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.