Week 2: Perfusion

This week, I decided to focus my Immersion experience by learning about perfusion imaging on multiple modalities.

I got this idea when I started looking at perfusion in echo, which in the textbook was described as a promising contrast-enhanced ultrasound application, but the clinicians today almost never associate echo with perfusion whatsoever.

Before I go any further, let me explain what perfusion is. Perfusion refers to the delivery of oxygenated blood through the vessels and capillaries to the tissue, and perfusion imaging allows us to get functional information about specific anatomies that we are interested in.

For example, abnormal myocardial perfusion is dangerous to the patient, as it can indicate a higher risk of cardiac death, or myocardial infarction (MI). The abnormality suggests insufficient blood supply due to coronary artery stenosis or some other phenomena, and if detected, the patient can be treated appropriately to reduce or eliminate future heart attacks.

After a meeting with Jonathan yesterday (Thursday) in which we discussed a potential project for the immersion, he helped me make an arrangement to spend a few days in the Nuclear Cardiology department.

I started today at the Nuclear Cardiology department, and learned about SPECT imaging and the different kinds of stress tests that were done. In exchange for the opportunity for me to stay for a few days, they jokingly asked me to make them a new camera; the photomultiplier tube system in the SPECT scanner.

I also got to briefly see a CT and a PET scan for the perfusion-type of tests, and was also able to sit through each of the three stress tests done in the lab; on the treadmill, injection of adenosine, and the infusion of dobutamine. Each of these stress tests also needs two SPECT images of the heart; one before and one after the test. We then get the following kind of image profile:

Source: http://www.bocaradiology.com

For each axial slice image of the left ventricle, we observe the heart at rest, and the heart under stress. The idea is to look for discrepancies that can indicate perfusion abnormalities. If healthy, the injected radioactive thallium can be observed throughout the entire myocardium. If diseased, we will observe gaps in the SPECT images taken after the stress test.

There's apparently a number of way for misdetection of abnormal perfusion to happen; most notably due to large breasts, implants or anything else that can shield the signal from the thallium; thus it requires great practice in order to quickly and accurately read these images. I thought that was cool.

I'm very thankful to Sandy and Sunil, who took me around for the entire day today. I'm looking forward to visiting the nuclear cardiology lab again next week.

Second week

I finally got my ID today. I got up so early just so I could get the ID in time to go into surgery, only to find out afterwards that an ID card is not enough. I also need "authorization" from the one in charge of the program. It is so much harder for me to get into the OR than some of you guys. While some of you come into the OR with only a Cornell student ID, I cannot even get in with a Weill ID. I also still do not have access to my clinician's lab. I need someone to let me in.
Today was an aggravating day. After I get my ID, I head towards my clinician's office where he said to meet between 8:30 and 9:00. But I cannot get into his lab because my card has no swipe access. I dial 3 different lab phone numbers and nobody picks up. I go to the clinical office, only to find that my clinician's nurse practioner is busy with a patient. Some people at the desk helped me out by paging him and calling his cell phone, but he didn't pick up. Finally his nurse shows up and that's when I find out I need authorization. I thought an ID was authorization.
In the mean time, I am writing a research protocol for a clinical trial on deep brain stimulation as a treatment for cocaine addiction. The thing is, writing the protocol is supposed to take up most of my time here, so I won't be able to see the experiment be executed. Yesterday I found out that another undergraduate from Cornell also is shadowing my clinician, so now I have to "share" him. She wants to go to the OR too. She is really interesting though. She studies the interface between biology and religion. I won't get too much into it since this blog entry is already too long.

Week 1 - Goose

My first week was short but fast paced. As soon as I met my mentor, Dr. Souweidane, he briefly introduced me to his crew and suggested that I see patients with him. He usually spends his Mondays in clinics meeting new patients and others for follow ups.

