My History

Dr. Sally Graglia
As an employee of the University of California, San Francisco, (UCSF) I work clinically at the Zuckerberg San Francisco General Hospital (ZSFG), a public hospital in San Francisco under the purview of the Department of Public Health. ZSFG is the only Level 1 Trauma Center in San Francisco. While just another hospital to some, ZSFG is one of my favorite places on earth. Every person who works there wants to be there. Diversity, equity, inclusion, and belonging is celebrated. Playfulness coupled with focused intensity (when needed) creates cohesion among staff. And likely most notably, the patients – with their own distinct stories, cultural background, language, vulnerability and gratitude – make ZSFG an unparalleled place to work.

WHY POCUS?
A summer working in Ethiopia was a defining point in my life: I would go into medicine. Since that summer, something as profound as my need for oxygen but equally as subconscious was clear: I wanted to equip myself to care for any patient, anywhere, and any time. After attending medical school at the University of California, Davis (UC Davis), my commitment was unwavering; I applied into residency in emergency medicine to prepare me to do just that. While a resident at UCSF, it was the same as I approached fellowship at Massachusetts General Hospital (MGH). I wanted to prepare myself to care for any patient, anywhere, and any time and – by that time – I had had enough exposure to point-of-care ultrasound (POCUS) to know that it was an essential skill I wanted to have to effectively work in low resourced environments.

Since my residency and fellowship training, my belief in POCUS has only been confirmed time and again.

In Peru, I learnt how to make diagnoses of tropical diseases, recognizing the appearance of echinococcal cysts of the liver. In Uganda, I saw how providers in the intensive care units, accidents and emergencies (A&E), and labor and delivery (L&D) used POCUS.

In South Africa, I learned how ultrasound is used to diagnose tuberculous outside of the lungs (extra-pulmonary tuberculosis or EPTB) and how it drives management. In Liberia, I saw ultrasound used by residents in Family Medicine, Internal Medicine, Pediatrics, Surgery and Obstetrics/Gynecology. Using POCUS, Internal Medicine physicians diagnosed necrotizing skin and soft tissue infections and cervical cancer after discovering bilateral obstructions causing back up of fluid in the kidneys (hydronephrosis). OBGYN physicians diagnosed fetal demise in the setting of traumatic uterine rupture. Pediatricians diagnosed Tetralogy of Fallot; Surgeons, pyomyositis.

Various diagnoses were made at the bedside that otherwise would not have been made. And POCUS doesn’t only have applications in low resourced settings. In San Francisco, the diagnosis of a collapsed lung (or pneumothorax) made on POCUS just prior to intubation saved a patient’s life from a complication of the procedure and prevented the need for intubation altogether. POCUS is well known to make diagnoses at the bedside and expedite care. Such cases are presented and published from urban health centers across the US and beyond.

Back as full-time faculty at UCSF, my passion for serving the underserved and POCUS continues to burn. I have the privilege of conveying this enthusiasm for POCUS to medical students from the first day of their medical school education. I get to expand POCUS curriculum for emergency medicine residents and fellows, and offer ongoing education to faculty who want to hone their skills. It is an honor to help equip others to care for any patient, anywhere, and any time.