Week 2 - Aniqua Rahman

This week Monday, Tuesday and Wednesday, Dr. Pannullo had to go out of New York City. Therefore, this was my opportunity to explore other areas at Weill Cornell Medical College.

On Monday, I teamed up with Danielle. Her Mentor, Dr. Nanus, is a prostate cancer specialist. Together, we went to three meetings with him. First meeting was with a group of Hematology oncologists. In this meeting, one of the Hematology oncologists presented a case of lymphoma. This case was about 43 years old female patient who was diagnosed with Asymptomatic Follicular Lymphoma about two years. That time she was doing completely fine and didn’t want to start chemotherapies or any other treatments because she has children under age of 10 to look after. So, the doctors suggested that in her case, they could ‘wait and watch’ her disease status. Because one of the British clinical journals, published around 2004, discussed that a brief period of “wait and watch” might not make a difference on the possible life span of patient’s with asymptomatic follicular lymphoma. But now after two years, the patient is back with some symptoms like sore and fatigue, and she is ready to start some kind of treatments. The main reason for calling this meeting was to discuss possible treatment options to provide a better quality of life and increased life span to the patient. The doctor who presented the case was quizzing junior doctors on how they would treat this patient after looking at all the test results. It was quite interesting to see how different doctors had different opinions on the same case. I realized sometimes (or most of the time), it is really hard for doctors to select a treatment for the patient. They rely a lot on clinical research studies to make decisions for a patient. The second meeting was a clinical-trial research meeting, where doctors were just making sure that the patients who are supposed to be on clinical trial drugs (or injection shots) were coming on regular scheduled time and getting their treatment (drugs/injections) on time. Because at the end of their treatments, doctors have to report back the efficacy of the drugs on patients. The third and last meeting was the tumor board meeting. This meeting was similar to the Brain Tumor board meeting that I attended with Dr. Pannullo. Here, oncologists went over several prostate cancer cases.

On Tuesday, I teamed up with David and spent the entire day in Cardiac ICU and Cath lab. We started rounds at 8:30am, which lasted until 12:00pm. During the rounds, getting to watch the real time cardiac ultrasound on patient was the most interesting.  During the rounds, we found out that an 80 years old female patient was going to have a surgery in a Cath lab. So we decided to follow the patient. This patient had abnormal heart murmur after heart failure. Doctors suspected Myocardial infarction (MI), but the result came out negative. Therefore, Ventricular Septal Defect (VSD is a hole in the wall separating the two lower chambers of the heart). She was not in a good condition for open-heart surgery. The best option for her was to place an occluder through catheterization procedure. This surgery lasted for almost more than four hours.  At first surgeons had real difficulty finding the hole (this delayed the surgery). But the at the end, the surgery was successful.

I went back to my regular schedule, seeing patient with Dr. Pannullo, after she came back on Thursday. I met two patients with metastasized breast cancer. These two cases really grabbed my attention as my actual research with Dr. Reinhart-King is on breast cancer metastasis. Here are brief summary of the two cases:

• 66 years female patient. Right-handed. She was diagnosed with breast cancer and had mastectomy, but her cancer was metastatic. There was a lesion found in her brain in 2012 and was treated with radiation surgery. Now reoccurance of two more lesions in brain stem. Dr. Pannullo suggested Stereostatic radiation surgery.
• 71 years old female patient with metastatic Breast Cancer. She had Cyber knife surgery which was not effective and then had gamma knife surgery to the left hypothalamus, which seemed to be effective. But recent MRI shows left frontal metastasis. She is here to have stereostatic radiation surgery.