Dr. Souweidane is a neurosurgeon who specializes in using an endoscope for minimally invasive surgeries. Hydrocephalous was the usual conditions that patients came in with the first day. Hydrocephalous is a condition in which the brain has trouble draining cerebrospinal fluid out of its cerebral ventricles. The condition can lead to chronic headaches accompanied with vomiting and eventually can cause damage on the neural tissues as well as the optical neurons or even death if left untreated. The conventional treatment for this condition is the installment of a cerebral shunt, an artificial one way valve passage, to facilitate the drainage of the spinal fluid into the belly. Shunts are permanently installed to connect the cerebrospinal fluid through the brain, the skull, then through the back of the neck, and into the belly. Shunts stay underneath the skin and have coils at one end to specially compensate the growing bodies in young patients. However, many problems are involved including bacterial infections in the brain which can cause patients to experience even worse headaches or faint. The cerebral ventricle is positioned at the center of a brain which makes it very difficult to treat as the surgical procedure may involve opening of the patients brain, craniotomy. The installment of an artificial device in the brain and the body not only affect patients physically but also psychologically.

Dr. Souweidane's approach to the condition is the use of an endoscope to reach to the center of the brain, cerebral ventricle, and make an extra opening for fluid drainage from the third ventricle to the subarachnoid space. Hydrocephalous may be caused by intraventricular brain tumors which blocks the passage for the cerebrospinal fluid and this is removed with the use of an endoscope.

Tuesdays are my chances for observing surgeries at the OR. I luckily had a chance to have a peek in the OR before I left to Korea for my sister's wedding in spite of all the daunting paper work I had to figure out just to go through the entrance. The patient was a 12 year old African American with intraventricular brain tumor which fortunately did not block the ventricle but somehow had improper draining of cerebrospinal fluid. The surgeons made a 15mm hole on the skull and inserted the endoscope. One of the first impressions I had while watching the procedure was that imaging has evolved to be an essential and parallel parts of a surgical procedure. The surgeons installed a small device near the patient's head which served as a reference for the computers to read the position of the brain and synchronize and match with the MRI images. This way the surgeons could find the exact location of the tumor, determine from where and in what angle to insert the endoscope to reach to the ventricle and avoid any loss of cognitive or motor functions. The surgery did not last longer than an hour and a half. The surgeons took a biopsy of the tumor and made an opening at the third ventricle--it was an amazingly efficient procedure.

As an engineer, though I have never been involved in any research for medical devices, I could already see small improvements in the use of an endoscope. The surgeons of course have to depend on what is seen on the screen through the endoscope and it is important that they communicate well to each other for the whereabouts and directions of the endoscope and where to cut and destroy. I noticed that the screen merely shows what is seen through the endoscopic camera. I thought what if the engineers can simply include angular reference as well as various choices for grids on the screen? Then the surgeons don't have to say things like "Would you turn the endoscope counterclockwise? A little bit more. Just a bit more. Cut the upper region of the circular part you see on the right side..." But instead they could become more specific with angular reference and grids and say "Let's turn the endoscope to 55 degree and start cutting the edge of the tumor from G6."

There is no whining in the real world.

Well, the first week is over and all I can say is wow. I can’t believe how incredible this experience is turning out to be. The doctors and staff are beyond accommodating to ensure that I am learning and adsorbing as much information as I possibly can. Plus the ability to run in and out of surgeries is a million times more amazing than actually watching discovery health channel for hours on end. The behind the scenes action is so much better than the fake actors that look like they have fallen out of the 80s and then hired to reenact cases.

As for my actual summer immersion experience, I’m in a unique position where I am able to watch a plethora of surgeries since my clinician, Dr. Spector, is in the plastic surgery department. The sheer variety of patients we see in the clinic and the OR is mind boggling. Dr. Spector may have a patient in the morning that has a suspect lesion removed before moving on to a patient who needs to have a rectus femoris muscle (one of the four quadriceps muscles) free flap to cover an exposed aortic graft in the groin. The free flap surgery itself is so innovative since someone at one point must have said, “gee, wouldn’t it be useful to cut along the sides and the distal end (the end closest to the knee) of the muscle and then rotate it up 180 degrees, snake it up under the skin to the exposed area of the groin/lower pelvis, and then sew it into place?” Who does that?

