Andrew - Week 4

This week was a great week. It began with some clinical work, nothing significant but still interesting. I put in a request to Dr. Frayer to shadow rounds in the medical ICU, and my first day was Friday. The day I spent in the medical ICU was extremely interesting. The attending physician is Dr. Berlin, who is very high energy and fast paced, not to mention something of a character. Initially on Friday morning, Dr. Berlin wasn't there yet so I just listened in to the fellows and residents begin rounds until Dr. Berlin arrived. The first two patients were elderly women with acute respiratory distress syndrome, or ARDS. I must admit, much of the discussion about these two patients went over my head, as the MD's spoke mainly in abbreviations and acronyms, however it was clear that the prognosis for these patients was not optimistic . Fortunately, there was a second year medical student there who recognized me from undergrad at Lehigh, so I was about to ask a few questions in the background and begin to follow a little better. It turns out that the medical ICU handles very diverse symptoms, because the third patient on rounds was a lady who was recovering from advanced alcohol abuse, in sharp contrast to the first two patients. As recovery from alcohol abuse can cause neurological decline and seizures, an alcohol surrogate must be given and slowly tapered off to zero. It was clear that this woman had a distinct problem with depression and/or anxiety, however the job of the medical ICU physicians was to get her back to health physically, not mentally. Once better, therapists will be called in to take over.

Part way through discussing the fourth patient, Dr. Berline jumped in and delivered a whole animated discourse on the current state of patient treatment which I found very interesting. Currently, doctors attempt to achieve and maintain very strict and narrow vitals and nutrient levels. Dr. Berlin feels that this is not necessary, and is in favor of wider ranges which would be up to the physician. Considering inter-patient variability, I found myself agreeing. Another highlight of my one-day ICU experience was that I observed the placement of a central line in a patient who was about to go to surgery for a lung tissue biopsy. I believe the patient had COPD with the possibility of infection.

In terms of research, my polymers showed up. I am trying to get in touch with Dr. Wernicke to find out where I can start experimenting with these polymers. First I have to figure out how to work with them which is something I've never done, so that will be interesting. I am a little concerned about this because I do not believe that Dr. Wernicke has a lab or lab space...or equipment. This will be interesting as well.

In terms of operations, I spent Wednesday shadowing Dr. Bookvar. Dr. Bookvar is a fairly friendly and vocal surgeon, and I suggest that if anyone wants to observe neurosurgery they should contact him (or just show up like I did). The first surgery of the day was supposed to be a tumor resection (well, a mass resection, it wasn't clear if it was a tumor or not but regarless it would need to come out of the brain) in a patient with MS. This patient, however, was scared and prevaricated about the surgery, which I'm sure annoyed Dr. Bookvar since she had already agreed and scheduled the surgery. However, if a patient doesn't want to proceed there is nothing more than you can do outside of trying to talk to them. Therefore, a surgery slated for later that day was moved up to give the former patient time to think, and this surgery was an elderly man who needed C3 and C4 to be fused together. Dr. Bookvar made quick work of this surgery, however he took time to show all of us students what was going on before inserting metal rods across both vertebrae with screws. The second surgery, the tumor resection, finally did happen and I was able to watch from the very beginning, including the actual peeling back of the skin and cutting out of the skull. A very large chunk of brain had to be removed, and I was captivated by the fact that the tumor actually looked different in color than healthy brain tissue. It is a dull, dead looking purple color, and I understand this to be a main way in which the surgeons know how much to remove. During the surgery, a small sample was sent to surgical pathology, who quickly responded that is was high grade GBM (glioblastoma multiforme). My first response was "cool." It wasn't until a few minutes later that I realized that this was basically a death sentence to the patient. I find it interesting, and a bit disturbing, that I lost sight of the fact that the brightly illuminated thing on the table surrounded on all sides by blue cloth was a person. The tumor ended up being very diffuse, so the surgeons had to remove a lot of brain, and dug all the way down to the brain stem (the tumor was towards the surface of the right temporal brain). I would like to follow up with this patient, it doesn't sound very good at all but I am curious to know what the prediction for the future of this patient is.