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.