Jan Kostecki – Immersion Student but Test Subject Too

So this week started off a little differently than the others have; instead of going to 4 North for 8am rounds, I began the day by going to the 2^nd floor GCRC to get a full blood work up. You may be wondering why I needed to get a workup, but this was for Dr. Kizer and his THrombophilia In Cryptogenic stroke (THICK) study. I was recruited by Lily, who is a echocardiology nurse on the 4^th floor. The study started off with filling out the standard medical history questionnaire, followed by a round of questions about my background, and a bunch of other paper work that needed to get done. After that I was lead into a room where a nurse was going to take the blood, at first I thought this was going to be like any other blood draw, but it turns out that they needed 15 vials of blood, each vial was only a tablespoon in size, but still 15! I’m normally ok with having my blood drawn, but I’ve never had the need for an IV needle, so when the nurse put the IV in and even before she began to take the blood, I had begun to see stars and soon I couldn’t see at all. This followed by a cold sweat, becoming completely pale, and on the verge of passing out. This whole time I was talking to the nurses and had this big grin across my face, and they thought I was just messing around with them. As soon as they saw me turn white and break out in a sweat they new I was not kidding. I stayed conscious through the whole draw, and regained my vision to see the last five vials get filled up. At this time, the whole room was filled with nurses just talking about what had gone one, suffice to say, I had put on quite a spectacle for the floor. After getting some juice and taking a few minutes to regain my composure, I went up to the fourth floor and by this time news had already spread to Lily who had a good chuckle. I then went in to get my echocardiogram and Lily took her time to show and describe the different parts of my heart, what she was looking at, along with the anatomy of the heart and blood flow. After the basic imaging of my heart was done, Dr. Kizer came in and took saline that had been oxygenated and injected it into the IV that was in my right arm. Upon injection of the saline, the echocardiograms revealed the oxygenated bubbles in the saline as they traveled to my lungs and were then expelled (no need to worry about a bubble of air heading to my brain). The study was to see if there was a hole between the two atria of my heart, and subsequently revealed that I was a normal control patient. The group is still looking for another 300 control subjects, and if you are interested please let me know and I will get you the contact information. A plus side is that the blood work and the echocardiogram are all free, so you’re looking at around $4000 for a whole cardiac work up for free!

After having that fun of a morning, I read MRI images with my clinician (mainly normal hearts so that I could see what a normal heart looks in comparison to a diseased one), and then was lead into the EP lab where I observed the mapping of a patients heart. The patient had passed out a few times and the doctors wanted to know if it was due to a electrical conduction problem (either the heart was beating too slow or too fast). The room looked like a standard catheterization lab where I had observed angiograms, with a slight modification. There was a big black box in the control room and two computer monitors that had about 30 different electrical signals being displayed. Here I was able to observe how the doctors were able to map the electrical signals across the heart and diagnose where the problems were occurring. It turned out that the patients electrical system was function correctly and did not have any abnormalities.

Tuesday through Friday were back to the standard routine of getting up for 8am rounds on 4 North, followed by meeting up with Dr. Weinsaft and reading images of MRI, CT, and nuclear exams. I also attended a seminar for fellows at the hospital on how to read nuclear exams (specifically related to SPECT images). From what I had already learned first hand with Dr. Weinsaft, this was basically a review course for me and I could already pick out the problems in the heart before the presenter got to them.

In addition to reading images through the week, I continued to work on my project. Since I had the list of patients that we would be using for the study, I now had to compile a demographics sheet that had the patients age, previous medical history, family history, and list of medications that they were on before getting their MRI and echocardiograms done. Many of the patient’s records were easy to access and the database entry was straightforward. There was however a handful of patients that did not have their records on file, so I learned how to use the hospitals other database to locate the patients records. In these records, I had to go through them page by page to see what the physicians had listed. This was more time consuming because I had to decipher hand writing of physicians, and what they do say about a doctors hand writing is true: its completely illegible most of the time, but then there are those exception to the rule which makes it so much easier to find the information that you need.

Overall it was quite a eventful and fun week, and I learned many more new things, not only about the medical field, but also about my own physiology.

Listed below are a few pictures of my mentor, Dr. Jonathan Weinsaft and I reading CT images. Basically my days are spent in small room looking at computer monitors.