Week 1: Ready, Set, Go! (Alberto)

Hello everyone! This is my (long delayed) first blog post for the summer, but I promise to keep this short. My name is Alberto and I have just finished my first year as a PhD student in Biomedical Engineering at Cornell. I am currently interning at both New York-Presbyterian (hospital) and Weill Cornell Medical College (medical school) for the summer. The premise behind this program is for a graduate student to gain a better understanding about medical practice and clinical setting, which in turn can facilitate the translation of academic research into medical innovation that can benefit the patients. That is quite a mouthful, but I do believe in the importance of knowing how medical is practiced for translational science.

Anyway, the first week has been quite interesting. In addition to taking care of ID card and other paperwork, I was able to observe the clinic for the first time in my life. Just to recap, I am assigned to the Division of Transplant Surgery and I got started by shadowing Dr. Jim Kim in the clinic. Although, I have not yet observed any clinical or surgical procedure, I am deeply fascinated by the interaction between health care professionals and patients. Any specific job on a certain patient is referred as a case and the act of describing such work is called presenting a case. There is a framework that is used in summarizing any case, which can be briefly described as consisting of chief complaint and history of present illness. Case presentation will be followed by assessment of past hospitalization and medication before making plans to figure out the best clinical procedure or treatment. A lot of questions are generated depending on patient information, so that standard case framework can generate a specific set of information that somewhat varies between patients. Progress notes will then be written to summarize what happened on that day.

In addition to clinical procedurals, it turns out that patients will be referred for admission into the organ waitlist if their kidney function has decline so much as assessed by the GFR level. Now this situation will turn into a Goldilocks problem, because kidney situation has to be worse enough for someone to be on the list and yet being too sick will exclude someone from transplantation due to the associated risk. Another interesting is that the quality of transplanted kidney can vary depending on where that organ is obtained. Kidney from live donor is usually preferred because it can work immediately following transplantation as observed from urine production and creatinine level, instead of experiencing a dormant period before functioning – the latter phenomena is called Delayed Graft Function (DGF). In addition to avoid spending time waiting, live organ usually has a longer half-life as well. This is why doctors will ask newly admitted patients if they have potential donor from friends or family members. Although organ from living donor may not always generate a good match, there is a system called kidney paired donation program – think of this as pay it forward in organ transplantation. Basically, an altruistic donor can generate a chain of donation, where willful donors will provide organs to others and similarly organs from others will reach intended recipients. In fact, an article from New York Times describe how chain of 60 operations was generated using this approach.

In the meantime, I am just trying to acclimate myself with both general and transplant-specific medical vernacular. There are so many abbreviations being used on a daily basis, such as TXP (transplant), CKD (chronic kidney disease), and HTN (hypertension). Stay tuned to this weekly blog post!