to a different facility.
“We see a fair amount of emergencies that can be fixed in 20 minutes or less at the hands of Dr. Golchin,” says Scott Cue, director of Outpatient Services. “Prior to his arrival, some of those emergency cases would be transferred in the hopes that the patient would survive the journey to get the care they needed. We no longer have to do that because they can receive that care at Mary Greeley.”
A few IR procedures were already being offered at Mary Greeley, but with the addition of Golchin, additional procedures are now being performed. Among them are the following:
- Port placement—A patient who requires frequent intravenous (IV) medications can be helped greatly by having a port placed. This allows healthcare providers easy, reliable access to administer medicine.
- Fistula creation—A fistula is extremely important for people with severe kidney disease who undergo dialysis. It allows for high blood flow so that the largest amount of blood possible can pass through the dialyzer, purifying as much of the blood as possible.
- Chemoembolization (coming soon)—A treatment for liver cancer, chemoembolization involves injecting chemotherapy drugs into the artery that supplies blood to the tumor in the liver. This allows for a higher dosage of chemo drugs to be injected than with standard chemo and can also decrease the side effects of standard chemo.
- IVC filter placement—An inferior vena cava filter is inserted to prevent clots from traveling throughout the body. This is the procedure that Alice May (see main story) had done after her pulmonary embolism.
Post-surgical Scare
Meet Alice
Alice May talks about being treated for a life-threatening blood clot by Dr. Nima Golchin, an interventional radiologist
Watch Alice's Video
Last November, May underwent cataract surgery on her left eye and it did not go well. When it came time to have her right eye done a month later, on December 18, she was anxious. The morning of her surgery, she woke up with chest pain and shortness of breath—all symptoms of a panic attack, which made sense considering her surgery was in a few hours.
Her surgery was a success and after arriving home at 2:30 p.m., she opted to take a nap. Upon lying down, her shortness of breath got dramatically worse, which confused her. With the surgery over, she assumed the anxiety would have subsided. She decided to wait an hour to see if things changed, but 40 minutes later she knew something was wrong.
“Healthcare providers are great at instructing their patients when to go to the doctor,” says May. “When it comes to ourselves, there’s almost this internal struggle that goes on. That day part of me was telling myself to just lie down and calm down. Another part was telling me this wasn’t normal. And then I heard Dr. Donnelly’s voice.”
Dr. Stephanie Donnelly had been May’s anesthesiologist earlier that morning. While in recovery, Donnelly had noted that Alice’s stats weren’t quite normal. Her oxygen saturation seemed low, but not low enough to be concerned.
With Donnelly’s words echoing in her head, May called for her husband and said they needed to go back to the hospital.
She and her husband pulled into the Mary Greeley Medical Center Emergency Department around 3:45 p.m. She remembers pulling in and telling her husband she didn’t think she could walk.
“He came around to help me out of the car and took my arm. We took four or five steps and my vision started going black. I knew I was going to pass out,” recalls May.
At that point, it was all hands on deck. May was wheeled into the Emergency Department, where the staff initially thought she had fallen and hit her head. It wasn’t until Dr. Travis Mattson, Emergency Department physician, asked if they had traveled anywhere recently that the pieces started to come together.
“My husband and I had traveled to central Missouri the previous week and that Friday, my leg had started to hurt,” May says. “I’d had back surgery 10 years ago and it was the same kind of pain. So much so, that the day before my cataract surgery I looked up my neurosurgeon’s number.”
An ultrasound on Alice’s leg showed what Mattson suspected—a clot behind her left knee that extended down her calf. She was then sent for a CT scan.
“Things started to move very fast at that point,” May says. “I remember thinking this is urgent—they’re worried.
Paging Dr. Golchin
May can remember hearing Golchin introduce himself and then she heard him say something about a submassive saddle pulmonary embolism. A healthcare provider herself, May knew that was bad. Even knowing that, May said she felt at ease with Golchin.
“He was able to explain things in a way I could understand,” says May. “Yes, I’m a healthcare provider—but it’s different when it’s happening to you. He didn’t speak to me like I was a provider, but he also didn’t speak to me in layman’s terms—he fine-tuned his communication to me and it was greatly appreciated.”
A couple months prior to this, May had listened to Golchin speak at a Physician Grand Rounds presentation at Mary Greeley. As a new interventional radiologist, he was speaking to other providers about the range of services he could provide for their patients.
“As they were wheeling me to the Cath Lab, I looked at Dr. Golchin and told him that I remembered him being introduced at Grand Rounds,” says May. “I also told him that I remember thinking that day that I hoped if I was ever critically ill, he would be the one to help me.”
She was about to get her wish.
Filtering Out the Bad
Once in the Cardiac Catheterization Lab, Golchin inserted something called an inferior vena cava (IVC) filter, which looks like an open, upside down umbrella. The filter gets threaded down into the inferior vena cava (a large vein of the heart that carries blood from the lower body) and sits there like, well, an umbrella. This way, if any more of May’s clot broke off, the filter would catch it and prevent it from traveling to her heart, lungs, or brain.
After the procedure was over, May went to the Intensive & Coronary Care Unit (ICCU), where Golchin told her that her oxygenation was very poor. She had suspected this as it was hard for her to breathe. She was told that if she didn’t improve, she would need to go back to the Cath Lab and the clot would have to be removed.
Golchin checked on May throughout the night, and slowly but surely her oxygenation began improving. At 4 p.m. the following day, he was confident that she was out of harm’s way and would not need to return to the Cath Lab. The next day Alice was transferred out of the ICCU on to an inpatient unit.
“I felt extremely comforted by the fact that it was Dr. Golchin himself that checked on me all night long,” she says. “It eased my anxiety knowing that if something did happen, he was right there and the ICCU nurses, who were also so attentive, wouldn’t need to call a doctor to come in.”
May would remain in the hospital for an entire week and was released on Christmas Eve day. She returned to her practice on February 3. Golchin had told her it could take up to six months to feel normal again, but she felt fine by the beginning of March. In fact, she began training to run a 5K this fall and will do so in late November with Dr. Golchin by her side, along with Scott Cue, director of Outpatient Services and a few of her McFarland Clinic co-workers.
Remembering her healthcare, May is almost brought to tears when asked about Golchin.
“If he weren’t here, they would have transferred me to Des Moines and 100 percent of my support is here,” she says. “I felt 100 percent confident being at Mary Greeley, and it meant the world to me that I could stay there because of Dr. Golchin. It adds a layer of comfort when you’re with people in a facility you trust.”
When Golchin is asked about May and her gratefulness for him, he smiles and shakes his head, almost as if he can’t believe someone would credit him with saving their life.
“I was glad to be here for her. I’m glad to be here for all of the patients I’ve helped,” he says.
Enhancing the Cath Lab
The Cardiac Catheterization Lab, or Cath Lab for short, is where Dr. Golchin performs nearly all of his procedures.
“With the addition of Dr. Golchin to our staff, we are now able to do procedures at Mary Greeley that we couldn’t do before,” says Scott Cue, director of Outpatient Services. “Some of these procedures would not have been possible without upgrading some of the equipment in the Cath Lab, so we did what we needed to in order to provide the best possible care for our patients.”
The x-ray equipment was due for an upgrade, and the new equipment provides better images and lessens the amount of radiation to which patients and staff are exposed.
A large 50-inch monitor allows multiple images to be shown on the same screen, and the quality of the images themselves has improved drastically.
“This new equipment gives us images with remarkable resolution and detail,” says Cue. “This allows us to see even the smallest arteries and veins, which allows us to better treat our patients and give them the best outcomes possible."