What also has been eye opening is the amount of hours these surgeons put in. The clinician isn’t always slicing and dicing then going to play a round of golf. The plastics department doctors can spend 12 or 14 hours in surgery one day and then have a day where they spend part of it in the OR, part of it in the clinic seeing post op or consults, and then another part working with the multitude of projects they oversee in their labs. My time here following Dr. Spector has really been split between seeing his surgeries and the surgeries of fellow attending, early morning rounds, poking my head into animal trials, and then spending hours consulting with patients in the clinic. But nevertheless, every time I put on the green scrubs I always laugh to myself at how amazing the concept of this program is and how I got to this point. Of course that’s right before I remind myself in the OR not to touch anything blue.

ID cards

I'll update this post at a latter date, but I wanted to talk about the issue of the ID cards. I feel this issue was not handled well at all. I came down to Weill a couple months ago and had to get an ID card to get access to certain buildings. The process, while very bureaucratic, can be completed in a day or two if the proper preparations are made. I take issue with the onus being placed solely on the students to put effort into the program and key administrative details seem to have been looked over. I say this with no disrespect and if asked I can and will help the students next year with any logistic issues that may arise. I hope the rest of the summer will run smoothly and we can all represent Cornell BME properly.

Immersion Course

I think I speak for us all in thanking Belinda for all her work. Moreover, I think that all of us are thankful for the experience that we are currently "immersed" in. Obviously, there were issues involved in getting started (to varying degrees for all involved), but I feel that we are all drawing positively from the chances we are now presented with.

One thing that Dr. Wang said, however, that I take issue with, is the suggestion that some of us are just complaining and not focusing our energy into making this work. I know that I put all my efforts in to getting my program underway once I got here (and this has been a successful endeavor for the record). Still, it is frustrating that things are so bureaucratic here (I'm sure Dr. Wang concurs). I realize that physicians are busy with important things, but I feel that what we do is also of paramount interest. My first post was not to suggest that the immersion program is a waste, as I think that it is a tremendous opportunity and represented this fact in my ebullient outlook of my upcoming project. But waiting in lines and filling out paperwork does impede me from building up my own thesis work, and this is all I was attempting to express in my initial post- I was using the blog as an venting forum, not making excuses for my own laziness.

My mentor's better than yours! Muah ha ha!

Unlike other people, my mentor isn't a surgeon. He is an OLD, distinguised hematologist dude who has been in this hospital forever. On the first day he gave me 15 articles and several books that scared the life out of me. I thought my fun time in NYC has just disapparated right in front of my face. Wrong... Being an old doctor is a great thing: very minimal actual hours of operation. I might get a lot of materials for reading, but I get a lot of time out of the hospital as well. Went sight seeing and did a lot of fun things during that time, but also a lot of reading.

Yeah, he makes me write down conditions and drugs during clinics and case reviews as my "homework". Everyone in our program probably misses many of the stuff being discussed--not me, luckily. Being old makes you talk slow, so that was perfect. Yeah, he quizzes me the next day about things we heard about the previous day. (This guy has surprisingly excellent memory and he remembers everything he said the previous day.) By the third day, he introduced me as a doctor and handed me the lab test for blood and JAK2 mutation and ask what kind of myeloproliferative disorders the patient has...in front of the patient. I messed up a few times but got it right for the most part. Was kind of proud, actually, cuz I'm definitely learning something from evening readings :)

There's no fancy gastroschisis or vascular surgeries or brain surgeries or prostatectomy with my guy. But I have gone to some of these surgeries with other people already. I'm very thankful people let me join their surgeries, but I basically saie "ooooh, aaahhh, cool" and that's it. The surgeons are always busy cutting up their patients and you just get to sit and watch. They don't seem to be teaching as much in each day, either, because they are so busy. While some doctors might not care if the students show up, my attending is definitely pacing up and down the hallway waiting for my arrival time! I feel like I am his primary concern as a doctor, in fact, and he seems so proud whenever I make the right diagnosis.

