Week 2

This last week I witnessed one particularly interesting cases. This is a 14 year old boy, who had to undergo his first crainotomy as young as age two. The main complaint he came to see Dr. Schwartz about was severe recurring seizures. Dr. Schwartz sees a lot of patients (generally adults though) with these symptoms and often this is a two step procedure where in one surgery, several electrodes are planted near the suspected site of seizure and are used over the next week to identify both the origin of the seizure and to map out where certain functional areas are exactly (such as those responsible for motor movement or language). If the seizure locus is distinct enough from these functional areas, it can be removed in a second surgery. This boy, however, also had a significant AVM in his right lobe. This is an Arterio-Venous Malformation, which is an abnormal collection of blood vessels. As Dr. Schwartz is not an expert with this and there is a significant risk involved if this AVM is ruptured, he decided that he first needed an okay from another physician to proceed with a surgical option here. He also suspected that due to this AVM from such a young age, the right lobe may not have any significant functioning and could be removed altogether, eliminating both the seizures and the risk of sudden rupture of the AVM in one big surgery. The boys movement on the left side is significantly limited as well as his visual field, and Dr. Schwartz suspects that this limited ability may be from the left lobe taking over certain functions in early development. If this were the case, the boys right lobe would be removed altogether and both his quality of life and life expectancy could be improved drastically. In order to check this, Dr. Schwartz first needs an okay to go ahead with surgery and then can check during surgery where the functional areas are exactly. I am not yet sure what this surgical procedure would be like exactly, but I believe the patient actually has to be awake and conscious during this to test whether certain areas have certain functions. This is obviously another consideration, especially in a 14 year old boy, but the potential benefits could greatly outweigh the discomfort of such a surgery.

Week 2

Summer immersion week two began with a project assigned to me by Dr. Tewari. Like I mentioned last week, my mentor carries out outcomes research for patients that underwent robotic prostatectomy, which involves asking patients about sexual function recovery, urinary continence, and PSA levels. Total reconstruction with preservation of the puboprostatic musculoligamentous complex and preservation of the striated sphincter has been employed to curtail urinary incontinence following radical prostatectomy. The outcomes research is to statistically determine how long it takes for patients to attain proper urinary function (continence rate).
Also, in my second week I had flu and my access to the operation room was limited. I spent most of my time on the project assigned to me by Dr. Tewari, and I worked on preparing three prostate cancer related articles in the European Journal of Urology for the journal club. I was exposed to the surgical pathology laboratory, where excised prostate and other tissues are sent from the OR. It takes about 20 minutes for tissues sent from the OR to get to the pathology labs, where they are inked and studied. As I mentioned in my last blog, it was fascinating to know that clinicians utilize multiphoton microscopy. Upon visiting surgical pathology, we obtained sample from a just concluded prostatectomy and proceeded to the multiphoton microscopy core facility for observation.Week 2 ended with a phone call to the occupational health safety (OHS) about my flu, and I was directed to stay away from the office and take lots of fluid/electrolyte. I look forward to Week 3 [my mentor is on vacation] as I plan to discover what goes on in other OR outside urology.

Week 2 - The Adventure Continues

Week 2 (Written June 29, 2009)
The second week of summer immersion I was stationed in Trans-Esophageal Echocardiogram (TEE). Essentially an ultrasound probe is put down the patient’s throat to image the heart without the attenuation by the chest wall seen in trans-thoracic ultrasound. Both pulsed wave and continuous Doppler is being used. I was shadowing a doctor, Dave, a third year cardiology fellow who was actually finishing his fellowship and leaving to a private practice at the end of the week. Donald was the nurse in TEE, and he was very good at keeping the patients calm and comfortable. The attending physicians, fellows, and nurses are an interesting kaleidoscope of personalities. Some are friendly upfront, they say good morning and they go out of their way to meet the unfamiliar person in the room; others are much more curt or reserved until they see me everyday; and a few look through me pretty consistently. Normally for a TEE there would be a nurse, a fellow, and an attending cardiologist.
First the nurse brings the patient in on a gurney (a rolling bed with rails that can also prop the patient into a sitting position). Next the fellow explains the procedure and risks of the test to the patient, reviews the patient’s medical history, and has them sign a consent form. The worst part of a TEE is actually when the patient must gargle two viscous anesthetics (one is swallowed the other spit out), and the fellow or the nurse sprays a topical anesthetic into the back of the patient’s throat. This is to numb the esophagus and prevent a gag reflex later during the test, but unfortunately it tastes terrible and everyone coughs, a few gag, and some even throw up. It was at this point that I found out I have a sympathetic gag reflex. Then the nurse has the patient roll onto their side, the lights are turned off, and then a medicine that makes the patient sleepy is delivered through an IV. The patient is still able to respond during the test (to swallow, cough, or tighten their stomach muscles), but the drug also makes it so that they remember nothing or very little of the test. A bite block is put in to prevent damage to the patient’s teeth, the probe, or the doctor’s fingers (some unconscious people are remarkably feisty). Then everyone waits for the attending cardiologist to arrive.
Once the attending cardiologist arrives, the fellow inserts the probe (which is about 3 feet long and has a diameter a little less than a quarter), passes the probe over the patient’s tongue, the patient is told to gulp, and the probe is pushed down the esophagus. The week I was in TEE was also the last week for many of the 3rd year fellows and also the week that the second year fellows are getting training for moving into new rotations. So, there were a lot more people in TEE than normal for some of the tests, and I probably learned a lot more since they were taking time to train and explain techniques to the new fellows. Although the fellow is controlling the probe, flexing and rotating it to direct the ultrasonic cone at different parts of the heart, the attending is like a navigator combination backseat driver directing the fellow in which valves and chambers to look at. The very first TEE I saw the new fellow and the patient had a bad time of it (the worst TEE in history according to the 3rd year fellow and the attending cardiologist) – the patient had particularly strong reaction to the flavor of the anesthetic, an unusual shaped palate, and a hyaline hernia. After 4 or 5 tries to get the probe into the patient’s esophagus they found that the stomach had pushed through the diaphragm and was blocking the view of the heart. When they woke the patient up and told them that no pictures could be obtained, he looked so sad that I wanted to cry.
During the week, since I was in TEE for five days, I saw a lot of different TEEs (okay I guess that was somewhat redundant sentence). The coolest part of the TEE imaging modality is that you can see the leaflets of the valves and the walls of the heart moving in real time, a color map of the fluid velocity profile can be used to identify plumes of regurgitation through the valves, and then there’s the bubble test. The bubble test is where agitated saline solution is injected into the blood stream through an IV, the blood enters the right atrium and then the right ventricle. This is used to look for holes in the wall between the right and the left sides of the heart, or a septal defect. Having a hole in this wall is apparently fairly common – almost 25% of the population according to one of the cardiologists – but the size determines how critical it is. The bubbles are obliterated in the pulmonary system so no bubbles should be visible on the left side of the heart, unless there is a septal defect.
People come for a TEE for different reasons. Several patients had arrhythmias but before they could undergo cardioversion a TEE is done to make sure that no clots are present in their heart. The cardiologist checks for clots or thrombi and areas of slow flow (which appears as “smoke” on the screen) if a clot is present, cardioversion is very risky because the clot could be dislodged and cause a stroke. Some people come in with heart symptoms and the TEE is used to try and determine what could be causing the symptoms. One person had a fungal infection in her blood and the TEE was used to check for endocarditis. To avoid giving a laundry list of all the cases – I’ll just mention that the valve replacements were the most interesting to see. Mechanical valves and bioprosthetic valves are checked for regurgitation, if the suture ring is properly seated in the tissue, and if the flow through the valve is appropriate.
The patients have mixed reactions to having the tests explained and signing a consent form. One woman was quite irritated by the process “I don’t know why you are telling me all these things, I have to have the test, so I don’t really care”.
Note: Germ phobia makes sense in a hospital setting. The risk of infection and the potential for fast transmission is immense. There is hand sanitizer everywhere in the hospital (unfortunately now I am completely paranoid when I leave the hospital and subway railings freak me out). One of the things that makes New York City so different from other places I’ve lived is the continuous noise of millions of people all living in the same place all at once. There is constant activity. It is like pure sensory overload 24 hrs a day – monitors beeping in the hospital and sound echoing through the subway, into your windows, and down the street. Perhaps that’s why in elevators most people don’t talk, because other than the ding and the well enunciating voice announcing the floor its somewhat sound insulated, and so they step into an elevator and that is their quiet time for the day.
I really enjoyed the second week of immersion, and I feel like I am getting better at reading new situations and learning to time my questions. If I catch a doctor at the right moment they are willing to let me tag along to something new, such as the “Cath. Lab” or cardiac catherization I got to see. A catheter is inserted into a person’s groin and snaked up to the person’s heart and dye can be released for contrast or a stent can be inserted along the same route and deployed in the coronary arteries. Also the very best part of the clinical week was when I got to help the nurse during one of the TEEs. One of the patients was a restless sleeper (chewing on the probe, thrashing, and fighting the IV tubes and EKG cables). So they needed and extra pair of hands to keep the patient from ripping out the IV. (Really all I did was hold the patient’s hand, but I was thrilled.)

