Week 6 - Joseph

On my second-to-last week here at Weill Medical College, I mostly continued my previous week's experience: lots of lab work for my research project, with a little bit of clinical experience to make the whole time slightly more applicable to the goal of immersion for the term (if I had wanted to do all lab work all the time, I would have stayed home in Ithaca!). In the lab, I continued pursuing my relatively straightforward goal for my project: 1) make a series of mutations to the AAV genome that would ablate native tropism and retarget the virus to the blood brain barrier, 2) grow the virus in mammalian cell culture, and 3) test to ensure the virus formed was functional and normal, aside from the changed tropism. This past week was focused on step #1, so it was just continuation from the previous week concerning mutating plasmid DNA, growing bacteria, harvesting DNA, analyzing it, and moving on to the next mutation. Nothing more to really say on it, other than thankfully everything has been successful, I have the final plasmid construct with all desired mutations, and hopefully next week we can quickly grow the virus and run some initial tests just to see what we've got.

The major clinical experience I had this past week was a visit to the Emergency Department (ED). I went in the afternoon on Friday and was there from 3:00 pm to 11:30 pm... and let me assure you, it was one long night. As soon as I came in and managed to find the attending (the reins were in the middle of being passed off at the time to Dr. Senturia, a fellow Texan), we were launched into a mixture of constantly rounding on the ~40 beds in our wing of the ED and dealing with the critical emergencies that would come in via ambulance. For the latter, the heat certainly made things crazy; we had several cases of critical heat stroke, with people coming in with body temperatures ranging up to 107 F (!) and suffering from all sorts of dehydration and delirium. We also had a couple motorcycle injuries. Thankfully none of them were fatal, but I liked how the EMTs brought the helmets into the critical care room to show the patients just how dead they would have been without them (the helmets looked like someone had taken a jack-hammer to them). When it came to the critical emergencies, I was thoroughly impressed at how the residents instantly snapped into action as a team, assigning a leader and various necessary roles and being ready to act at a moment's notice when the EMTs came rolling through the back door. When it came to normal patients, I was impressed to see the level of empathy the attending and residents managed to convey time and time again, something I had seen surgeons struggle with when they only needed to see several patients a day. There are many little details I could comment on - seeing the usefulness of multilingual talent for a doctor working in an ED, learning how to assign likely diagnoses for chest pain and headaches based on statistical data compiled solely on age and history, learning that fixing a posterior shoulder dislocation is as simple as "picking an apple" - but what impressed me the most was the stamina these doctors showed in the face of their unrelenting job. The pace of the ED was physically draining, the need for constantly drawing on a diverse reservoir of clinical knowledge was clearly mentally draining, and the need for ping-ponging empathy between dozens of stressed out patients simultaneously was even more emotionally draining. This was in no way an easy job... honestly, at the end of it I was exhausted purely from the physical and emotional drain, and that was merely as an observer! And on top of all of this, I'd finally like to comment on something from the viewpoint as an observer who personally has been to the ED several times as a patient and have had a 100% frustrating experience every time. This team and this hospital's particular ED experience, even though it clearly made a number of patients far from satisfied, was truly a cut above the hospitals I had been to before. These doctors cared, were professional, and got the job done as fast as possible. They represented NYP very well in my eyes, and it was very meaningful for me to stand on the other side of the ED experience and see how one of the harder jobs in the hospital was supposed to be handled.