One thing I really hate about my clinical experience is the aspect that medicine is an art and not a science. As an engineer, I determine my threshold level and anything above that line is A and anything below is B--not so in medical practice. A patient could come in with a JAK2 positive and fibrosis in the bone marrow like in polycythemia vera, but yet his phenotype is elevated platelets and red blood cells and anemia like in essential thrombocytosis. What the heck? The point of blood work and gene testing is to determine what disease it is. If we can't just read the test and make a diagnosis, then what's the point? I like it black and white like the engineering way and not gray like in medicine.

Why is every patient in this hospital balling? Even the neonatal babies are balling! Do they only let rich people come here or something?

Sorry for the long read but I like blogging. I guess Dr. Wang is just gonna have to live with it.

how is this summer immersion course organized and who is in charge?

For the purpose to help you better profit from this clinical summer immersion, I would like to respond to SP's posting entitle "always wasting time". Well, stop wasting time, do something.

As I said at our last Pizza dinner, this summer immersion gives you an opportunity to experience and look into the real world of medicine. The privillege to observe and engage at the medical center is the main thing this course offer. How much you can get out of the privillege depends on how proactive and initiative you are.

By now you should have learned enough about the medical center operation to realize that neither Belinda Floyd nor myself is running the medical center. Even our Dean Caren Heller in charge of facilitating our program needs was not aware of the recent change in ID card policy that prevented us getting ID on the first day. You might have realized that when you were not able to get ID, I was the most frustrated and unhappy person in the world at that moment. As you wish, I do wish more than you that the medical system can be easier accessed by us. We are at the mercy of many bureaucrats, and our volunteering doctors with good intentions may be too busy to be approachable. This is the reality of medicine world we have to learn to live with. Guess this learning is part of this summer immersion course.

This is not the end of the world. Indeed, it is far better than other medical centers I have seen. I really want to advise you all take a positive attitude towards reality. Think not that you are the master of the world; think how you can get into the system. Instead of complaining, focus your energy on how to help get things done.

You should really be grateful to Belind Floyd who has worked tenaciously to get your room here, Dean Heller who has worked on authorizing your housing, your internet access (I just learned), and your other privillages of being here, Dr. Frayer who is putting in a lot of efforts into this course. While I have no authority at all to order people around the medical center, I do have put in significant efforts in working on the disresponsive medical system and in getting money to pay you. From the posting I see that most of you have now passed through the bureaucratic gate into the fun part of clinical immersion, and you all survive the "bloody first week". This is good progress we should celebrate!

First Week of Immersion

My first week at Weill started off a bit slow, but things are picking up. As usual when moving to a new place, dealing with administrative details leaves a person walking in circles and scratching their head for a good chunk of the day. The first day at Weill was no exception. It began with ID card confusion and proceeded to predictable difficulties with the IT department. But everything ended up working out in the end and now things are going smoothly.

I met with my mentor Dr. Schwartz on Wednesday, and we immediately discussed an image processing/data analysis project. Over the course of the past two years, massive amounts of optical reflectance image data have been accumulated by a graduated med student on exposed rodent cortex. He's since moved on to bigger and better things and nobody else in Schwartz's lab has time to analyze the large amounts of data. That's where I step in. I will be spending the next month and a half working on making sense of gigabytes of video data. The project actually seems pretty interesting and is well-tailored to my background in electrical engineering.

Dr. Schwartz also allowed me into the OR on Thursday to watch him perform two surgeries. The first was reparation of a leaking frontal sinus in an elderly woman, and the second was the removal of a tumor in a young man's spinal column. I'd never seen a surgery before, so I was pretty grossed out initially by the sights/sounds/smells but I eventually got over it. I'm actually looking forward to seeing some more of Dr. Schwartz's surgeries during my stay at Weill.