Week 2 - Differences in the OR

I began this week with an experience quite different than the reconstructive surgery cases I saw last week—neurosurgery. On Monday, my mentor was unable to meet with me due to some other obligations so I went to see neurosurgical cases with David. Since the day was so different from my experiences last week, I've decided to focus on it for this week's blog. It was nice to stay at Cornell for a day (Dr. Grant works from Columbia most days) and see some new cases. I was surprised at the stark contrast of the operating room, with the large Zeiss microscope that was used to aid in precisely removing tumors, to the more ‘standard’ operating rooms that I had been in with the plastic surgery cases. Dr. Schwartz was already well into surgery, excision of a meningioma (a typically benign tumor that occurs due to growth of the meninges into the brain), and it was really interesting to watch him use various tools to remove the tumor. Although the surgery was going well, I couldn’t help but notice the tense atmosphere in the room and it reminded me how serious one mistake could be for rest of the patient’s life.

Next, we entered an operating room where Ear, Nose, and Throat specialists were working with neurosurgeons to remove a pituitary tumor intranasally. The patient had markers that were glued to their head and the precise location of the probe that was being used could be determined by correlating the relationship between the markers and the probe to a MRI was done that morning. It was really interesting to watch the surgeons ‘remove’ the tumor—it really seemed as though they were fishing with a probe to take out as much of the abnormal tissue as possible. They were able to identify the pituitary gland with the MRI and leave it unharmed. To close the area (they had to break bone to access the pituitary gland), they excised some adipose tissue from the abdomen to use as a cushion, placed a piece of cartilage they had removed from the nasal passage, and then sutured Alloderm to the outside to hold everything in place. It was amazing to see how much can be done due to endoscopic technology.

The last surgery of the day included Dr. Schwartz removing a subdural hematoma using two burr holes. Although it was a simple procedure that has been done for many years, the patient would have likely had major complications or even died without it. The surgeon drilled two holes in the cranium using a special drill that stops cutting just before it reaches that brain tissue and irrigated the area using saline to remove the hematoma. The whole procedure was completed within 15 minutes.

I feel that this week has shown me how important biomedical engineering is to physicians as well as how specialized the equipment needs to be for the different specialties. Without specialized equipment such as operating microscopes, edoscopic probes, and precise drills, neurosurgeions would not be able to operate as efficiently and accurately as they currently due. For example, before endoscopy became common, pituitary tumors had to be removed by doing a craniotomy and likely harming tissue in the path of the surgery. This week has also made me realize how important it is to communicate with physicians and even observe their procedures before designing products so that we can effectively meet their needs. As Dr. Grant told me last week, “A device or new technique must save the physician at least 15 minutes to make it worth their time to try it.”

Week 1: Fai

Until now I have been in NYC for one week. I gained lots of experiences here, especially clinical experiences which must be one of the most valuable experiences in my life. I would like to thank NIH and everyone who made the program happened.

First thing that I learned here in early of the first week are medical ethics. As common sense we all know that ethics are important for every career. The two ethics seminars here helped me realize even more how much important they are and learn what principles underlying medical ethics. Also, the seminars clarify me what exactly responsible conduct of research is.

My clinical mentor is Dr. William Frayer, an Associate Professor of Clinical Pediatrics and Associate Attending Pediatrician at Weill Cornell Medical Center. His expertise is in the care and intensive care of newborn infants, with a special interest in pulmonary and nutrition issues. He thought, and I strongly agreed, that it would be a great opportunity for me to see several diagnoses and treatments in different units.

For the first week, I shadowed Dr. Schumann to round and see many newborn patients. There were around six or seven people in the team including Dr. Schemann, one or two fellow pediatricians, three nurses, and one clinical nutritionist. The nurses, who had responsibility for their own newborn patients, reported several clinical data to the team such as weight plus the change from yesterday, total volume and calories of feeding, amounts of significant electrolytes, complete blood count (CBC) results, and many other data based on case by case basis like x-ray, MRI, ultrasound, cell culture results, amount of used antibiotics. The pediatricians then jotted down the data and investigated whether all date are in normal or expected ranges or not. If not, they would discuss with each other to figure it out what was going on, why the number was so low, what was the best way to test their hypotheses and to treat the patients. In some cases there were many hypotheses coming up during the discussion. Each hypothesis had substantial reasons to support and it seemed hard to answer the question if based on medical knowledge alone. In these cases “Experience” seemed greatly helpful. For me, the way and process of thinking for solving the problems are not far different from what we have done in lab for research. We all use the same scientific method— consisting of the collection of data through observation and experimentation, and the formulation and testing of hypotheses. Thanks to summer immersion, I have learned a lot how to apply the scientific method to solve new problems which I have never ever think about and definitely not found in the lab at Ithaca.

