As I said last time in my post, I have been working on my project most of time during the past week. My project is to build up a website for updated MR protocols, which can also function as a platform for the quality control of MR scanning and the database for both radiologist and technicians.
The funny thing is the project on which I am working very hard now actually didn't sound very interesting to me at first. Building a website, I am afraid this appears to be more IT related to most of you. Even I at first thought perhaps one skilled IT technician in medical school can finish this project in a week easily too. However, the more I learned about the motivation to do this project from Dr. Prince, the more I feel the reason why I am here is more to learn what kind of difficulties biomedical engineering may encounter in hospital rather than to do some contribution from the engineering side as I thought before.
One thing happend last week made me have this strong feeling. A salesman from one medical software developing company came to Columbia to promote one new program for the CT analysis of liver. Without doubt, this is a fancy program at the first sight. It can automatically calculate the contour of liver from 2D CT iamges and reconstruct a 3D model. Calculating the volume of different parts of liver after incision is also easily achievable. However, this new software is not so satisfactory that Dr. Prince can be persuaded to purchase it. One reason is when he tried out cutting the liver 3D model in a way that surgeons would do to a donor of liver in surgery, it was really an awkward experience for him. He spent 10 more minutes to finally find a satisfactory cutting track, which right across the portal vein and middle hepatic vein. Obviously, it doesn't save much time for the radiologist who are trying to make a decision whether to cut this much liver from the donor or not. From their standing point , this new software is not appealing enough for them to change the current measurement of liver from size to volume, though the latter one is more convincing measurement theoretically.
Is that because the imaging processing technology is still so dumb nowadays that it cannot realize doing all calculation automatically for the busy radiologists? Definitely not. Defining the contour of blood vessels with high enhancement in CT images is actually a piece of cake for most electric engineers. Based on that, it won't be that difficult to reconstruct an incision plane that surgeons will make in surgery. The problem is, the communication between doctors and engineers is still not well enough. Even though both of them know that volume is a better measurement than size in clinic, even though numerous software have been developed to make volume calculation more automatically, in order to get a desired measurement, most radiologists still use size as the only measurement in report, just because they need to put a lot time on defining the desired countours manually on each slice if they choose volume as the measurement.
This story taught me a good lesson that there is actually a big disconnection between engineering and healthcare. When patients come to hospital, they pay more attention to the comfort, efficiency and safety. However, these are what engineers always consider at last when they design the medical equipment. During the last two weeks, I witnessed how much the obese patients suffer when they are "squeezed" into the MRI scanning machine, how the uncomfortable feeling in the scanner resulted from bad cushion, noises and pain make some patients disobedient to doctors' request. In fact, one of the biggest impedance in healthcare now is bad consideration and communication.
Because of this, I think my project is not a only website which an IT technician can hand in perfectly within a week now. Actually, the quality and design of this website directly affects how much the communication between the clinicians and technicians in this hospital can be improved. By putting my observation and learning in this immersion program into this project, I actually experienced a post-engineering stage which most engineers may not notice most of time.
Showing posts with label Week 2. Show all posts
Showing posts with label Week 2. Show all posts
Wednesday, July 2, 2008
Monday, June 30, 2008
Robotic Prostatectomy
We’re nearing the end of week two and I definitely feel like I've settled into the routine of things here. As well, a few things have come to my attention reinforcing the fact that I do not want to be a doctor. First of all, the early mornings, I'm usually not even awake enough to drink a cup of coffee before our 7:30am surgeries, yet the surgeons and nurses are alert and ready. Secondly, I have to write everything down and then reference my notes to remember the terms and anatomy, let alone the details of any given case. With these two realizations I’ve adjusted my lifestyle for the time being by going to bed early and always carrying pen and paper.
On to more interesting things: my clinician’s most frequent surgeries are robotic prostatectomy and robotic cystectomy. At this point I’ve learned how a patient proceeds through the diagnosis, treatment and recovery of both and thought I’d outline the general process for prostate cancer patients in this blog. As well, if anyone wants to watch a robotic prostatectomy there are a few sites you should check out in advance to better understand what you are seeing. The first link is an anatomical animation of a prostatectomy and the second is a video of a prostatectomy with commentary.
