Week 6 - Julie

Wow, week 6 already! I had the opportunity this week to spend 5 days in the neonatal intensive care unit (NICU) during morning rounds. I learned a lot from this because I got to follow the babies through their treatments. There was one baby who had severe lung disease and had been in the hospital since January. The cocktail of medication he was taking was so complex that the doctors sat down and listed out which receptors each drug affected to make sure there were no foreseeable adverse reactions or opposing drugs. There were babies who were born after 24 weeks or had complicated twin pregnancies. These babies often have hearts with holes, as they are in the placenta, but when they are breathing air out of the mother this is an issue. It was interesting to learn which medications they use to try and develop a more mature heart for them. Another baby was born and was thought still born, but after 20 minutes he started registering a heartbeat, and later they got him to breathe. I learned that this type of baby needs his head to be cooled for a few days in order to slow down the metabolism before they check his EEG and check for brain signaling. One baby was seen as an emergency C-section by one of my BME colleagues and I saw him on the NICU floor the next morning. It was good to see that although this “ghost baby” had endured hours of poor blood flow, they could nurse him to health after birth.

It was interesting to note the social issues surrounding the NICU patients as well. One mother would not allow her child to receive any vaccinations, but consented on all other medical care, due to their religion. There were children where the mother was also sick and could not visit the child, or another one whose mother was in and out of a homeless shelter. I could tell that while the doctors did not treat the patients any differently, they did worry more about sending these children home to unstable environments. Parents also have different levels of education or comfort administering a treatment at home. Sometimes it’s important to realize that certain parents will or won’t pay attention to certain signs, which affects patient compliance. I also thought to my parents, because I was a premature baby. There are special sections for babies who are not complicated, but just born early and are very small, like I was. Parents with these children were just as nervous and concerned as the parents with the severely ill children.

There were also other short activities this week. For my research project, I fixed my cells and prepared my samples for histology. They went through the VIP and wax embedding steps and then next week I can stain them for H&E. Our collaboration between my lab in Ithaca and Dr. Spector’s lab continues to develop with video conferencing. I also got to see patients with Dr. Spector in office hours, and again learned about post-operation wound care. We got to meet a girl whose case I have been following for weeks. She was hit by a truck and needed vascular surgery to provide blood to her foot and leg. I saw her first present, then the surgery, and then in post-op care. I was really excited that she had vascularization in her foot and she was learning to move it! My other activity was attending the neurosurgery weekly report, where they present the most interesting patients to consult with other doctors. I learned how to identify brain tumors with histology and MRI images, and then how doctors think through the process of treatment or surgery.

This Saturday night I spent shadowing in the Emergency Room. I got to shadow a fellow in the A-wing as well as see ambulance and walk-in triage. I was amazed at how slow the night was, because I expected weekend nights to be the worst. There was a girl my age who had a golf-ball sized cyst above her ovary, and I learned that that is normal, however she also had bleeding in her abdomen. Other patients presented with post-surgery complications. But the most exciting case was a man who was having a heart attack. I observed him from being wheeled in on the stretcher, to learning his history, and then diagnosing the heart attack as a lengthened QRS segment using EKG and noting a clot with X-ray. Then I followed the team to the cath lab and watched them perform an angioplasty and stent placement. I found the technology in this procedure really amazing. They snaked wires up from his groin to his heart, pumped in dye to detect the clotted area and removed part of the clot. Then they snaked through a balloon and inflated it and then placed a long stent in this area. I was fascinated by how they made the small decisions, such as how to chose the correct compliance and length of balloons and stents, determine which arteries to place wires through, which pressures to use, and using ultrasound to check that the stent is placed correctly. I have been waiting to see this procedures as it correlates most closely to my atherosclerosis research back in Ithaca. Overall, I had a very productive week, and I look forward to seeing the MICU and CCU next week as well as finishing up my research project!