Reason, Observation, and Experience - the Holy Trinity of Science.

~ Robert G. Ingersoll

Week 1

The first week of the anticipated summer immersion term is over. Thanks to all that made the transition from Ithaca to New York city hitch-free (Dr. Yang,Belinda, Mitch, etc.) I remember reading the last email from my advisor before I left Ithaca "I hope it is useful." Based on the interactions I have had so far, I believe that it is the onus of each individual to maximize the opportunities presented through the summer immersion. After the orientation on day 1, we had a bio-ethics class. The ethics class was quite interesting, and I remember a few of us having debates later that evening on what the consequentialist theory entailed. Honestly, I expected a bioethics class to be a discussion of DON'Ts; however, it was more philosophical in approach, prompting a genuine interest in ethical issues involved in research/ medical care. Apparently, the CITI course had some overlap with the ethics course.

My mentor is Dr. Ashutosh Tewari, the Director of Robotic Prostatectomy and Prostate Cancer- Urologic Oncology Outcomes at Weill Cornell . Besides robotic surgery, His main research interests are in the field of prostate cancer, outcomes, molecular marker for cancer aggressiveness, and strategies to improve nerve sparing and sexual function recovery. On meeting Dr Tewari, I was also introduced to members of his research team, who interestingly utilize multiphoton imaging for tissue biopsy. We discussed my expectations for the summer immersion term, and the journey began.

I observed my first robotic prostatectomy on Wednesday. I changed into my scrubs and headed for the operating room, which had about 8 or 9 individuals present (I was curious to know each one's role.) The best analogy of my experience while viewing the surgery was the IMAX theater--a real-time 3D view. I talked with a nurse anesthetist monitoring the ECG of the patient amongst other vital signs, and I recall his claim that nurse anesthetist and anesthesilogist do the same thing. Dr. Tewari controlled the robotic arms of the da Vinci surgical systems from a console about 2 feet from the patient, and he was assisted by physician assistants ,who were by the patient in the traditional sense of surgery. I look forward to observing and learning more from the OR.

Outside the OR, I spend my time learning about the clinical presentation, diagnosis, and staging of prostate cancer. I joined the journal club in Dr. Tewari's group, where we discuss new articles on prostate cancer from different urology journals. With my project yet to be finalized, I look forward to week 2 of the immersion term (minus the flu).

First week

The Cornell summer immersion experience has been great so far. I want to thank all of the people who worked so hard to make this opportunity possible for us. Also, I want to especially thank Belinda for all her help in keeping things organized and getting us down here. So far the experience has been extremely insightful. During my first couple days of being in NYC I spent some time getting settled into the residence hall and figuring out my way around. All of the first year students got together for dinner on Sunday night at a local mexican-style restuarant called Cilantros, which was nice to kick off the summer experience. During Monday and Tuesday all of us participated in a short ethics course that emphasized the basic responsibilities we have towards patients in a clinical setting. It was interesting to look at things from the clinical perspective as opposed to the bench-side view I am more accustomed to.

During my time in NYC I have decided to work with clinicians in Ophthalmology, as this field interests me and is highly relevent to my current research projects. During my first few days in the clinic I spent my time working with my clinical advisor and the residents seeing patients. I found it extremely insightful to be sitting with the clinicians as they met with and diagnosed their patients. What was also interesting is that they used instruments with seperate observation optics that allowed me to inspect the patient along with the clinician. One case was an individual with a scratched cornea, which I have seen from pictures in research publications. However, it was intriguing to see it live and understand how such a problem is diagnosed. I am hoping to get into the OR sometime next week and perhaps see some LASEK procedures performed as well.

1st week

I also want to thank everyone who made this possible, particularly Belinda, Mitch, Keigo, Dr. Freyer and Dr. Wong. The first week has been very eventful and exciting. I met my mentor, Dr. Theodore Schwartz from Neurosurgery, on Tuesday and immediately realized how much more hectic and busy hospital life is. I got to join him on his clinical day and two main things really impressed me there. First of all the contrast of what is going on behind the scenes at a doctors office to what my experiences have been going to a doctor. As a patient you walk in and (for the most part) everybody is very friendly and patient with you, while in the back everything is streamlined to work at highest efficiency. It seems like every second is of immense value, and I actually had a hard time walking as fast as my mentor. When I did catch up with him to see a patient, the atmosphere changes in an instant. Suddenly, it is relaxed, appearing to have lots of time, personal, and yet somehow highly efficient. That day we mainly saw patients where Dr. Schwartz's recommendation was to go for surgery and obviously these patients are initially highly reluctant and simply just afraid of surgery, yet he manages in a very quick time to explain rationally why surgery is the best option for them and why he recommends it and within 5-10 minutes most had agreed and accepted it. Later that day I got to sit in on the Neurosurgery department discussing cases where the surgeon wanted a second opinion from others before deciding on a therapeutic plan which was highly interesting. I think other departments may have these meetings weekly as well and I need to figure out the schedule for them and can only recommend these meetings to everyone.
The next day I got to meet his lab which was very exciting as they actually have done experiments using new optical instruments in the surgical room and it gives me hope that I might see my PhD project used in a surgery room at some point in the not too distant future.
Most of Thursday was spent watching surgeries. After some initial trouble getting scrubs and getting into the surgery room (a hospital ID should be all it takes from what I know now). These were very interesting and I saw two tumor resections in the brain (through a craniotomy) and one repair of a spinal fluid leakage operated endoscopically through the nose. I saw a surgery before, but am always fascinated by how well the OR organization and team work together. I also discovered that if you want info during the surgery, the anesthesiologists are an amazing source as they seem to know most kinds of procedures very well and actually have some time to talk during the surgery. I am very excited about this summer immersion and about spending more time in the hospital. Thanks again to everyone who made it possible.

The first step to summer immersion

First of all, I really thank to all who have contributed to setting up this program which offers me a unique opportunity once in my life, and have helped everything go smoothly. Thanks to Dr. Frayer, Dr. Wang, Mrs. Belinda, Mitch and prof. Claudia Fischbach, who helped us to be a part of Weill Medical College and settle down in NY city without any problems, I already have had an invaluable experience while I was shadowing my mentor, and his residents. Also, I am no doubt that I will have more great experiences that I have never had here in Weill medical college during summer immersion program.