In general, patients with prostate cancer present with an elevated PSA (prostate-specific antigen) score. Patients are then further classified by stage and grade. These levels are defined by the results of a TRUS (Trans-Rectal Ultrasound Guided Biopsy) which can be performed during an outpatient visit. Biopsies are done through the rectum, under local anesthesia, with the guidance of ultrasound visualization of the prostate to ensure biopsies are taken from different locations throughout the prostate. The results of these biopsies are then combined to determine the patient’s Gleason score. At this point, the patient is advised as to which treatment they should consider: radiation, open surgery or robotic surgery. This consultation also takes into affect the patient’s age and current general health status.
If the patient opts for robotic prostatectomy, the surgery generally follows this video’s commentary. Two valuable aspects of robotic surgery are: 1) the ability to spare the nerves required for erectile function and 2) the ability to take biopsies during the surgery and have them immediately analyzed by cytology to ensure that all cancerous tissue is removed.
Last, the patient recovers in the hospital overnight and usually heads home the next day. They keep a catheter in their bladder to allow the new urethro-bladder junction to heal. Postoperatively, urinary control returns followed by erectile function. The recovery period varies by patient and generally tends to depend on age as well. Patients are then followed after surgery every few months for the first year and over progressively increasing time intervals for the years to come. Follow up visits usually include a conversation about the status of urinary and erectile function and a rectal examination of where the prostate was removed to ensure no re-growth has occurred. Overall, the process from diagnosis to recovery is definitely stressful for the patient but often results in very happy conclusions.
On to more interesting things: my clinician’s most frequent surgeries are robotic prostatectomy and robotic cystectomy. At this point I’ve learned how a patient proceeds through the diagnosis, treatment and recovery of both and thought I’d outline the general process for prostate cancer patients in this blog. As well, if anyone wants to watch a robotic prostatectomy there are a few sites you should check out in advance to better understand what you are seeing. The first link is an anatomical animation of a prostatectomy and the second is a video of a prostatectomy with commentary.
In general, patients with prostate cancer present with an elevated PSA (prostate-specific antigen) score. Patients are then further classified by stage and grade. These levels are defined by the results of a TRUS (Trans-Rectal Ultrasound Guided Biopsy) which can be performed during an outpatient visit. Biopsies are done through the rectum, under local anesthesia, with the guidance of ultrasound visualization of the prostate to ensure biopsies are taken from different locations throughout the prostate. The results of these biopsies are then combined to determine the patient’s Gleason score. At this point, the patient is advised as to which treatment they should consider: radiation, open surgery or robotic surgery. This consultation also takes into affect the patient’s age and current general health status.
If the patient opts for robotic prostatectomy, the surgery generally follows this video’s commentary. Two valuable aspects of robotic surgery are: 1) the ability to spare the nerves required for erectile function and 2) the ability to take biopsies during the surgery and have them immediately analyzed by cytology to ensure that all cancerous tissue is removed.
Last, the patient recovers in the hospital overnight and usually heads home the next day. They keep a catheter in their bladder to allow the new urethro-bladder junction to heal. Postoperatively, urinary control returns followed by erectile function. The recovery period varies by patient and generally tends to depend on age as well. Patients are then followed after surgery every few months for the first year and over progressively increasing time intervals for the years to come. Follow up visits usually include a conversation about the status of urinary and erectile function and a rectal examination of where the prostate was removed to ensure no re-growth has occurred. Overall, the process from diagnosis to recovery is definitely stressful for the patient but often results in very happy conclusions.
Week 2
My second week of summer immersion consisted of working with Dr. Skubas, Dr. Girardi, and Dr. Salemi. Dr. Skubas works within the department of anesthesiology and specializes in echocardiographs. This is extremely important in cardiothoracic surgery because echo is a minimally invasive technique which can monitor the performance and state of the heart. Specifically, they use a process called (TEE) transesophageal echocardiogram in which the device fits down the throat of the patient and can easily monitor the heart because of the close working distance. I plan on working with Dr. Skubas by quantitatively assessing the echocardiograms before surgery under the given state of valvular disease. For example, valvular disease usually consists of stenosis (when there is blockage or resistance of blood through the valve) or regurgitation (leakage of blood through the valve). Using echocardiograms of these diseases states performance of the heart, stress on the heart, and strain on the heart, velocity profiles, and many other interesting features can be assessed. We hope to use these features to better understand the endpoint before surgery and, to observe the role in which hemodynamics plays within the heart as a further promoter perhaps of valvular disease.