Week 1: Following the heart using ECHO

I started working at the Cardiology department last week, and for the first few days, I shadowed a fellow in the department, Dr. Fay Lin, who showed me some echo cardiography. The first task I received was learning how to read echos, or ultrasound images of the cardiac systems. I got access to several references (Fay told me about Yale's med school web site, which has an excellent outline), and two texts; one is a textbook, and the other is the list of protocols used at Weill. The patient data are currently stored in VCRs, and at Weill Cornell, echo data will soon be stored using digital medium at some point during the summer. What really interested me was the protocol involved in getting a set of images in about 10-15 minutes. The echo images are shaped in a flat fanbeam, so one can only see the 2-D profile of the heart. Therefore, the echocardiographer obtains images of the cardiac cycle from about 3 or 4 positions, and rotates the probe by 60 degrees at each; this gives many different image profiles, such as 2-chamber view, 4-chamber, and 5-chamber view, that are useful for observing different chambers, valves, and blood vessels. Interestingly, the fifth chamber in the 5-chamber view is actually the aorta.

I also got to observe a trans-esophageal echo, which involved a probe that was threaded down to the stomach and obtained the cardiac image closer to the source. The probe tip can be controlled tp move in 4 directions, and while I was observing, another fellow/resident was learning how to control the probe, while the doctor leading the exam, Dr. James Min, operated on the computer. The images obtained during this procedure were much clearer than typical echo cardiograms. While the setup/sedation process took easily over an hour, the imaging part took about 10 minutes altogether.

While the trans-esophageal procedure seems to provide much better images than typical echocardiograms, it is also much more difficult to perform in a hospital. The trans-esophageal procedure requires sedation of the patient using moderate anesthesia, which does not require the presence of an anesthesiologist, and in total takes about 2 hours to perform on a single patient.

In addition, I also got to follow my mentor, Dr. Jonathan Weinsaft, in the Cardiology ICU for the morning rounds, usually starting around 8 am, and going on until noon. I got a lucky break from day 3, where I could join them a little bit into the rounds. Sometimes, such as on Saturday, the rounds apparently took until 2:30 pm in the afternoon. During the rounds, there were about eight medical students, residents, and fellows who gathered around Dr. Weinsaft on a workstation computer set up in the middle of the ICU, and they gave details on what happened to each patient overnight to Dr. Weinsaft. Since the patients all have conditions that require constant care, the entire team spends anywhere between 15 minutes to even half an hour or more looking through each patient's case. While the rounds were quite exhausting, it is an integral part of providing care to the patients.

Also, I got to observe a CATH (Catheter) exam. X-ray angiography was used to look for stenosis in the coronary arteries, and the insertion of the catheter into the femoral artery surprised me a little.

In summary, the first week has been a novel experience. In addition to the clinical aspects, it's great to hang out with fellow BME PhDs again.

Bloody start...

Last week was a bit slow, but I am optimistic that things will pick up soon. During the first few days I was sent to all corners of the hospital and medical college to get my ID/badges/scrubs so that I can have access to, well, everything: my physician’s office, my lab, and the OR. I managed to get everything by the end of the week, so I’m ready to get things rolling.

I’m currently in the process of ordering materials that I need for my summer project, which is determining how a pressurized environment affects co-cultured vascular endothelial and smooth muscle cells. For those of you who didn’t notice, I had to drag a 50 pound “pressure chamber” (a.k.a. metal box) from Ithaca. The lab manager here was supposed to help me with the ordering, but unfortunately she was on vacation for the week. I needed to contact another person to help me set up an incubator, but he never picked up his phone. Hopefully by next week I’ll be able to cross a few things off my “to do” list.

