5th Week Brings A Change to the Routine

So Monday and Tuesday were the normal routine where I got up early, went in for rounds with the residents on 4 North at 8am, and observed cases till about noon. After that was done, I headed down either to the MRI room or the SPECT room or the CT room and read images with the fellows and attending doctors that were in the room. It has become quite easy to diagnose the common diseases that the doctors see on a regular basis in the hospital and I have become proficient at using the software and manipulating the data/images to make a diagnosis or to show a person that is observing where the problem lies.

During these two days as well, I cleaned up my patient data set that I had already complied and excluded some patients that had complicating factors or that there was not enough data present to make sure that they fit our study. After going through this group and making sure that the patients that we had all fit our criteria, I took the list down to the MRI room to have the data retrieved and placed on the workstation so that I could begin the real data analysis. Suffice to say, retrieving the old records is always put on the back burner, and as I write this blog a week later, I am still waiting for the patient files.

In addition to the work that I had done, on Friday I met up with Dr. Matthew Janik and he showed me the correct way to trace images on the MRI software (the tracings use a complex algorithm that allows for the measurement of size, shape, and functionality of the heart). These tracings are the method in which I am going to obtain the data for our study, but one thing that is blatantly apparent is that the tracings are all subjective to the person that is doing the tracing. Since an MRI image takes a slice of the object, the image has items that are both in and out of the plane, and these items can be either traced or not traced. Therefore, the tracings of the images that we have will be evaluated by three experienced MRI imaging experts and then those opinions will be taken into account for the final values obtained.

Now the fun part of the week begins…well Wednesday and Thursday. So my clinician left for a conference and since I could not do anything related to my project I talked with Julius and asked if I could observe some of the medical procedures that had been going on in his area of expertise. On Wednesday I was able to see an aneurysm get clipped in a 30 year old woman. When we walked into the OR, the woman was already on the table and the fellow had already removed her scalp, pinned it in place, and was beginning to clean up the skull so that there could be access to the brain. At the same time, there was an incision made in the woman’s neck and a clamp was placed on her carotid artery to stop blood flow into the region where the aneurysm was. The first thing that struck me in comparison to the imaging that I had been doing these last few week was the smell of the OR. The smell of tissue being cauterized is something that many people don’t forget, and for those that wonder what its like, I think its like when you singe the hairs on your arms when reaching over a stove or a camp fire. The smell is really that pungent, but you begin to be desensitized to it quite quickly. After that I also realized the amount of instruments and technology that goes into a surgery and how everyone has a specific role to play. Once the skull was cleaned off the surgeon took a tool that looked like a Dremel and went to work cutting out a portion of the skull where the aneurysm was located. After removing the skull and dissecting the way down, the aneurysm was pinpointed on the microscope and tv monitors that were present in the room. The next step was to take small clips (yes, clips like those used to hold laundry on the line) and clip the blood flow to the aneurysm. To make sure that all the blood flow was stopped, both ultrasound was used to see if there was any flow through the area and a fluorescent dye was injected that could be seen under infra red monitors. The clip was in the correct place and then the surgeon popped the vessel and closed up the region. That was an amazing procedure and took about 5 hrs to complete.

The rest of Wednesday and Thursday were spent in the Interventional Radiology room on the 5^th floor where I was able to observe catheterization procedures that mapped the blood flow in the brain. These procedures were the same as those as I had seen in the cardiology catheterization room, but the focus was on mapping flow through the brain. One patient that we had seen had a tumor that was detected by CT, but upon looking at the blood flow via that catheterization the decision was not to perform surgery because there was no single vessel feeing the tumor and there was no risk to the patient. The rest of the cases were also uneventful but it was interesting to see how the same procedure could be used to diagnose other conditions in the body.