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!