Week 7-Mary Clare

My last week of Immersion Term was a bit more rushed than anticipated. I spent the first half of my week in Florida taking care of some unexpected family business. Due to these events I was not able to see cardiothoracic surgery. However while I was gone, the longer time point of my research project was running. The last two days of my immersion experience were spent trying to wrap up all the analysis for my study. This involved extracting, isolating, and analyzing RNA from my samples. Although our findings were interesting, I think there is still a lot of follow up work to be done before the study has conclusive findings.

Week 5-Marsha (Last Week)

            My last week of summer immersion was all about completing as many clinical rotations as possible. Monday: Cardiothoracic surgery. Tuesday: Lab. Wednesday: Emergency Department. Thursday: Medical Intensive Care Unit (MICU). Friday: Neonatal Intensive Care Unit (NICU). While each experience was unique, I think the emergency department will be one of the most memorable experiences of the summer.

            Since I had never been a patient in the emergency department, I didn’t know what to expect and in my mind was envisioning typical television dramas. Well, let me begin by saying real life is different than television. Over the course of the day there were two high alert patients where doctors, residents, and nurses rushed to the intake room. Aside from that, most patients did not have acute ailments. They came in because of some inexplicable feeling of discomfort—illness, digestive, or other, but were not in a life-threatening state. With the exception of the acute cases, the doctors and staff monitored patients at a calm pace, not frantically as I had anticipated.

            My memorable case was a sickle cell anemia patient. I learned about the challenge of pain management in sickle cell anemia from a physician’s perspective. Pain is one of the most common symptoms of sickle cell anemia and severe pain can be managed at the hospital using therapeutic drugs. In theory, every patient should be allowed to come into the hospital and receive unbiased treatment for their symptoms. Especially, in the case of sickle cell anemia where the pain is well documented and IV drug administration is the status quo. However, the situation becomes complicated because after a lifetime of morphine, Benadryl, and other drug administrations the line between patient and drug addict can become blurry. Should a physician be able to tell someone yes they can receive medication for their pain or no they cannot? How do you know if a patient is really telling the truth. After administering a combined pain treatment to a particular sickle cell patient, one of the attending physicians was explaining to me the challenges of treating these types of patients, and expressed that he really believed this patient was in pain. Two hours later, it was revealed the particular patient had been to the emergency department 28 times over the past 6^th months using different names and birthdays. When confronted by a social worker, they got up and left—of course having already received their treatment. This particular patient really highlighted the challenges that even the most experienced physicians face when trying to elucidate what is fact and what is fiction when talking to patients. It was also a good “last week” scenario because it showed the continued need to improve both diagnostics and treatments in medicine. We as a medical field are not doing a good job if our treatments turn patients into drug addicts.

            As a whole, summer immersion was without a doubt a once in a lifetime experience. Watching surgeries, rounds, and office visits I gained a better insight into how physicians think and the environment in which new medical advancements would be implemented. 

Darvin

In all, the summer immersion experience, though challenging at times, was incredibly unique and enriching. My medical vocabulary expanded by orders of magnitude, and I was given the privilege of seeing things that are usually exclusive to only medical students and clinicians. On top of it all, I had an interesting and useful project. I was partnered with Dr. John Kennedy, Foot and Ankle Surgeon at the hospital for special surgery.  Dr. Kennedy research interests are: osteochondral defects, cartilage regeneration using bioscaffolds, bone remodeling/fracture healing and platelet rich plasma (PRP) in Soft Tissue Injuries. Overall, I feel Dr. Kennedy was the perfect match, especially given that my thesis research involves cartilage biomechanics.

My summer project involved a long-term tissue database registry proposal, which will be submitted and reviewed by the New York clinical review panel. The conditions included in the registry will be any involving articular cartilage and soft tissue pathology of the ankle. Which includes but is not limited to, osteoarthritis of all grades, osteochondral lesions of the talus and distal tibia, degenerative joint disease, ankle arthrosis, joint and synovial inflammation, any pathology of the macro or micro environment of the joint or articular cartilage, ligamentous injuries and any associated tendinopathies. The registry aims to compile all data relevant to cartilage and soft tissue pathologies and treatments, biological state of the cartilage and related joint tissues, and the composition of biological adjuncts used to treat these pathologies and correlate this data to outcome data, mechanical studies, imaging studies, and already existing patient and surgical data currently collected in the Foot and Ankle Registry.  The data complied in this registry will allow many important research questions to be investigate that may impact clinical practice.

OVERALL, I  loved this experience. Thank you Cornell BME. 

Week 7 - Tara

It's pretty difficult to believe that summer immersion is already over. In some ways, I feel as though we just got started. This week happened to be very busy with different activities. I spent some time in the neurology group (as in the previous weeks) seeing patients with Dr. Gauthier. I also had to attend a couple of lab meetings and present my work over the last few weeks. This experience was nice as it solidified the background and purpose for the project in a general discussion with the post-docs and PI of the lab. Based on some primary data I was able to gather, the group will be optimizing the vaccine design going forward. I still have a few experiments to complete, and will stay back until the end of next week (8/2) to see them through to the end.

The highlight of my week came on Friday when I was able to view a cardiothoracic bypass surgery. This case in particular required an artificial bypass during the surgery in which Dr. Girardi was able to remove a section of the aortic arch and replace it with synthetic tubing. The best part about this experience was that I was able to stand very close to the patient and get an aerial view of the surgery being done from time to time. An open human heart on an operating table is something I will never forget. Furthermore, this surgery was interesting by watching the attending extensively suture the synthetic tube to the existing anatomy so that there would be no ruptures or tears. It was quite unlike any other the other surgical procedures I have previously seen, especially when observing the interplay between the artificial bypass and anesthesiological monitoring.

