Frustration and Awe in the 2nd Week of Immersion

The beginning of this week was pretty dull overall. The majority of the first half of this week was just like the last week, with me going to the CAP clinic (see previous post) and shadowing some rheumatologists in the hospital or in the office doing physical examinations. The CAP clinic was interesting as usual; the 16 year old female patient had a rare bone disease where some of her bones were actually being resorbed by her body at a fast pace. They called this "vanishing bone syndrome." It was eating away at her hip socket so that she walked with a severe limb and had her left leg be a full 2 cm shorter than her right (due to the way the bone sat in the disintegrating hip socket). Performing a full hip replacement was an option, but due to the instability of the hip socket and the surrounding bone, it might have future complications. Lengthening the bone might be an option as well, but would complicate any future joint replacements. Due to the rarity of the disease, it was hard to tell what the doctors should do, as there is only one treatment on the market today that has been shown to help stop her excessive bone resorption, but it had severe side effects, and would jeopardize her ability to have children in the future. The patient surprisingly did not have any pain, so this confused the doctors. Should they treat something that caused the patient no pain, and risk bad complications due to the treatment? Or should they see how the patient's condition progresses down the line and make a decision then? Both have their pros and cons, obviously. I thought it was very interesting that a patient's pain level significantly influences a doctor's decision in this case. It was obvious that she needed treatment, and that her hip would eventually fail catastrophically, but since she had no pain, the doctors had to think twice about the mode of future treatment.

On a less related note, I was very frustrated with the Immersion program this week. One of my biggest complaints is its apparent disorganization overall. Yi Wang and Shannon have been helpful overall, but they did not know how people should go about getting IDs for HSS access, did not know how to get scrub access for watching surgeries in the OR (for both HSS or Presbyterian), did not inform people that choosing a non-surgeon mentor would complicate seeing surgeries overall, and did not get things rolling with seeing surgeries in the CT field until the beginning of the third week. I believe that most of this stuff should have been taken care of ahead of time and that more information be given to the students before we get here. For the first two weeks, most of us have been running with our heads chopped off trying to get access to the OR, get our HSS IDs, find a way to get scrubs, and to find things to do overall. I have spent dozens of hours trying to find out how to do the aforementioned things, with no apparent guidance from the administration. I have contacted Yi and Shannon multiple times regarding these topics (among others) and although they have been working hard at figuring this stuff out, they did not have any good answers. In fact, I (as well as the rest of us, for the most part) have been able to solve most of these issues ourselves, with no outside help. The worst part about it, was the ease at which most of these issues could have been solved, only if they were looked into BEFORE we got here in the summer. It is very frustrating knowing I wasted many hours of my time trying to solve these programs when we only have a short 7 weeks here in the first place. On a good note, it seems like will be able to rotate with a lot of the ER and ICU units around the hospital in the coming weeks (thanks to the Cornell admins).  

Another big problem I have with this program so far is the lack of communication about ANYTHING. I was under the impression that we would be seeing lots of surgeries just like the last year's group, but it seems like that will not be the case (at least not according to Yi or Shannon), but let me explain more about that later. Again, it would have been a great help to get some handouts about expectations from the program (such as how much time we should be spending doing research etc), potential problems we would be facing (scrub access etc), and just general contacts (to help us get scrubs, connect with surgeons, etc) that we could have to help us find our way with our time here. It would have been helpful to just have MORE information about just about anything, but I get the impression that Cornell doesn't care about the program enough or just can't be bothered with finding out information about logistical issues before students arrive here. Everyone involved with the Immersion program could have done better in this regard.

On a more happy note, many of us now have OR access and have seen a surgery or two at least. It seems like all we had to do was to contact a surgeon, get him to fill out an OR access form, then scrubs and OR access would be granted to us. It was fairly simple to begin with, and will get even simpler. Once we have scrubs and OR access, it seems like we can just come and go to the OR as we please, as long as we get the OK from the surgeon first. I now plan on seeing as many procedures as possible. 

On Friday, Greg and I went to see a prostate get removed from someone who has cancer. The surgery was performed by Dr. Scherr (a Urologist) and he specializes in using the Da Vinci Robot surgical system in his procedures. It was truly a sight to behold, and was one of the most amazing things I have ever seen in my life. The Da Vinci allows a surgeon to perform tasks with unprecedented precision and speed and allows for the surgery to be as quick and painless as possible. Before the surgery began, they inserted a catheter up the man's penis (which we found out why later). For the surgery, they first had to open up a couple of "ports" on the patient's stomach so that the robot would have access to the abdominal cavity of the patient. Once inside, the surgeon uses a 3D reconstructed image from a camera on the robot. He controls the robot's instruments using video-game like controls (I believe the instruments on the robot included a harmonic scalpel and a electrified bipolar clamping device). Dr Scherr was able to cut effortlessly through the tissue of the stomach to the prostate using the robots scalpel and cauterization tools. Nurses were able to access the cavity as well through the side ports; they were busy sucking out residual blood and clamping any blood vessels they decided not to cauterize (see below). There was very minimal bleeding as well, until they got to the prostate and bladder. Since the prostate and bladder are attached, they had to bisect the two as well as the ureter which ran through both organs (which took a while). After they were bisected, they pulled the bladder down to access the prostate. Next, they had to clamp and cut the vessels that fed the prostate, but they could not rely on cauterization to stop the bleeding this time, because this might have damaged some of the sensitive nerves in that area. Overall, they did an excellent job in clamping all of the vessels and removing the prostate, but there was a tense moment or two when the suction device stopped working for a minute (which caused the cavity to start filling with blood). This is one of only cons to this type of surgery; once the cavity starts filling with blood, the only way to remove the blood is with a suction device. If that stops working for some reason for long periods of time, then the only way to stop the bleeding is to remove the robot and open up the patient (which is much more risky surgery). They removed the prostate through the hole on the stomach and were able to reconnect the ureter to the bladder and sew the catheter to the wall of the bladder with dissolvable stitches (from the man's penis). The man would have to have that removed in a couple weeks. It was truly amazing, and I cannot wait to see some more cool surgeries. Also, my mentor will be back next week so I will be able to get underway with my research project as well.