I was able to observed one surgery on Friday. The patient had restenosis of a stent graft in his left thigh. My surgeon and her team first inserted a catheter into his right thigh. Aided by x-rays they managed to feed the wires into the left thigh through the bifurcation and were able to re-stent the artery. There was some sort of complication with a newly formed blood clot after the re-stenting but it was dissolved using tPA. I watched the entire procedure on a computer screen behind glass windows which was nice because I didn’t want to get in anyone’s way, have blood squirt on me, or put on the lead aprons.

I was surprised that the patient wasn’t put under—I would be pretty weirded out if I had a metal wire coming out of my leg. I noticed that Dr. Vouyouka was a little irritated with the patient. I believe it was because he didn’t watch his diet and continued to smoke heavily after his first stent procedure. I mean, when you have to get two stents before the age of 50, you’re doing something wrong.

Other than getting lost in the hospital, I’ve been getting lost in the city. I’m thinking of making a Google map of all the places I’ve been to for memory’s sake. If anyone wants to explore NYC let me know. I’m always game for random adventures and especially good eats. Happy birthday Zoe!

69th Street and York

After my first week at Weill, I'm finally done with all the meetings and hassle which comes with moving into a new program and apartment. I got my internet hooked up, wrote emails, finished citiprogram, and met with my doctors, etc.. My three doctors whom I met with are very knowledgeable and nice. Dr. Girardi and Dr. Salemi are cardiothoracic surgeons which specialize in Congenital Heart Disease, Minimally Invasive Cardiac Surgery, Mitral Valve Surgery, Aortic Dissection, Coronary Artery Bypass, Marfan's Syndrome, etc. Dr. Skubas is an Anesthesiologist who also works with these patients and conducts echocardiograms. These are particular interesting because they identify the hemodynamics of the heart under normal and diseased states. This week I will be conducting rounds and viewing aortic valve replacements Dr. Girardi.
Things I miss back in Ithaca. My…. TV, PS3, apartment, lakes and trees, lab, fishing, low noise level, bed, normal sized dogs, places for dogs to relieve themselves, almost cheaper everything, grass, and Belinda.

My first week in Weill

The first week in medical school is definately an exciting experience for me. Overwhelmed by tons of new terms and maze-like buiding, I was so happy that survived the first week.

First, I need to thank my mentor Dr. Martin Prince, who is a super nice genius radiologist, with super patience. On the first hectic day in medical school, he gave me a book "MRI, from picture to proton" as present. Though until now, I have just finished 5 chapters, it is really a good book for a freshman in MRI. Even if I still cannot understand part of his comment when he is reading films, at least I won't be scared away by the terms in MRI right now. I also need to thank him for tolerating my bad vocabulary in anatomy. Somehow, I was really ashamed of myself for this because I am actually a bio background person. For a moment I really hoped all the text books in my undergraduate were in English, so that I would not feel so mad sometimes that I knew some anatomy terms in Chinese but don't know how to say them in English. However, no matter how busy Dr. Prince is, he is always very patient to my bad English, which helps a lot to get back my confidence.

Since I have such super good mentor and the chance to be bustling here and there with him, I learned more about the world of medical school than I expected. Watching the whole process of MRI scanning, biopsy, case meeting, facing patients, hearing all kinds of stories happened here and even attending the administration meeting of MRI department really taught me a lot on how different the hospital system is from graduate school. Medical school is a distinctive world that the ultimate respect and indifference for human life both exist. Yes, here is the place full of "common God".

Last, I was told the project I was going to do last week. It was definitely not my specialty, but I like challenge. I will basically start to work on my project this week and hopefully I can talk about some details about it next week.

Welcome back, Goose! Hope all of you enjoy your immersion this week and every day in NYC is full of friends, fun and wonderful experience. And I think all my wishes made on my birthday should come true~

Wasting Time Always

So, after 1 week here, I've basically found out that Weill is about bureaucracy. I had to wait in line for an hour for an ID that I never even got (how is this course so badly organized when the people in charge had a year to prepare?). After that, my clinician's secretary made me fill out what felt like stacks of forms. Don't even get me started on the nonsense that ITS pulled with me.