To sum up, it's been a really valuable experience and one of the best and most unique parts about being able to do a PhD at Cornell. I am sure some people have come away with knowledge about clinical practice, and others have caught a glimpse of the physical impact/contribution of their research in Ithaca in medicine today. In my case, I can say that there is an added level of meaning in that I have also discovered a new research interest that I will pursue in the course of completing my thesis. When I began Cornell, my primary interest was on developing therapeutic systems. However, after this summer, I realize I am more interested in better understanding the mechanisms of disease. Being able to see the practice of medicine (from the clinic to diagnosis to treatment to preventative measures) reinforced that enhancing current standard of therapies relies on a better understanding of the intricacies that trigger progressive disease. Furthermore, I have been able to see the diversity of patient's physiological response to the "same" disease. It is clear that some patients are asymptomatic, others have a severe and sudden onset, and others still fall under having a "spectrum" disease where their symptoms overlap with other pathologies. The question then arises, how do we go about treating the ever increasing complexity of disease that we see today and predict to have in the future? I would not have been able to see this research interest so clearly without having this clinical exposure firsthand. I am extremely grateful to have been able to participate in the immersion term.

Week 7 - Ashley

My last week of clinical immersion I decided to try the other departments I hadn't been to. My first experience was in the MICU (Medical Intensive Care Unit). Rounds started at 730 AM and our first patient was brought in for overuse of alcohol. She was unresponsive and on a ventilator since the night before she was admitted. The attending surgeon recommended keeping an eye on her until the team could get her fully awake. We saw many patients that day, but the one that grabbed my attention was a patient with a bacterial infection that was negatively affecting his whole immune system. The most intense part of the situation was that he could not speak English, and always pointed at his son to make his medical situations. There was still a communication barrier, but son was able to make the necessary decisions for his father because his father was giving him consent. 

I also decided to do an OB shift this week, and got an amazing experience in triage and in labor and delivery. The most exciting surgery I witnessed was a planned C-section. The surgery began with an epidural being placed, and the first cutting followed shortly after. The fascia was first removed to expose the uterus, and slowly the water broke and the baby's head followed. The umbilical cord was then clamped and cut. The baby was prepped and handed to the father standing nearby. The placenta was completely removed, and the uterus was then sewn back up. The procedure was relatively fast, safe, and completely memorable. This particular experience stands out from my entire experience. 

To sum up this summer, it was a completely unforgettable experience. I have met fascinating individuals that have taught me so much. I'm really thankful to have had the opportunity to meet and be mentored by excellent clinicians in their field. A special thanks to Dr. Lane for being a great mentor and allowing me to shadow him the entire summer.  

Week 6 - McCoy

This week I spent a great deal of my team reading up for my project, medical journals were a little difficult to get through in the beginning due to the various jargon, but now I think I have a much more firm grasp on reading them without actually having to look up the definition of every other word. This week we were able to sign up for MRI’s and have scans of body locations of our choice. Naturally, I chose to have my brain scanned and was able to see the result. There is something very meta about a brain wanting to see itself, though that’s a discussion probably best left for another time.

As far as clinical rounds and patients are concerned, this week I had more down time than previously due to the working on my project as well as being given some time to go and do things in the city that I should do before I have to go back to Ithaca. I did attend clinics still, however, and was able to see a few patients. One in particular sticks out as it was fairly emotional. A woman had been in a car accident and had gone to get a CT scan, though she felt fine after the crash. At the behest of her kids, she chose to go ahead and upgrade to an MRI scan; the results of the scan indicated that she had a malignant glioma deep within her brain even though she appeared to be asymptomatic. She is on chemotherapy regiment currently and the tumor has appeared to shrink slightly in size, though Dr. Boockvar has indicated that it will eventually become resistant and that it is inoperable with current technology. Still, the woman has been given several extra months, possibly years to her life purely because of a quick, seemingly unimportant decision. This is likely the most important story I will remember from my time in the immersion. 

Week 5 - McCoy

This week I had more down time to begin working on my project, which is more so of a literature search and review on the uses of ultrasound in chemotherapy delivery, particularly in seeing whether or not disruption of the blood-brain barrier would be possible or appropriate. Current limitations to using chemotherapies for brain cancers are their inability to pass through the blood-brain barrier and reach their therapeutic target. Additionally, I also followed a med student in Boockvar’s lab, Kartik Kesavabhotla, and saw how many of the med students practice for their eventual surgeries – on animals. It was actually a bit more interesting as I was able to be closer to the actual surgery and I could ask a lot more questions than I would normally be allowed to within a human surgery.

I spent some time again in clinicals with Dr. Boockvar, though much of the time was spent going through patient history, previous treatments, and other data that would be useful in his understanding of their cases. From this, I was able to pick up on key things that he uses in identifying different cases and his course of action for each of those. In particular, he seemed to be fairly accurate at diagnosing brain tumor types from their location and MRI appearance, something that he said he’s picked up on over his years of experience with them. He also told me about many of the basic therapies that are used for many of the gliomas, though due to their unique location and proximity to vital tissues, the list of possible therapies was very small. Additionally, he told me about many of the different nuances of surgery and thing he has to consider when he decides whether or not he wants to continue with surgery on a particular patient.