Immersion week 3: Jam Packed

Summary: Week three was jam packed. I was able to see more surgeries, observe and shadow breast imaging procedures, visit the ED and shadow an ER doctor, and finally spent the weekend in Boston with Marianne and Matt, presenting a poster at the AACR meeting on Engineering and Physical Sciences in Oncology.

I started the week in radiology and Dr. Drotman was able to place me with her senior resident who I shadowed for the day. I was able to observe several mammograms and I must say that I was honestly shocked by how aggressive the procedure it. The technician explained that they have to apply up to 20lbs of force onto the breast to compress it enough to acquire the resolution necessary to correctly identify potential cancers. Continuing the week, spent time in ambulatory medicine with Dr. Talmor and was able to observe two breast reconstructions. The first patient was a previous survivor of breast cancer who underwent a nipple preserving double mastectomy and had silicone implant placed to reconstruct the breast. Well several years later the woman had a recurrence in her left breast and had radiation therapy performed. The radiation caused hardening of the left breast tissue and caused a visual defect in the appearance of the woman’s breast. So, to correct this, Dr. Talmor purposely tightened the skin of the opposite breast and resized the woman’s breast. After the procedure, the woman was left with much more symmetrical breasts.  The second procedure was a breast reduction for a young woman who has suffered with back and shoulder pain for much of her adult life. I found it quite interesting how subjective breast shape and size were for everyone in the OR. After the patient had nearly two and half pounds of tissue removed, the surgeon sat the patient up and conversation was had on the best shape and size for the reconstructed breasts that would meet the patient’s wants and needs. After the procedure the patient had went down three cups sizes and should hopefully be able to live a much more comfortable life. The last procedure was a lower leg tumor resection. I was able to see the nuclear med team inject a radioactive solution into the patient and observe the surgeon use a Geiger counter to find the sentinel node. That was a very interesting procedure and the surgeon was able to remove the cancerous mass. Lastly, I was able to observe Dr. Peter Steel in the ED. In the short time I was in the ED I was able to observe a great deal. I saw two emergencies and was able be in the room as the ED team rushed to stabilize the patients. It was a different world than that off the OR with this impeccable sterility and calm demeanor. In the ED it is a free for all and the attending doctor had to do all he could to wrangle the 20-30 people racing to save the patients. I would recommend observing ED medicine to all the immersion students who want to get a feel for practical medicine.

The oncology conference was a great experience and I got to listen to several of my scientific heroes talk about their research. People like Jain, Langer, Mooney, Schartwz, and Austin, all authors of BME cornerstone papers. My poster was well received and had a lot of good comments. For the following week I hope to spend some time in pathology, seeing patients with Dr. Vahdat, and shadowing Dr. Simmons in the OR.