Andrea's Mega-Blog Post

Yeah, I know how late this post, I am the ultimate procrastinator, but I don’t blame myself this time. I blame the city and all of its distractions. Living in New York City and working at Weill Cornell was surreal.  Between moments of benevolence and of debauchery, I saw humanity in its raw form.  I saw humanity walking in a 3-piece suit down 7^th avenue, I saw humanity picking up escorts at 3am, I saw humanity the size of a potato wiggling in a plastic case barely able to open her eyes, and I saw humanity gasping for his last breath.

New York City never sleeps; the bars close at 4am as the cafés next door open for breakfast. You feel alive, electric, as if your blood could match the neon signs that light the city.  The hospital never sleeps either.  The hand of death waits for no man, yet the doctors still fight through the dawn to keep him at bay. Pregnant bellies turn to crying babies at every hour.  Doctors are the bringers and defenders of life. To them, 9-to-5 doesn’t exist.

Here, I tell the story of how my view of life changed in 8 weeks at Weill Cornell through a series of chronological short stories.

Note: Patient names have been changed

Olin Hall

The bus pulled up outside Olin Hall shortly after 3:00pm that hot Saturday.  We burst into the reception like starry-eyed children about to embark on a Disneyland adventure, but our wits were quickly stolen as the man at the desk explained the policies and procedures of the dorms as if we were going to bring its destruction. We all got our keys anyways.

The room wasn’t terrible, or at least it didn’t smell. The living room was set up with a round wooden table, a mini-fridge, and a twin bed; the adjacent room had two twin beds separated by a nightstand, with a south facing window on the wall; a bathroom was built off the bedroom. The walls and the exposed pipes were painted off-white and the linoleum floors were a similar color specked with darker neutral tones. The bathroom was a desolate place. Little blue square tiles lined with darkened grout covered the floor. The shower stood in the darkest corner covered by a beige curtain with trimmings of dark pubic hair pasted inside.

I sat my oversized suitcase next to the bed closest to the window and let my body fall onto the bed barely dampened by the springs of the mattress. I stared at the ceiling and imagined staring at the same water stained spot for two more months. I smiled regardless and fell into daydreams of New York City summer life. Olin Hall is definitely not a glamorous place to live, but with a roof, a bed, and a really good excuse to not stay indoors all day, I was content.

 I said nothing.

“This is Andrea, she is a BME summer immersion student who’d like to shadow you.” Dr. Wang quickly said to Dr. Trost.

Just the day before, Dr. Wang had expressed concern for my ability to get clinical exposure while working with a pathologist. After finding my interest in radiology, he basically shoved me on to the first person willing to take me.

“Hi, nice to meet you.” Dr. Trost said, as Dr. Wang quietly disappeared. “Put these on.” He handed me a pair of navy blue scrubs with ‘Interventional Radiology’ embroidered above the left breast pocket.

We made small talk as he led me into the procedure room. I was surprised by how quickly we transitioned from shaking hands to being in the procedure room. The room had two main areas. The IR procedure side that was prepped with a patient bed and a C-arm for imaging, and the control side that looked like an office with computers and chairs, but with a window that peered into the procedure room. The control room was safe from radiation produced on the IR side, and this is where certain machines could be operated from and images could be analyzed.

I was excited to see my first procedure. Dr. Trost introduced me to some of the nurses and residents in the control room, and then bounced.  They told me I’d be seeing a thyroid biopsy in which they would guide a needle into the suspected lesion using ultrasound, and then take a sample to send off to the lab.

I placed a blue bouffant cap on my head and a mask over my nose and mouth and entered the procedure room. I was excited and prepared to see my first procedure, a thyroid biopsy, but I saw much more than that. I entered the room and saw a 14-year old girl on the procedure table, crying. 