I was able to appreciate the different side of what I have already known such as ‘Ethics’ and ‘Botox’.
On Monday, We had a good start having an orientation meeting and Ethics class. The class was so instructive that I was able to have a great time to rethink about what exactly ethics is for scientist and categories of ethics are. Also, ‘case study’ was really useful to understand what we’ve learned. After class, I met my mentor for this program, Dr. Jason A. Spector who is plastic surgeon and he gave me a chance to see his patients together during his office hour. One of his patients has suffered from Hyperhydrosis which is excessive sweating especially on palm or feet. To treat this symptom, Botox in saline solution was injected to the patient’s palm and sole to block secretion of Cholin from the synapse to the specific muscle that is responsible for stimulating sweating gland. I thought that Botox could be used only for a wrinkle free purpose but I realized that it is used in various ways to treat patients.

It was the first day for me to get in OR.
On Tuesday, Dr. Spector introduced his residents and I went to round with them in the morning. ‘Round’ was one of the efficient ways to interact with patients and learn how patients are treated. After rounding, one of his residents let me in the Operating Room (OR) and observe transverse rectus abdominis myocutaneous (TRAM) flap which was breast reconstruction of breast cancer patient who underwent mastectomy. Also, TRAM flap for patients who have already gone through mastectomy is called ‘delayed TRAM flap’. This procedure was done by transversing endogenous soft tissue from abdomen to the mastectomy side of patient. It was long procedure but at the same time it was really worthwhile surgery that can help the patient reconstruct her womanhood. For the another perspective of this program on the top of the clinical experience, I attended to lab meeting of Dr. Spector’s group and saw what research is going on in his lab. In general, most of his research aims to utilize the state of the art of tissue engineered technique for clinical application. Specifically, his lab is working on protecting muscle or skin from ischemia and side effects of irradiation using H2S. Also, one of his interesting projects is investigating material and geometry of scaffold to make cell survive for longer term with revascularization within scaffold.

What a broad world is beyond plastic surgery!
On Wednesday, I went to Dr. Spector’s office hour which is for pre or post operation of patients. Whenever patient came in, Dr. Spector introduced me as his student majoring in Biomedical engineering who will potentially help patients so that his patients felt more comfortable with me in the room. Thanks to his help, I was able to actively interact with his patients and learn what kinds of problems brought patients to the department of plastic surgery and how patients were diagnosed. It did not take long time that I realized the area of plastic surgery can cover unimaginably wide spectrum including cosmetic surgery, microsurgery for nerve reconstruction, skin graft, removing a wound area and tissue expansion. One of his patients had surgery to remove a brain tumor from the front part of his head. However, the incised part of his forehead was too wide to be sutured so scalp graft had to be done. To use endogenous scalp for grafting, his own scalp was expanded by injecting tissue expander under the skin of his head. While scalp is stretched out expanded, the patient definitely feels painful. However, this procedure will be able to make the patient look better like originally how he looked.

Microsurgery for nerve reconstruction!
On Thursday, I had a great chance to see microsurgery for nerve reconstruction which was rebuilding nerve which was damaged or broken apart using endogenous fragment of vein. In general, microsurgery is proceeded to allow anastomosis of successively smaller blood vessels and nerves. One patient completely lost his sensation on the area of his right thumb since one of the nerves on his right wrist was torn apart. Thus, what was done was taking out the exact same length of vein on his wrist as the broken part of nerve and gapping the disconnected parts of nerve using the vein as a bridge. Microscope-attached goggles played a critical role in this elaborate surgery successfully.

Already Friday!
On Friday, the first patient was Korean old lady and she was not fluent in explaining her status in English so I happened to help her as a translator. Also, I was really pleased to help patients rather than only observing their painful time. The old lady has a couple of health problems such as diabetes and failure on kidney so she has done dialysis. Especially, in diabetic patients, glucose level in blood cannot be controlled to a normal level and subsequently muscles become stiffer and stiffer, which potentially loads abnormally high pressure on feet and ankle. Consequentially, diabetic patients have a high chance to have a severe wound on their feet or legs and their lower wound-healing capacity causes to delay their recovery. Thus, she had a serious wound on her leg so the wound part was cleaned up and skin graft was laid on the part. Also, to make her Achilles tendons more flexible and stretched out, three parts on the Achilles tendons were incised.The last surgery of this week was removing out the wound parts from the abdomen of the patient who had kidney transplanted a couple of weeks ago but got infected in the incised part. It could be much more risky if transplanted kidney was infected. However, fortunately the soft tissue right under the skin was infected so the infected and wound part was scrubbed out clearly and sutured. During this surgery, my mentor let me sterilized scrub on and take a closer look at the wound part and helped him to do surgery. It was a great opportunity to observe the surgery right next to a surgeon and assist him as a part of Weill medical college.

Again I am really honored and grateful to have an invaluable opportunity once in my life during this program and I will take an initiative to develop and progress interdisciplinary study between engineering and medicine.

Week 1 - Huang

Week 1 was a pretty relaxed week for me as I eased into the immersion term. I want to thank Dr. Wang, Dr. Frayer, Belinda, Keigo, Mitch, and everyone else that made our transitions from lab to hospital as smooth as possible.

My clinician mentor is Dr. Douglas Scherr, the Clinical Director of Urologic Oncology. He focuses on studying and treating prostate, bladder, kidney, and testicular cancer. He specializes in robotic surgery using the da Vinci Surgical System, which offers a minimally invasive alternative to open surgery. So far, I have been doing some background reading on the various urologic malignancies that Dr. Scherr deals with as well as on some of the treatment options.

I have sat in on some of Dr. Scherr's patient consultations. Dr. Scherr explained to the patients (and me) the three most critical pieces of information obtained after a prostate biopsy; stage, grade, and prostate-specific antigen (PSA) level. PSA level is a quick indicator of the presence of cancer; PSA blood tests are used to screen for prostate cancer. Stage obviously refers to what the current stage of the cancer is. If I remember correctly, stage T1 is when the cancer is confined to the prostate and there are otherwise no other symptoms. In stage T2, the prostate may feel more firm, indicating that the cancer has spread around the prostate. Higher stages indicate that the cancer has metastasized to other neighboring organs. The grade tells how much the tumor tissue differs from normal prostate tissue and suggests how fast the tumor is likely to grow.