Dr. Girardi and Dr. Salemi work within the department of cardiothoracic surgery and specialize in a number of special surgeries such as coronary bypass and aortic valve replacement. These two surgeries I had the privilege to observe in the OR. Understanding the mindset of doctors is important when designing devices because, as shown through surgery, the efficiency and effectiveness between every person and tool is phenomenal. If the device is not consistent and effective within a timely manner, there will be major problems. After speaking with Dr. Salemi, he has many ideas on particular devices in which could be useful for surgery such as minimally invasive devices for valve replacement or specific microfilters which was very interesting. During this week I also completed a few rounds with patients in the ICU after their surgeries. Hopefully next week, I will be able to visit consultations before their surgery as well.
Lastly, my ID card problem continues. After a week of observing the OR, I was told specific paperwork needs to be filled out even after I had received my new ID card. Confidentiality forms, consent forms, and a drug test on top of that. I am waiting to hear back from the department concerning this. This is extremely frustrating because it makes me look irresponsible to the doctors whom trusted me in the first place. It is already the third week and I hopefully by this Wednesday; everything should be back to normal.
Dr. Girardi and Dr. Salemi work within the department of cardiothoracic surgery and specialize in a number of special surgeries such as coronary bypass and aortic valve replacement. These two surgeries I had the privilege to observe in the OR. Understanding the mindset of doctors is important when designing devices because, as shown through surgery, the efficiency and effectiveness between every person and tool is phenomenal. If the device is not consistent and effective within a timely manner, there will be major problems. After speaking with Dr. Salemi, he has many ideas on particular devices in which could be useful for surgery such as minimally invasive devices for valve replacement or specific microfilters which was very interesting. During this week I also completed a few rounds with patients in the ICU after their surgeries. Hopefully next week, I will be able to visit consultations before their surgery as well.
Lastly, my ID card problem continues. After a week of observing the OR, I was told specific paperwork needs to be filled out even after I had received my new ID card. Confidentiality forms, consent forms, and a drug test on top of that. I am waiting to hear back from the department concerning this. This is extremely frustrating because it makes me look irresponsible to the doctors whom trusted me in the first place. It is already the third week and I hopefully by this Wednesday; everything should be back to normal.
i wake up at 7am on the weekends...
I had my first experience in the clinic this week. On Monday, I watched a procedure Dr. Vouyouka called an endovenous ablation of varicose veins. Varicose veins occur when the veins in the leg become more elastic and valves that prevent backflow malfunction. Blood ends up pooling in the leg, leading to enlarged, varicose veins.
Babies and Surgery
There is quite a lot to be said for all the things that I've seen, learnt and experienced the last week, but I'll try to keep it short...
1) Not all babies are cute. Most babies are cute... but there are some ugly babies out there. Twins are almost always adorable. There is a pair of twins (a baby boy and girl) in the NICU who are the most adorable creatures around. They were hospitalised for prematurity (multiples are at a higher risk than singletons) and were initially placed in separate isolettes. Now, they are co-bedding in the same isolette right beside each other. Sometimes, you can even see them holding each others' hands! For those who are interested in the kind of diagnoses and treatments that go on in the NICU, do read this blog on premature twins from the perspective of their proud parents. They describe some of the common issues and concerns in neonates, such as PDAs, feeds, infections, ventilation, blood gases, bilirubin levels etc.