I didn’t know what to do. I wanted to tell her that it’d be ok, but maybe it wouldn’t be. I didn’t even know why she was crying. Was she scared of the procedure? Was she scared of what the results of the biopsy might say? Did her 14-year old boyfriend just breakup with her. I couldn’t fathom what was going on in her mind. Maybe nothing is ok in her life right now. I wanted to distract her, crack a joke or two, but I couldn’t find the words. I questioned if I even was allowed to talk to her as an observer. I’m neither a nurse nor a doctor; maybe it wasn’t my place to say anything.

She was terrified and I just stood there, watching. I said nothing.

The nurse looked in her eyes, held her hand and said, “We’re almost done. It’s going to be ok.”

 A different view

Sometimes, you go to a place where when you look around you realize just how vast the world is. Could be the top of a mountain, Arthur’s seat in Scotland, a grassy hill in the dustbowl of California, just anywhere where you realize how very few, if any other humans surround you. New York City is not one of those places. On the boat cruise to Liberty Island with a few other BME kids, I looked around, past the seagulls drifting in the boat’s wake and realized just how occupied all of the land around us was. New York City is not a place people go to feel peace. New York City is a place people go to be part of something bigger. In New York City, I feel small.

There’s a board in my back

Pain. Probe. Poke. Feeling sick. Waiting. Lab results. Bad news. Leukemia. 14 years old. Radiation. Drugs. Radiation. Drugs. Hair clogging the shower drain. 15 years old. Drugs. Drugs. Drugs. The hospital becomes a home. Drugs. Drugs. Delirium. Drugs. Delirium. Take the board out of my back! Delirium. Delirium. Delirium. Different drugs.

You’re just gonna leave him there… like that?

Scrubs on, ready to go, they wheeled him up just as I got to the OR door.

“Well, hi, I’m Andrea, a biomedical engineering student. Would it be ok if I observed your surgery today?”

“Very nice to meet you.” He shook my hand, “Please, go ahead, so long as you have their permission.” He pointed beyond the OR doors.

I assured him that I do, met the two nurses with him and listened to the nurses explain to him exactly what the procedure would entail before he signed the bottom line. Kirk would be having an aortic valve replacement and aortic conduit placement. He seemed rather chipper. When the nurses asked if he was ready before taking him into the room, he replied “I’ve been ready for weeks.”

Why was he so excited for this surgery? Maybe he feared his mortality more than usual or maybe he was really looking forward to being active again. I wish I could’ve investigated his claim more, but as soon as we walked past the OR doors, I was immediately hushed.

The anesthesiologist for the procedure immediately hated me. I made my way around the room introducing myself, excited to take it all in, but when I got to the head of the bed where the anesthesiology team stands, I barely got a word out before being told my place in the room. The anesthesiologist made it clear that she did not want me in her area and pointed to the wall on the patient’s right side as a place where I would be allowed.

Already feeling useless in the room, I obeyed… for a while. Once the machine on the other side of the room caught my eye, I couldn’t help but wander over. The beautiful heart-lung machine is a dynamo, standing nearly 5 feet tall and 6 feet wide, she demanded my attention and I had to give it to her. I first stood behind the perfusion team just admiring her parts. She’s such a simple lady, yet can do so much, she can become the heart and the lungs; she can hold your soul in her tubes and then give it back to you. What a lady!

Curious, I began asking the perfusion team about the machine. They actually seemed excited to tell me about the interplay of the hollow-fiber filter with oxygen, the role of all the pump, buckets, and tubes, but as I was asking questions, the anesthesiologist yelled over at me “You need to be quiet,” keeping eye contact with me, she pointed between herself and the people at the table around the patient, “We need to be able to hear each other so we can get this procedure done.”

I didn’t say anything back, but obeyed. Who was I anyways to even be in that operating room. It was a privilege for me, a student, to be able to see this surgery, this phenomenal event take place.

I went back to my wall.

Kirk was now fully under anesthesia. One of the nurses used a blue pen to mark where the incisions would take place on his chest as well the location of his veins from his groin to his legs.