Of note was one patient in his 60's who was diagnosed with prostate cancer from a PSA blood test, and after a prostate biopsy, it was determined that he was in stage T1 and the tumor grade was 7/10 (on the severe end). Dr. Scherr concluded that he was a prime candidate for robotic prostatectomy, and scheduled an appointment for next month. Another patient in his 80's discovered his cancer from CT scans that he had done for an unrelated condition. However, because the tumors were quite small and given his old age, Dr. Scherr decided to have the patient wait it out for another six months to see if the tumor will continue to grow. It was determined that the harmful risks of surgery outweighed the benefits.

Other than consultations, I had the opportunity to get into the OR and watch some simple (well, relative to the other surgeries they do here!) biopsy surgeries. In these surgeries, an endoscope is inserted into the patient to provide a magnified and lit view, and next a tiny laparoscopic device is used to collect the tissue sample. Nothing too exciting here, but I did find it a little amusing that hospitals also suffer from the occasional hardware malfunction that we are all so used to in lab. At the beginning of one of the surgeries, the computer that controlled the X-ray screen crashed and there was a bit of panic as technicians rushed in to fix the problem (the patient was already anesthesized at that point).

In week 2, I look forward to watching Dr. Scherr perform the more complex robotic surgeries as well as meeting with inpatients and outpatients. I find it quite refreshing to interact with everyday people, since I have been surrounded by academic-type people for most of my adult life!

Patient Quote of the Week:
Patient (after being anesthesized): ... I'm petering out now...
Doctor: Yea we're all pretty exhausted today.
Patient: But don't peter out on my peter!

Summer Immersion finally started

It seems that we have experienced one year's preparation for the Summer Immersion program since the orientation week when we are told the program. My initial curiosity about the hospital life faded a little after "immersion" in my lab which is also part of Presbyterian Hospital in 55th street. But I still longed for a real immersion from diagnosis to surgery and it finally came. I am very grateful for the organization of Dr. Wang and Belinda. They do have contributed a lot since the early meetings to mentor selection to the physical test. Keigo and Mitch are also excellent guys. They made the first few days since we came easier.

I arrived several days earlier, so I missed the bus time with the others. As I live in Lasdon separately, I did not met the wireless or housing problems. Everything went on pretty smoothly including getting my ID. This seemed to be a trouble as expected, but turned out to be all right for everyone. So our immersion started with meeting breakfast and NYC life experience talk, a joyful start. Dr. Wang and Dr. Weinsaft introduced the program. I think it is just as what Dr. Wang said, this immersion experience is invaluable to most of us because we may only have this chance to get to know the real hospital life. This makes me better aware of this opportunity, to learn how doctors think, to think in a clinical way and to combine what we learn with what we see. The first day ends with the ethical seminar. I related this seminar with my experience of being scanned in an MRI machine. That was my third time being scanned in my lab by the other lab members, but one of the fellows still asked me to fill out the safety form and authorization form. At that time I couldn't quiet understand why such forms are so important for research including human subjects. But now I know ethics in researches is a big issue and should never be under emphasized. Also writing these forms is what I should learn in my research work.


My mentor is Dr. Prince specialize in radiology. He is an expertise in MRI especially MR Angiography. He is a very nice person and is always patient to answer my questions. The first time we met, he gave me a detailed list of ongoing projects and ask me to think over which one to take. I met him on Tuesday morning in the reading room of MRI unit. The reading room is where doctors look at and discuss the MRI cases. It is in the basement of hospital, perhaps because the doctors don't need sunlight, even avoiding it, while working. The light in the reading room is always turned off to make the images more clear. Dr. Prince discussed the cases with two other fellows in radiology. I felt bad because I can't understand the specific point in the analysis. The terms in anatomy and medicine is too hard for me. Though I do understand the general idea by looking at those images on the screen. As an MRI student, those images are kind of easier and intuitive for me. It seems that radiology is a specialty of teamwork. At least, discussion is very important. It is hard even for expertise radiologist to explain every abnormality in those images. It reminds me that one of my friends told me that radiology is the most hardest to specialize in for medical school students. I guess it is because you have to know so much and so accurate about the whole body anatomy. Later on that day I read the first few chapters of book which Dr. Prince is writing. It is about how to use MRI scanner. Learning the book and making some revision is part of my immersion work. As I already have some experience on that, I quickly went through it.

Wednesday is a practice day. I watched a lab member scanning and used the scanner myself! Actually, I have been scanned for many times. So being scanned for me is neither an new experience nor a painful experience. But they both are for the first time scanner. Lying still in a cylinder, annoyed by big noise could never be pleasant experience. But scanning is another thing. I had to be very careful not to make mistake which is hard the first time standing in front of the huge machine. I scanned a phantom that day not a real human. I just had to make sure that the instrument is connected correctly and what matters is to adjust the parameter in the computer. While, when scanning real human, safety is big issue. I have to make sure the subject has no iron with or within the body. I do need more practice before I can get a person in my scanner.

On Thursday I met with Dr. Prince in the meeting room as usual. So I know that for Dr. Prince, looking at cases is routine in the morning. He is more like a consultant for the other fellows. I noticed that he also helped the doctors in Columbia University analysing cases. That was done through remote reading. He talked to the doctors on telephone and read the cases on the screen which I guess was transmitted from the database of Columbia. Experience is really important for radiologists. What you know largely depends on how many cases you have seen before. The fellows there discussed the cases and gain experience by learning from doctors like Dr. Prince. Although I still had no idea of what they were talking about the images, I got more idea of how they looked at those images and how they found problems. The software is advanced and could provide functions like vessel segmentation. By clicking part of the vessel, the software automatically grew into a 3D vessel system. By dragging the images, doctors could see the vessels from different angles which is pretty cool! I also saw a case about liver transplantation. Radiology can be very useful in these organ transplantation surgeries. They help the doctors to identify the position even the volume of the organs. Specifically, for the liver transplantation, as the doctors have to decide how much of the liver should be excised in order for an successful procedure, accurate measurement becomes crucial. By using contrast agents, the liver could get an enhanced contrast compared with other body parts.

First week is a good start. I have fixed my project to be designing sleeves for MRI scan. I hope I can make steady progress in the future weeks. Also, I already have schedules for watching procedures in Columbia University. Exciting!

Immersion Adventures Week 1

I arrived with the other first year biomedical engineering students (there are 11 of us) in New York City on Sunday evening June 14^th 2009. We got off the bus and settled into our new rooms at Olin Hall near 70^th Street and York Avenue. One of the hospital residents explained that you always say the streets and avenues in a particular order. My apartment has a view of the street and a mini-fridge (both are good for the soul).