2) Surgery can be REALLY cool, but is not always as cool as they make it out to be in TV shows (i.e. Greys Anatomy). In many cases, the condition is a lot more interesting that the surgery itself. One case I observed was encepholocele (PG-rating for potentially gruesome) in an infant. The occurrence was somewhat bizzare and interesting. The surgery, however, was a relative simple procedure - a 1-hour process that involved craniotomy and excision of the cyst. The one really fascinating surgery that I watched was the robotic prostatectomy. There is a series of WCMC youtube videos (6 parts) that guides you through the surgery. If you are ever going for the surgery, you really should watch these. It is amazing how much robotic technology has progressed to the point where we can confidently control it with such precision and accuracy in surgery. But can the robot ever completely replace the surgeon?
Some other quick thoughts: In the past two weeks, I have gotten the impression that doctors are generally the ones who are more interested in "what" happens, whereas scientists are somewhat more interested in "why" something happens. Of course, this is not black and white; medicine and science are not distinct, and both questions often need to be addressed at the same time. What do you think?
1) Not all babies are cute. Most babies are cute... but there are some ugly babies out there. Twins are almost always adorable. There is a pair of twins (a baby boy and girl) in the NICU who are the most adorable creatures around. They were hospitalised for prematurity (multiples are at a higher risk than singletons) and were initially placed in separate isolettes. Now, they are co-bedding in the same isolette right beside each other. Sometimes, you can even see them holding each others' hands! For those who are interested in the kind of diagnoses and treatments that go on in the NICU, do read this blog on premature twins from the perspective of their proud parents. They describe some of the common issues and concerns in neonates, such as PDAs, feeds, infections, ventilation, blood gases, bilirubin levels etc.
2) Surgery can be REALLY cool, but is not always as cool as they make it out to be in TV shows (i.e. Greys Anatomy). In many cases, the condition is a lot more interesting that the surgery itself. One case I observed was encepholocele (PG-rating for potentially gruesome) in an infant. The occurrence was somewhat bizzare and interesting. The surgery, however, was a relative simple procedure - a 1-hour process that involved craniotomy and excision of the cyst. The one really fascinating surgery that I watched was the robotic prostatectomy. There is a series of WCMC youtube videos (6 parts) that guides you through the surgery. If you are ever going for the surgery, you really should watch these. It is amazing how much robotic technology has progressed to the point where we can confidently control it with such precision and accuracy in surgery. But can the robot ever completely replace the surgeon?
Some other quick thoughts: In the past two weeks, I have gotten the impression that doctors are generally the ones who are more interested in "what" happens, whereas scientists are somewhat more interested in "why" something happens. Of course, this is not black and white; medicine and science are not distinct, and both questions often need to be addressed at the same time. What do you think?
Week 2: Goose
A 17 year old boy entered the OR shedding tears with his mom tightly holding his hand. The boy was very nervous, I could tell, and he seemed to know exactly what problems he had in his brain and the surgical procedures he was about to go through. He could not stop weeping. The mom and the son hugged and cried until the anesthetician started the preparation and the nurses escorted the sobbing mother out of the room.
The boy had a benign tumor in the middle of his left cortex and had to go through an open brain intracranial surgery. The surgical procedure began by making an incision to open up palm size skin on his left side of the head. As the underneath skull revealed, the surgeons cleaned up the blood and drew a line where they were planning to cut the skull open. I did not see any measurement or any calculation being done-the line was drawn entirely by guessing. From the surface of the brain, the surgeons started performing the procedures while looking through a huge magnifying scope to see the sites better. As the surgeon carefully made their way through the brain tissues to the tumor by carefully making small incisions, he decided to cut the skull a little bit more. The surgery lasted a long time. Finally the tumor was out and the physicians closed the brain up.
I could tell that the surgery was one of the routinely performed procedures for the neurosurgeons. But for the boy it clearly wasn't. The rest of his life depended on it. Other patients I have seen were pretty different cases than him, either they were very young and little or old, and all of the procedures had to be done on the cerebral ventricles which involved the use of minimally invasive endoscopes. However, he was old enough to understand what disease he had, what procedures were to be done on his head, and what consequences he may face after the surgery--I could see it in his shedding tears. For his case minimally invasive technique was not an option. Although the surgeons did their best to avoid any loss in cognitive or motor functions, they could not get to the tumor without making incisions. The boy's brain, the left cerebral cortex, was left with a permanent cavity-he will not be the same as he was before.