But, in the end, I got to meet my clinician, Dr. Healey, and everything looks promising so far. I will be undertaking a case study in the radiological profiles of the proximal femur of bone metastases patients. This coincides with my research interests (i.e. bone metastasis), but it gives me an opportunity to see it from a different place. The radiology study is cool, because I will get to investigate the blastic vs. lytic phenotypes of different cancers, which I have read about extensively since starting my PhD but have never actually seen. Essentially, I'll be collecting data that provides insight into how and where bone metastases tend to strike. Other stuff that I will see include orthopedic surgeries (specifically involving removal or bone cancers - primary or metastases) and micrographs that relate to bone biology.

That's about all for now. I won't bore anybody with random details of my quotidian pursuits, but I will say that NYC is fun to be in right now. To conclude: capital letters are good.

welcome to cornell medical center

hello summer immersion class 08,
i am sure you have experienced various things in your first week. i am eager to read them.

Babies"R"Us

Today marks the start of the second week in the neonatal intensive care unit (NICU). Unlike most other units and departments, all the patients in the NICU are babies; many of which are extremely tiny, premature babies with respiratory issues. This is how tiny some of them are. I observed several interesting procedures too. Of particular interest last week was a case of gastroschisis, in which the baby is born with an open abdominal wall, such that the intestines and some of the organs develop externally. Surprisingly, the survival rate for such cases are actually relatively high (~90%), and the treatment procedure is rather simple - the surgeon just tucks the organs back over time and applies pressure until the wound is healed. The organs cannot be tucked back all at once, as it would lead to compartment syndrome. How would you know how much to tuck back in though? Tucking too much can cause compartment syndrome, but tucking too little over time may increase the chance of infection too. I guess experience really helps here.

Apart from the procedures, I also learnt a lot from going on daily rounds with the NICU team. The first couple of days were confusing, as I wasn't accustomed to all the medical terminology and numbers used in the reports. An afternoon in the library reading up on the relevant terms and data used (such as typical laboratory values) helped a lot. The subsequent rounds I went on made a lot more sense, and I was able to keep up with the progress of some of the babies, from admission to diagnosis and through therapy.

This coming week should be busier and more exciting, with more surgeries and procedures that I may be going for (I finally managed to get scrubs! Now, if only I can get a photo ID...). I've also begun some background reading for the project that I will be contributing to. On a side note, the one thing I love about NYC (and most other places) is the food!

Getting Started

Well it's the end of week one and it's already been a whirlwind of experiences. I got off to a slow start since my clinician, Dr. Scherr was in Ithaca on Monday, but it's definitely picked up since then. Tuesday is Dr. Scherr's day in the clinic, so we met with a number of patients for follow up visits (3 mo - 3 years out). I think the most interesting case was a patient from Europe who had discovered testicular cancer while in the states on business. So while Dr. Scherr operated on him, the post-op treatments would be done back in Europe. What was so interesting was to see how Dr. Scherr was not only a resource for this patient’s disease status, but also was familiar with differences in treatments in Europe versus the states and able to recommend a physician for the patient in his home country.

Wednesday, Thursday and Friday are all surgery days for Dr. Scherr which this week included: a robotic cystectomy, a partial nephrectomy, a pelvic cancer mass removal, the robotic removal of a urachal carcinoma and three robotic prostatectomies. The best part of robotic surgeries for me is that I get to watch them on a screen rather than try to hover over the patient with three surgeons and multiple nurses. Of course Dr. Scherr also met with patients in the clinic between surgeries, so he kept very busy. To be honest, I'm absolutely amazed at how he keeps it all straight from current surgeries to phone calls about referral surgeries, from new patients being diagnosed to the round reports he receives from his residents; it’s crazy! At this point, I’m still learning all the terms for the diagnoses and surgeries, but can’t wait to see more and learn more.