Day 2

The next day we went to the ID office to get official ID cards. The ID guy was nice and helpful and it wasn’t as harrowing as we had been warned to expect (probably because of a great deal of coordinated effort by the people running the immersion program). One thing I found interesting is that they fingerprint the doctors and those get stored in the computer with their profile. I asked one of the doctors in the nuclear cardiology department about it later and it sounds like most if not all permanent employees at the hospital are fingerprinted –however, they didn’t know what kind of data base it went into, perhaps it aids in background checks, preventing serial killers from practicing neurosurgery. Then there was an orientation meeting with Dr. Wang, Keigo, Mitch, and Dr. Weinsaft. Dr. Weinsaft is my summer immersion mentor and this was the first time I had met him in person. The meeting was held in a conference room in the radiology area of the hospital - the waiting room for radiology was classy – there were even real orchids on the tables. The key points from the orientation meeting were – take initiative, completely immerse yourself in clinical experience for the short 6-7weeks available, and the scheduling and interactions are flexible (shadowing with other clinicians and groups is acceptable even encouraged). The girls ran to lunch down the street to a pizza place – genuine NY pizza - and then we went to the Starr Pavilion for part one of an ethics seminar. We discussed badly behaved scientists, ethics versus morality, and different ethical theories.

Next I went to Dr. Weinsaft’s office and was introduced to several of the residents, and Dr. Weinsaft discussed with the group a paper that had been reviewed for the journal Circulation: Cardiovascular Imaging, what changes needed to be made, and what data to be included before it could be published. Then Dr. Weinsaft took me downstairs to Nuclear Cardiology where he had arranged for me to shadow some of the doctors during the first week.

Day 2

The Weill Cornell Medical College and New York Presbyterian Hospital conglomeration is composed of several different buildings that have levels that don’t connect, different elevator towers for individual sections, and veritable maze of hallways and locking stairwells. Essentially I got lost trying to find my way back to Nuclear Cardiology the second day, but seven people’s directions and an information booth later and I arrived successfully. I met several fellows, senior fellows, an attending physician, a resident, a technician, and several nurses in Nuclear Cardiology. I had to run to part 2 of the ethics seminar and then I returned to Nuclear Cardiology. In Nuclear Cardiology they evaluate the perfusion, contraction, and viability of the heart using a stress test and a Positron Emission Tomography (PET) scanner. A radioactive isotope is injected into the patient’s bloodstream, such as Thallium or Technetium. Sometimes the isotope interacts biologically inherently, such as if it is a sodium analog and cells are then inclined to uptake it, or if it is modified with a biological ligand. The radioactive isotope reaches areas of tissue that are perfused by blood, and the isotopes used in Nuclear Cardiology are selected because they target tissues that are particularly metabolically active – e.g. the heart. The patient is injected with a radioactive isotope at two states, rest and stress, and a PET scan taken during each state. Rest is during a resting heart rate and for the stress test the patient is put on a treadmill to excersize and reach an elevated heart rate. During stress the amount of blood directed to the heart and through the coronary arteries should increase as the arteries dilate. The scans show areas of relative brightness of isotope, and when the stress test and resting test scans are compared, defects and areas of incomplete perfusion can be identified. The first full day in Nuclear Cardiology I saw the doctors looking through many scans, they were very helpful with explanations and definitions , and vocabulary learned helped me process information the subsequent days.

Day 3 and Day 4

The next two days in Nuclear Cardiology involved learning variations and more elaborative explanations of the tests for the heart. I actually got to witness the stress test – running on the treadmill with increasing incline for approximately 20 minutes looks hard, some of the patients were in really good shape. If a patient can’t run or walk, adenosine (ADO) can be injected to give some of the similar physiological effects of exercise, such as blood vessel dilatation. One of the most interesting things about Nuclear Cardiology was how the nurses, technicians, residents, fellows, and attending physicians worked in coordinated teams. Everyone seemed remarkably informal and friendly (especially considering that cardiologists have a reputation for being arrogant). Changing combinations of people throughout the day and for each step of the process carried out the necessary tasks to obtain quality scans and analyze them. From the charts and the information about the patient the appropriate approach for excersizing and scanning the patient has to be determined (who can can handle the excersize, how much radiation they can be exposed to, can they lie in all the positions necessary in the machine), the patient has to be consented and the process explained, the patient is exercised and injected with the radioisotope, the patient lies in the scanner and has to hold still for quite awhile or the images are flawed, and then the scans have to be analyzed. During analysis the doctors have to account for attenuation of the radiation through different tissues, such as if the person has a large belly or breasts. Reading of the scans took place in the afternoons by one of the attending clinicians with all of the fellow’s and residents gathered around so that they can learn the process and also offer input and discussion. Everyone heads out of the office around 5:00PM.

Day 5 (Friday!)

In the morning I went to 55^th street to a separate office and met up with Dr. Weinsaft to see cardiac MRI readings. MRI scans of the heart are far more visually detailed than the PET scans, and fluid flow and different tissue type is visible within the heart. I saw a brain scan and a heart scan being carried out by several technicians and nurses. Two cardiologists (Dr. Weinsaft and Joe) read the scans/data and wrote up the reports. One main feature of clinical work that I have noticed so far is that it is highly social - everyone is constantly checking information with eachother, moving in and out of different parts of the hospital, and multi-tasking like crazy. It is quite impressive.

Week 1-Beginning of Immersion

This week was a fairly seamless transition from Cornell Ithaca to Weill Cornell, thanks to Dr. Wang and Ms. Belinday Floyd's hard work preparing the way, thanks so much! Incoming PhD student, Mitch Cooper, has also been a fantastic help in getting us all oriented and guiding us around the hospital and general Lenox Hill area. This left us to focus on getting started with our clinican-mentors rather than being distracted by other issues. Which is great since coming from a primarily academic institution to a hospital is an abrupt transition in itself.

My clinician-mentor for the summer is Dr. David Nanus, clinical chief of the Division of Hematology and Medical Oncology at Weill Cornell. Last week I had the opportunity to shadow Dr. Nanus during his office hours as he saw various patients suffering from prostate cancer (PCa). Before attending graduate school, I had actually not heard very much about PCa, despite the fact that it is the 2nd leading cause of mortality in US males with cancer. This experience was extremely enlightening for me as 1) Seeing the process as an observer rather than a patient is very different and 2) My current research project involves PCa.

The patients Dr. Nanus saw were all in various stages of dealing with their disease, and he always took the time to break down the terminology as he explained to them how he interpreted their test results and his suggested courses of action. This was as much for my benefit as theirs, especially for the more experienced patients. One common theme for every patient was 'what do we do now?' and I have to admit I was surprised at how much the answer varied depending on the situation.