As I saw the procedure I kept thinking and asking why would a tumor form in young patients. Is there a way to prevent it? Is it their lifestyle, genetics, or just a bad luck? Is there any other method to kill the tumor without such a surgery? Why would not the surgeons carefully plan before making incisions and cutting to avoid opening more later? I was bombarded with thoughts like these and was irritated to realize that this may be just about the edge of human knowledge and technology. Of course the boy would otherwise have died by the tumor if we did not have surgeons and techniques that we have. We could praise the current era of advanced technology and health care for sure with a young boy's life just saved. But I could also see that we were just too far from where we could say it is good enough yet.
What have I learned after 2 weeks?
Seeing the way that physicians work firsthand has been a pretty cool experience. Just this week I witnessed a tumor board conference that was focused on diagnosing patients. Not as simple as you might imagine, it turns out. I work in an orthopedic department, so all of the cases in question are centered on bone. The initial tests are all x-rays, and the physicians must be able to spot the smallest abnormalities in these scans. After a while, you start to notice the things that they do, but everything is very subtle. Clearly the consequences of missing these "subtleties" are dire, so that gives me an appreciation in the meticulousness that these people must undertake everything with.
When tumors arise on bone, they are most likely metastases (~100,000 cases/year). Less often, sarcomas, or primary bone tumors are seen (~1000 case/year). Even so, when diagnosing these cases, it is important to distinguish as the appropriate treatment strategy varies. Even for sarcomas, there are a wide range of types depending on which cell type is transformed (osteocytes, chodrocytes, and even giant cells are among the possibilities). Some of these tumors are radiation-resistant, which obviously affects how you might treat it. What I have seen is very pertinent to my research clearly. For one thing, it kind of humanizes the problem, as I am not just looking at cells anymore. For another, it shows me where my research fits into the overriding picture of combating cancer. Using that as segue, I think that one broad thing that this immersion term teaches us is that we as engineers must shape the future. While physicians do their best with what they have, it is us who provides the tools. As we look to the future of disease in general, we are the ones that hold the keys to a better outlook. This experience has shown us the current SOTA- it is up to us to turn art to science and solid cures.
On a closing note, I must say that seeing the NY Philharmonic live in Central Park was a great experience. Enjoying the performance from the Belvedere Tower was the way to go. It was so cool, calm, uncrowded up there, and we could really hear the beautiful music. I almost feel bad for all those that were cooped up on a blanket in the midst of all the extra noise on the Great Lawn. Definitely one of my NYC moments of the past week!
When tumors arise on bone, they are most likely metastases (~100,000 cases/year). Less often, sarcomas, or primary bone tumors are seen (~1000 case/year). Even so, when diagnosing these cases, it is important to distinguish as the appropriate treatment strategy varies. Even for sarcomas, there are a wide range of types depending on which cell type is transformed (osteocytes, chodrocytes, and even giant cells are among the possibilities). Some of these tumors are radiation-resistant, which obviously affects how you might treat it. What I have seen is very pertinent to my research clearly. For one thing, it kind of humanizes the problem, as I am not just looking at cells anymore. For another, it shows me where my research fits into the overriding picture of combating cancer. Using that as segue, I think that one broad thing that this immersion term teaches us is that we as engineers must shape the future. While physicians do their best with what they have, it is us who provides the tools. As we look to the future of disease in general, we are the ones that hold the keys to a better outlook. This experience has shown us the current SOTA- it is up to us to turn art to science and solid cures.
On a closing note, I must say that seeing the NY Philharmonic live in Central Park was a great experience. Enjoying the performance from the Belvedere Tower was the way to go. It was so cool, calm, uncrowded up there, and we could really hear the beautiful music. I almost feel bad for all those that were cooped up on a blanket in the midst of all the extra noise on the Great Lawn. Definitely one of my NYC moments of the past week!
Friday, June 27, 2008
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 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
Source: http://www.bocaradiology.comFor 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.
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.
Thursday, June 26, 2008
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.
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.
Wednesday, June 25, 2008
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.
Tuesday, June 24, 2008
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.
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.
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