She dripped a clear sanitizing liquid over his chest. It looked like candle wax, it looked like some strange ritual was about to take place on this guy. Next, she scrubbed him his entire anterior side with povidone-iodine. As his skin turned from a flesh color to Oompa Loompa orange, I realized how quickly Kirk who I had met in the hallway was turning into something that wasn’t even human anymore. His face was completely covered, then they draped the pieces of his body not need for the surgery in blue cloth. If I had walked into the room at the point I would not have been able to identify the thing on the table as another human being, but maybe that’s how surgeons can do this every day. If the thing on the table is not human, you can do your surgery as an art, carefully sculpting pieces of meat, rather than dealing with the anxiety that operating on another human life, full of stories, and family, and love can bring. If I were a surgeon, I think that’s how I’d want it, I think that’s how I’d do the best job. Just not knowing what hangs on the line.

Some nurses in the corner of the room were on their phones loudly gossiping about and watching videos of J.Lo. They didn't get yelled at.

Dr. Girardi’s fellows entered the room. I tried to introduce myself, but they were focused. I thought one of them was actually saying hello to me, but he was just telling me to put on eye protection. I obeyed.

From my wall, I saw them begin. They gently led a scalpel down the line marked on Kirk’s chest, things escalated from there. A cautery unit was used to keep bleeding minimal and separate connective tissue as they traversed layers of his skin. Kirk was no stranger to having his chest opened. A few years back, a small tumor had taken home in his left lung and had to be surgically removed. The fellows had exposed Kirk’s ribcage and were almost ready for the bonesaw, but before that they had to remove the metal sutures from his previous surgery. Metal sutures are strong, even more so after they’ve healed into the body. The fellows took turns taking the sutures out. They’d clamp onto each suture with a hemostat and pull with all their might. They pulled so hard that Kirk’s chest was being lifted off the table. This was the only time during the procedure that I felt queasy. I had to look away.

The bone saw sawing through his rib cage was less spectacular than I had imagined; It just looked like an electric knife cutting a Thanksgiving turkey. The fellows cauterized his ribs and spread the metal retractor the bridge the gap over his severed ribcage. As they rotated the lever on the retractor, the cage became wider, exposing the tissue underneath the ribcage. They used the cautery unit to gently cut through the newly exposed layers.

I could barely see from my wall, I kept trying to take a few steps to the left, right, or forward to get a better view, but the angle wasn’t ideal.  I looked over to the anesthesiologist’s section at the head of the patient, and there was plenty of space. I avoided eye contact with the hateful anesthesiologist and made my way to that alluring spot. I claimed my land and looked down to the patient. Beyond the surgeon’s perspective, this was the best view in the room.

In the center of the metal cage holding his ribcage open, there it was, the organ that so many poems, songs, and stories have been written about, the organ that proves and provides life, the beating heart. It looked larger than I had imagined. I asked the nearest med student if it was a normal size, it was, after all, the first human heart I had ever seen in person. She affirmed that it was slightly enlarged, but mostly it looked big because Kirk’s a tall dude.

Things in the room slowed down. Dr. Girardi was still operating on another patient, so we waited. Fine by me, I was still in awe, staring down at the beating heart in the open chest in front of me.

Another person entered the operating room and stood next to me at the head of the patient. Before he had a chance to say hello, the anesthesiologist asked who he was and started ranting at him for not introducing himself upon entering the room. When he told her that he was one of Dr. Girardi’s med students, she changed the tune of her rant to reflect her hatred for students in the OR. She said that there are already too many students in the room, pointing over at me, and that she’s just fed up with all these summer students being in the operating room. Direct quote: “See, when I’m in the operating room, I have a purpose, I’m needed, but these students are just watching another procedure and getting in everyone’s way.”

I was 3 feet away from her as she’s calling me and my experience useless. I stayed quiet. I obeyed, but inside, I was furious. I wanted to shake her and remind her that without biomedical engineers designing and bettering the tools she relies on, she’d be out of a job. Students create the future. She once was a student, has she forgotten this? I lost respect for her in that moment and even more firmly claimed my ground at the head of the table. I would move only when medically necessary, no longer just because she didn’t like me there. I’ve never been so passive-aggressive before in my life.