One such patient (Patient A) came in because his physician was concerned about his increasing PSA levels (Prostate Specific Antigen), which is one tool physicians use to determine if a prostatectomy is successful. After a prostatectomy (prostate removal), PSA levels should theoretically go to 0. If they begin to rise, physicians look at this doubling time to gauge the rate at which the cancer is coming back, and if it's likely to spread. Patient A's PSA levels were indeed rising, which was cause for concern. However, this was complicated by the fact that he also had pancreatic cancer. For Patient A, it was recommended that he wait until his next checkup to make a decision because his PSA levels were not rising quickly enough to merit as much concern as his pancreatic cancer, which is a more aggressive cancer with a lower timeframe of survival.

Patient B came in as a follow up to a previous visit where he had been experiencing a lot of swelling in the legs due to one of the drugs he was taking. He was happy to report the swelling had gone down and that in general he felt great. Patient B was making travels around the globe and generally enjoying his life and wanted to know what his next steps were. Dr. Nanus and the patient decided to leave everything exactly as it was because Patient B was feeling quite well, and due to his advanced age (late 80s), any further treatment would likely cause discomfort without significantly lengthening his lifespan.

The last patient I'll mention also had increasing PSA levels. It was actually doubling in a quarter of the time as Patient A, which was of serious concern. However, he also had several cardiac issues and his cardiac physician wanted to collaborate with Dr. Nanus on what combination of drugs and treatments they could use without interfering each other or harming the patient. It was slightly mind boggling to hear the list of problems this patient had while looking at someone I would have assumed was a perfectly healthy and able elderly man.

It amazed me how resilient and calm these people were as they heard their prognosis, no matter how grim they may have been. They were also very accepting of having me in the room as they discussed their issues and were examined by Dr. Nanus. I will see a different side of patient care in the coming weeks as I observe various procedures that are a consequence of these office visits. I've spent over a year working on PCa from a research/academic point of view and I'm so grateful for the opportunity to observe it from a clinical prospective. With assistance from the physicians and researchers here at Weill, I plan to make the most of it.

The Beginning

One of the greatest mysteries of our universe is the fundamental properties of life- in particular, the first principles from which life is spawned. In most major hospitals, the utmost concern is with human life, and in most bioethical circles, human life is considered sacred both religiously and non-religiously, i.e. even many atheists believe that life is something special.

Working in the clinical environment brings us that much closer to eternal salvation understanding the fundamental clockwork of the human timepiece. Every operation we see, every diagnosis we hear, every whimper of hope we feel from a surgery that is to improve and enhance the life of a fellow human being- all of these give us a greater sense of self, of who we really are on the inside, of who we should or could be on the outside.

As we all may already know, compassion is an intrinsic part of humanity. Every day, we empathize for the sufferings of life; we all suffer and we all live. In the hospital, we are often times pushed to the limits of what we can even fathom to empathize, for the experience is so far beyond our encounters in the everyday that our senses are inundated with confounded solicitude. All we can really feel and share is simply the experience of life as human beings, but perhaps that is enough.

This first week of clinical immersion has been eventful, as it has catalyzed our gait into the gates of a sacred human establishment. We will learn, and we will prosper.

Week 1 - Start of Immersion

My first week of summer immersion has been absolutely amazing! Everything was organized and ready for our arrival on Sunday evening so our check-in went smoothly (thank you Belinda for setting things up!). Mitch was a great help and scheduled appointments for us to get our ID badges before our orientation meetings began on Monday. This proved to be very helpful as the ID badges are absolutely essential to enter the hospital buildings and operating rooms without being hassled. The orientation meeting went well and Dr. Wang offered some useful advice about the program, expectations, and NYC in general. The ethics meetings on Monday afternoon and Tuesday went relatively well but were probably not necessary in addition to the CITI course that we took online. However, some interesting points were made and a few discussions proved to be thought provoking. After Tuesday morning, we were free to begin working with our mentors.

Although I was quite apprehensive about beginning the summer without having met my mentor (his schedule conflicted with mine so I was unable to visit prior to the immersion term starting), everything seemed to work perfectly and I had a busy and varied week. I met Dr. Robert Grant, Chief of Plastic Surgery at Cornell and Columbia New York Presbyterian Hospitals, on Monday afternoon at the Columbia campus for about 30 minutes and was so relieved to find that he is a friendly person who is very passionate about his practice. He seemed excited to begin teaching me about his profession and I agreed to meet him on Tuesday afternoon while he saw patients in his Columbia office. I was also very excited to find that there is a free intercampus shuttle that goes between Cornell and Columbia once an hour - it is much faster and easier than taking the subway.

On Tuesday afternoon, I was able to see a variety of cases ranging from patients who had cysts that needed to be removed to a woman who had undergone a mastectomy and was getting a tissue expander filled with saline so that she could receive implants in a later reconstructive surgery. Dr. Grant even had to see a man who had hernia repair and was unhappy with the results to provide an unbiased analysis of his post-surgical condition for the court as the man was suing his surgeon. We discussed things such as insurance coverage and malpractice insurance and I learned that there are a lot of political concerns that go along with being a physician.

On Wednesday, Dr. Grant invited me to come to a product evaluation that was being sponsored by Covidien. Covidien’s new product, V-Lock sutures, is a uni-directional barbed and absorbable suture that should save surgeons time when closing large wounds because they do not have to tie knots or do a double layer of stitches. An external company, Argent Global Services, set up a series of time studies quantitatively test the time it would take plastic surgeons to close wounds of varying sizes using a variety of suturing techniques including the only other barbed suture on the market-Quill. Dr. Grant had recruited 4 other plastic surgeons from the area to help with the studies (they were paid for their time by Covidien) and Covidien representatives were there to record qualitative information and get feedback about their product. It was a great experience and I was able to talk to the people from Covidien, the industrial engineers from Argent, and most importantly, the other plastic surgeons. Dr. Rhee, a plastic surgeon at Cornell specializing in pediatric and craniofacial surgery, volunteered to let me observe his surgeries as if I email him a day or two in advance - it will be great to see another side of plastic surgery. The day was very fascinating and I am glad that I was able to see how industry interacts with surgeons.

