Wednesday, December 28, 2011
Friday, August 26, 2011
Thursday, August 25, 2011
Saturday, August 13, 2011
This week started off on a bad note for me, doctors in the ER had to remove my nail as my crush injury aggravated. This again gave me a new biology lesson on human body.
As far as research was concerned, luckily for me I had few successful experiments in the previous few weeks. It gave me enough data to analyze. My dependence on huge amounts of pain killers did inhibit me from doing experiments. But, I thought I could visit more surgeries and medical units this week. Which turned out to be impossible since The Joint Commission for Accreditation was visiting all campuses of NYP this week and we were specifically instructed by Dr. Laura Forese, Chief Medical Officer at Weill Cornell NYP to not participate in any clinical experiences for the rest of the week. Hence, majority of my time involved data analysis.
This summer experience gave an incredible insight into the medical world and its people. I think my trip back to Ithaca will be filled with the satisfaction of learning beyond my area, exploring a new life and enjoying myself at Weill Medicall College. Au revoir!
My 2nd last week of Summer Immersion took on a pretty different note un-expectedly. The summer immersion ensures that we get an insight into almost every department but for one. And that is the patient side of the story - which turned into my story of the week. I crushed my finger in a door and spent most of my week immersed in ER visits and huge amount of pain killers. This interestingly gave me a new insight into the human body’s sensory process where finger tips and nails top the list. I came to know of the whole process on the ER side and found the nurses here to be really nice. Most of the patients during the day came with mostly minor ailments varying from fever, sprained ankles, fractures and viral fevers.
Later during the week I visited Dr. Schwartz for his clinic visits. This time I had the opportunity of seeing a lot more patients with a wide variety of tumor issues. One patient came in with a rare case of optic glioma. In the CT scans, the glioma appeared to be big round mass very close to the optic chiasm, and stressing on one of the optic nerves. This did cause loss of some sight in one of the eyes of the patient. The issue was that it could not be operated because of its proximity to the optical chiasm and possibility of harming both the eyes. The more focuses Stereotactic radiosurgery was chosen as the mode of treatment here. Another unique case was of a young patient suffering with Craniopharyngioma. It interestingly has calcium deposits found in teeth. Being near the pituitary gland and optic chiasm, it had significantly affected the patient’s eyesight.
Monday, August 8, 2011
As promised, this week was packed full of clinical experiences at New York Presbyterian! I’ll give the day-by-day rundown:
Monday – I spent the afternoon in the emergency department and shadowed a resident. We saw approximately six patients, with varied complaints. Nothing was that earth-shattering: we saw a lot of fevers, abdominal pain, chest pain, one woman with continued pain after a C-section who wanted further pain medication, one woman who had fell down stairs and was cleared of any neck/back fractures. One patient that sounded very interesting but that I did not see personally was a Con Edison worker who was electrocuted. His co-workers performed CPR and defibrillated him in the field and that was the only reason he survived. I’ll come back to him when I visit the burn unit on Wednesday. Overall, my experience did not match the TV show “ER” – things were pretty laid back, and there wasn’t as much rushing around and saving lives as the show leads you to believe. That being said, I can see where it would be one of the more interesting places to work in the hospital, since you see such a variety of ailments.
Tuesday – I spent the day in the medical intensive care unit, starting with rounds in the morning with the medical team. I asked one of the residents what exactly the MICU specialized in, or which patients would come here specifically, and he explained that the main difference with the MICU was that the nursing staff to patient ratio was much higher, since these patients require such intensive care. The patients in general were not responsive, and were almost universally on assisted breathing devices. One patient became agitated during the day and began trying to get up and rip out his IVs and breathing device, and had to be restrained.
Wednesday – Burn unit. I was able to see several central lines be replaced, which is when there is a catheter placed into a large vein in the neck. These have to be replaced every 3 days to minimize infection at the site. The basic procedure involves advancing a wire down the existing catheter, removing the old one, sliding the new one over the wire, removing the wire, and suturing the new line into place. I also learned a bit more about the Con Edison worker, although I did not get a chance to see the extent of his burns in person. They were very concerned about his brain after the electrocution, so they chose to perform a cooling regimen, where his body temperature was reduced to 34C over 24 hours and then rewarmed to 37C over another 24 hours. They were just about to begin the rewarming process while I was on the unit, and he had handled the cooling process adequately. The extent of his burns had not really been assessed yet, due to this process. Unfortunately, there was another patient on the unit who was very sick, and the doctor met with the family to try and convince them to agree that the hospital would not take any extraordinary measures if the patient worsened. It was interesting that the family refused, saying that he was a fighter and that he would make it through and that they wanted everything possible to be done. The doctors had to accept this request, but were clearly frustrated by the family’s decision. This was an interesting aspect of medicine to see, as I can understand both sides of the argument. It must be incredibly difficult to basically “give up” on a family member, yet as a doctor who has seen this situation many times, it is probably frustrating to not be able to convince the family that there is very little chance the patient will recover.
Thursday – Neonatal intensive care unit. The highlight of this experience was assisting the fellow with a spinal tap on an infant. I was allowed to hold the baby in position, with the help of the nurse, and kept the infant preoccupied with its pacifier to try and distract it. I also saw a baby with a rare disease called “ichthyosis”, where the infant’s skin is scaly, like a fish (the ancient greek word “ichthys” means fish). The baby was doing much better, but apparently will eventually slough off the entire skin layer, almost like a snake. I was told the baby will always have strange skin, and some scarring, but should be otherwise healthy.Friday – Labor and Delivery. I was able to see a natural birth, and I held the mother’s leg to assist her delivery. It was pretty powerful to see this very natural human experience in person, especially when I could be removed emotionally from it in a way, since it was neither my own labor nor anyone I know! At the same time I became part of the team as I encouraged the mother and put my own effort into the birth! The whole process was very rapid for this particular patient, she came in fully dilated and from start to end it was probably only 30-45 minutes. Although she requested an epidural, she was too far along for them to place it, so this was a truly natural birth. The result was a healthy baby boy who weighed 8lbs 3oz! After the birth, the fellow showed me the placenta, which was a lot larger than I realized. Seeing a baby born was quite the way to end a really incredible summer of clinical experiences!
Friday, August 5, 2011
The final week was semi-fun. I spent most of the time finishing measure the images that I had so I could report the information during lab meeting and during our conference call with Ithaca. The study seemed to fit well into the scope of what we are doing now and I received some feedback on what to expand on. Learning about teh cracking joints was no doubt one of the most memorable things I did this summer and I plan on continuing with the topic alongside my work on the intervertebral disc. I also started planning for the upcoming rat surgeries for my project. Overall I loved my time in NYC with the Hartl crew, however I doubt that it will be the last time I see them since we do collaborate on the IVD project and our in vivo work is done at the Medical college. I gained a great deal of knowledge that I will be bringing back and implementing in my research, especially when we begin to tackle the problem of scale up. I got to see numerous examples of what I am working on in Ithaca will be addressing in the clinic and got a sense for what I have to keep in mind when designing. I also learned a lot about the spine itself and how stuff goes on in the operating room. Everyone was great to work with and I look forward to coming down to the city again soon.