On the first day, after the orientation meeting I met with my mentor, Dr. Linda Vahdat in breast cancer. She has outlined the different processes involved in diagnosing and treating breast cancer for me to watch and learn this summer. Then, since she is not a surgeon nor does she run her own lab, she asked me what other surgeries I wanted to see. Dr Vahdat then emailed surgeons in the related fields, which I thought was really nice of her. Then we discussed my project for the summer, which she has touch based on with my advisor back in Ithaca. That meeting ended without the final outline of my project, and instead she gave me a couple of articles to read to get started.
On Tuesday, I followed Dr Vahdat in seeing her patients. I saw about 10 patients that day, all of them with late stage breast cancer, with lots of complications. It was interesting to see lots of patients looking perfectly normal on the outside, some of them especially with the help of wigs. Also, I was able to connect some of the research going on in my lab to the conditions of the patients that I met, such as breast cancer metastasis to bone, as presented by several patients of Dr Vahdat's. These appointments mainly consisted of; patients updating Dr Vahdat of their conditions and asking questions that they've had since the last time they talked with the doc (the patients seemed to know more about breast cancer than I did); outlining the next treatment plan; doc examining the patient; finally scheduling the next appointment. Some patients were in better conditions than others, as they were allowed to come back in a year or two, compared to a couple months later. I thought it was a really busy day as Dr Vahdat didn't even have time to finish lunch, but surprisingly I was told by a fellow that this was ideal as Dr Vahdat had time to come back and forth between the exam room and her office and eat her lunch.
The next day, I spent the day in OR watching Dr Tousimis's surgeries. She had three cases: two lumpectomies and one mastectomy. I learned some vocabulary that day; scrubbing in meant actually participating in the surgery, which I first thought meant same as merely watching the surgery. I got to touch the tumors in the body, which was really a lot harder than normal tissue. I also saw some nerves running behind the armpit when Dr Tousimis was removing lymph nodes. When possible, the incisions were made in such a way that the scars would remain invisible. They used biodegradable sutures so the patients wouldn't have to come to the hospital again. For the mastectomy, reconstruction was done by a plastic surgeon Dr Sherman. The breast tissue was entirely removed so I could see the muscles that lie underneath. Then, a cavity was made under the muscle where the implant was inserted. A silicon expander was also placed. Each surgery took about two hours.
Thursday was less hectic compared to the last two days. Between the ethics training and the weekly meeting, I met with my lab's collaborator to talk about the experiments that I'll be running while I'm in the city.
Friday, I was supposed to watch total hip replacement, to be done by Dr Lane in orthopedics, of one of Dr Vahdat's patients that had problem walking. However, it was cancelled due to administrative issues. Instead, I watched other surgery of Dr Lane's, which was removing the screws from fractured tibia, and inserting collagen scaffold doused with growth factors, onto which bone marrow cells harvested from the patient herself at the surgical table were placed. A vendor was there to help with the cell harvesting process, which involved harvesting bone marrow, placing it in a patented cup, spinning it down in such that red blood cells are separated from other components, removing excess plasma, and mixing the rest. It was really interesting to see tissue engineering applications in surgery. Then I met with Dr Vahdat to discuss the project. What I will be doing is a typical clinical research where I analyze data of different patients to see if there is a positive correlation between obesity, desmoplasia, and different molecular subtypes of breast cancer. The hypothesis is that the more aggressive the breast cancer is, the more obese the patients and the more desmoplastic response is present in the tumor. While it may not be similar to what I've done back in Ithaca, I think this would be an interesting project to see if the knowledge we have gained from experiments correlates with real life patients. Next, I attended the weekly case conference where different doctors in the breast center gather and talk about different (or difficult) cases they had this week, and watch a presentation online. My day ended with a lab meeting of my collaborator's.
Overall, it's been a busy week and I have learned and seen lots of different things. I am sure that by the end of the immersion term, I will be able to at least baby talk the medical jargon and see incredible increase in the amount of medical knowledge that I have.
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