After this intense moment, the med student told me that Dr. Girardi would be at least another hour before the other procedure was finished. I looked down at Kirk, his chest open to the room, and back up to the med student. “You’re just gonna leave him there… like that?!” I asked. She said it’s pretty standard practice and that he’s stable. I couldn’t get over how strange it was, me taking a lunch break while Kirk’s beating heart was just hanging out, beating for the world to see.

When I got back from lunch, Dr. Girardi had just entered the room and immediately got to work. They pulled Kirk’s blood through the heart-lung machine, then stopped his heart. The machine became Kirk. In contrast to the brute force the fellows were barely able to muster to pull out the metal sutures, the finesse needed of Dr. Girardi’s to replace the aortic valve was that of a fine artist. It was phenomenal watching him work.

Soon enough the procedure was over. Kirk had a new valve and a new piece of aorta and his heart was beating on its own again. Dr. Girardi left the room as soon as the procedure was finished and no bubbles were seen on the ultrasound. The fellows cauterized the bleeds, closed the retractor, rammed new metals sutures into his ribcage, and closed him back up.

The blue drapes were removed from his body. With a refurbished heart, Kirk was human again. 

Dorothy wants to go home or a story where absolutely nothing happens

85 year old Dorothy walked in to the emergency department in fear that she was losing her ability to walk. She woke up in the middle of the night and her hips and back felt so tight that she could barely move. The pain had been building for a while. She was no spring chicken. The hours that her in-home care had spent with her had been increasing over the years, but never had she considered having help stay overnight.

Dorothy came into the hospital curious to see if there was something new affecting her already osteoporotic back. She was used to pain in her upper back, but it had been recently radiating to her lower back.

The emergency department was packed. The senior resident directed the junior residents and fellows in a well-orchestrated song to see each of the patients. Still, there were not enough rooms to house each patient. Dorothy’s bed was shoved against a wall in the hallway.

After doing rounds with the doctors, Dorothy recognized me and asked if her results would be back soon. She had already been in the ED for 6 hours and had a CT of her back and hip taken. Dorothy felt better. Dorothy wanted to go home.

I asked the doctors to check if Dorothy’s CT had been uploaded. It had. They reviewed the image, but her osteoporotic bones lessened the readability of the image and they had to place a request for a trained radiologist to read it. Preliminarily, they said it most likely was pretty normal given her baseline.

Compared to many of the other patients in the emergency department, who come in sick, bleeding, crying, screaming, or worse, Dorothy was a seemingly healthy ray of sunshine.

Two hours later, some of Dorothy’s blood work was returned. It was normal except for some ketosis. I talked to Dorothy, asked her if she had eaten at all, she hadn’t, the ketosis made sense (ketones are a byproduct of fat and muscle metabolism, which happens when your body goes into glucose starvation). Dorothy really wanted to eat some food, Dorothy wanted to go home.

Another two hours passed, Dorothy remained in her bed against the hallway wall, still no read on her CT. While going around to other patients with one of the junior residents, Dorothy pulled me aside. Adamant, she expressed her desire for going home once more. I said I’d see what I could do, while knowing that I couldn’t actually do much other than try to poke some higher-ups.

I went to the row of computers where the emergency department doctors spend most their time carefully taking notes and reviewing updates on each patient coming through their doors. I found the senior emergency department medical resident and told her about Dorothy and Dorothy’s desire to go home.

I passed the message along to Dorothy that she was welcome to leave, but her leaving would be against medical advice and she would have to sign a waiver denying expert medical opinion, releasing the hospital of any potential liability in her decision to leave. Dorothy did not like that, but she pondered.

Dorothy pondered for two more hours. Still no read on her CT. Hungry. Social workers had already been by to her to setup more care in her home from this point out. Dorothy felt that she would be taken care of. Dorothy wanted to go home, so Dorothy took action. The senior resident talked to Dorothy for a while about the pros and cons of her decision to leave, then allowed her to sign the waiver.

A bed in the emergency department opened back up, soon to be filled with bleeding, sickness, crying, screaming, or worse.

Dorothy finally got to go home.