Week 7 - Julie

My immersion experience came to an end with a big cardiac week! I got to see different rounds, finish up my research project, and see a cardiac surgery. I attended rounds this week for the adult medical ICU (MICU), the cardiac ICU (CICU) and the cardiac critical care unit (CCU). It was interesting to see how similar the MICU and CICU were in terms of how they monitor patients. MICU receives all different types of diseases and medical conditions, most of whom are complex cases involving respiratory, hemodynamic and metabolism disorders. The CICU receives just as complex patients, but who have also just undergone heart surgery. They both still monitored ins and outs, urine analysis, cognitive function, and other basic stats on the patients whether they were a respiratory or cardiac case. I realized that this is very important not only for easy cross-talk between departments, but is necessary to understand the whole patient, and not just focus in on the main ailment. I also learned about the post-death procedures for the staff, such as the paper work, registering the death, a minute to minute dictation of the death, and deciding about autopsy and organ donation.

In the CCU, I learned about the different medications and regiments for post-cardiac arrest or cardiac failure patients. I learned about reading ultrasound, chest x-rays and EKG’s to determine the exact heart disease. It was good to see how much attention they pay to each patient, and that they stay in that critical care for a week after a serious heart condition. I learned that the heart failure team is its own division and is called in as a consult around the hospital. It was good to see the interplay between them and the CCU team and bounce ideas off of each other. I also got to see the patient who came in this Saturday with a heart attack, and who I followed through his stent placement. It was reassuring to see him doing well and being discharged after having no major incidents all week!

My summer research project came to a conclusion this week. I microtomed my samples, and stained them with H&E. Then I imaged them with light microscopy and compiled the photos. I quantitatively compared my samples versus the standard procedure in the lab. I wanted to know if seeding vascular cells in the bulk of the collagen would lead to the cells lining the lumen of our microvessel setup. This was compared to cells which were injected directly into the lumen, which a longer procedure and we were hoping to find a different and quicker technique. After quantitative analysis I determined that injecting the cells is best at obtaining cells lining them lumen. Therefore, although my technique is quicker, for now they will have to stay with injecting the cells directly. I began writing up my poster presentation of this research data and completed my HHMI fellowship grant, which is a step towards a collaboration between my lab in Ithaca and Dr. Spector’s lab here in NYC.

The cardiac surgery was very exciting to see because they have to stop the patient’s heart and then start it again, which is unreal. The surgery I observed was a mitral valve repair, because there was regurgitation of blood through this heart valve. I was able to see the real-time ultrasound that they take of the heart through the esophagus to visualize the regurgitation and decide on a repair strategy. Since there was a lag time between when the patient was ready and when the surgeon came in, the residents took the time to show me the anatomy of the heart and explain the procedure. We also learned about the function of the heart lung machine, and the anesthesiology monitoring systems. When the surgeon came, they threw what looked like an ice-slushy onto the heart to stop it, and immediately it shrunk down and stopped beating. This was a tense time since the patient’s life was being controlled not only by anesthesia, but also by the heart-lung machine technicians. They sewed in a ring above the valve to prevent regurgitation and I saw after the surgery the improvement using ultrasound. To start the heart again they perfused warm fluids through the heart and turned up the room temperature, and all at once the myocardiocytes began pulsing. It was really amazing to see the complexity of the surgery and how well the patient was able to survive through it.

My immersion experience has been really great, and is definitely something I will remember for the rest of my life. I feel much more connected to the health-care system in our country. I think this experience will help me approach my research in a more clinical aspect after seeing how necessary my work in atherosclerosis is, and how it could be helping patients right now.