I was able to see my first surgeries on Thursday beginning with a breast reduction. As Dr. Grant put it, he first had to ‘explode’ the breast to remove tissue before piecing everything back together. I was surprised at how few people were in the operating room considering that Columbia is a teaching hospital. One of the 2nd year plastic surgery residents named Brian assisted Dr. Grant in the surgery by operating on one of the breasts while Dr. Grant simultaneously worked on the other. It was fascinating to see how everything came together to create a smaller breast - it was really a feat of engineering to take apart and reconstruct the breast while maintaining a blood supply to the pedicle (the area of tissue that they left to supply blood to the areola). After, I watched the end of a mastectomy and the following reconstruction of the breasts. The woman was quite nervous about the procedure but it was truly amazing to see a woman start out with her natural breasts, then have a bilateral mastectomy, and then have tissue expanders placed so that the process of reconstruction could begin. Although it was somewhat horrifying to realize that within two hours, the woman no longer had her own breasts and literally lost part of her womanhood, it was quite lifting to see that she would be able to regain that aspect of being a woman through reconstructive surgery. During the surgeries, Dr. Grant was kind enough to explain what he was doing and and also showed me some of the different products he was using and explained why they work for his application. For example, he showed me the tissue expanders and explained that they are better than previous versions because of the rough outer surface so that the tissue can adhere to the implant and create a more uniform distribution of force. I appreciate him taking the time to explain the procedures, answer my questions, and offer suggestions about how products can be made better.

I expected to watch an array of office procedures on Friday but was surprised to be able to watch another bilateral mastectomy and reconstruction—this time they were able to save the woman’s areola and nipple (this sounds like an insignificant detail but is actually quite an advance for the field and has been found to contribute greatly to the overall happiness of the woman who receives the construction). At the end of the surgery, Dr. Grant and another resident named Tara were called into another operating room to create a muscle flap to cover a vascular graft that had been done for mechanical support. There, I met a fellow who is willing to allow me to watch some vascular surgeries next week – I’ll be emailing him to find out what ‘interesting’ cases he has. After, Dr. Grant performed a couple office procedures and then was called again into another surgery to create a muscle flap for another patient. I have quickly realized that there is no such thing as a normal “day in the life” of a physician/surgeon -they tend to vary greatly.

Overall, I feel very fortunate to be participating in this program. I have learned so much about clinical medicine already and I am very excited to continue in the weeks to come.

Week 1 - Getting Started

This week was the first week of the summer immersion program, and I have already learned a great deal. I first want to thank Belinda for working so hard to get us down here, and thank Mitch and Dr. Wang for taking care of us after we got here – I think that everything has ran fairly smoothly so far this year, and I for one am very grateful.

My physician is Dr. Eleni Tousimis. She is a breast cancer surgeon dealing primarily with early stage cancer. Most of the patients she sees have been referred to her after finding a lump in their breast or something abnormal during their yearly exam or mammogram. She has been absolutely amazing to work for, and she is very accommodating. I met with her for the first time on Tuesday, and she immediately invited me to come into the OR with her the next day to watch two lumpectomies. She also had already come up with some ideas on projects which she pitched to me (4 of them – wow!), which I will discuss in a little bit or in a later post. So I joined her in the OR on Wednesday morning. The first patient was an older lady who had a small area in her right breast which had minor calcifications and a tiny tumor (only a few millimeters). The whole process is very interesting. In the morning, the patient goes down to radiology, where they take an MRI and, using the MRI, insert a metal wire into the breast, with the tip of the wire at the tumor site. The wire helps the surgeon localize the tumor. Also at that time, the radiologist injects a radioactive dye that is used to localize the sentinel lymph nodes. During the surgery, Dr. Tousimis injects a second dye which is blue, which she can then use to visually identify the sentinel lymph nodes. A very commonly used tool here, sentinel lymph node biopsy is routinely done during lumpectomies to determine whether or not the cancer has spread. If they find evidence of cancer in the sentinel node, then the cancer has spread to the lymph system. However, if they don’t find cancer in any of the sentinel nodes, then it has not spread, since it is impossible for it to spread to any other lymph nodes without passing through the sentinel node first. So Dr. Tousimis removed the tumor and calcifications and sent it down to radiology, where they scanned it and reported back that the margins looked clean (which means there is a 95% probability that the cancer hasn’t spread – the final conclusion is made after the tissue is examined by a pathologist). This was an outpatient procedure, and the patient is under mild, general anesthesia during the process, so they are really just in a deep sleep. This was very interesting, as the patient occasionally moved her arm or leg during the process, and the resident would have to tell her very loudly to relax her limb. The patient wakes up quickly after the procedure. In fact, we talked to the first patient maybe 20-30 minutes after her procedure ended.

The second procedure that day was identical to the first, except for the fact that two tumors were removed instead of one, and at one tumor site a hematoma had formed after a prior biopsy. We met with the patient before the surgery, while she was having her MRI done, and it was so amazing to me the effect that Dr. Tousimis had on this patient. The patient was so anxious, and so nervous, and after only a few minutes of talking with the doctor, she visibly relaxed and looked more steady.

On Thursday I went into the clinic with Dr. Tousimis, and we met with patients for several hours. During these visits, Dr. Tousimis would perform a breast exam and then discuss what they had found and possible options they had. One consultation that I sat in on was between the doctor and a patient, who had come in with her husband. This patient’s sister had lung cancer, which was in remission. Twenty years after she had been diagnosed with the lung cancer, a tumor was found in her breast, which while not unheard of, is highly unusual. During treatment for this tumor, the sister underwent genetic testing and was found to have the BRCA2 gene. This patient was then immediately tested and found to have it. Because her chances of having cancer were so high, she immediately underwent all of the testing and scanning, and they found an extremely small tumor in her breast. However, because of the gene, the patient was opting to have a double mastectomy with immediate reconstruction, to improve her chances of staying cancer-free.

Finally, on Friday I went into the OR again to observe a double mastectomy. This procedure was very disturbing to me, but very fascinating. A plastic surgeon first removed the patient’s nipples and aureoles completely, and then Dr. Tousimis began at the exposed area, carefully cutting the breast tissue away from the skin, finally cutting the entire breast away from the muscle underneath and removing the tissue through the hole. After Dr. Tousimis was finished, the plastic surgeon would come back in, they would turn the patient over on her stomach, and the plastic surgeon would remove flaps of muscle and fat from the patient’s lower back to be implanted as new breasts. Additionally, because the patient did not have enough excess fat there, he would also be using silicone implants to help make the breasts look more natural. Then he would decide whether to reattach the nipples that were removed earlier, or to reconstruct the nipple with new skin flaps. The whole procedure would take 8-9 hours. Dr. Tousimis’ part was only about 2 hours. I am starting to get more comfortable in the OR, which is nice! And I have such great respect for all of the surgeons. For one, I'm amazed at how much time they spend on their feet on surgery days - it is incredibly tiring for me!

Welcome

Welcome to the blog for the 2009 Cornell BME Summer Immersion Program. This is a place for you to share your thoughts and experiences before, during, and after the immersion with your fellow students. Don't know what to post? Look at last summer's blog for examples: bmeimmersion08.blogspot.com. Also, if you so desire, you should be able to register your mobile phone to upload blog posts by sms or mms (standard rates do apply). So have at it--start posting your thoughts, experiences, and relevant photos...