Friday, June 18, 2010

Urological impressions

I must say that the first week of summer immersion under my mentor Dr. Douglas S. Scherr was not exactly as I had expected it to be. In fact this first week went above and beyond my expectations of what I would be experiencing and seeing on a day-to-day basis from encountering nerve wracking surgeries to talking with my mentor about artificial organs.

First I would like to talk about my mentor Dr. Scherr in the urology department. He went to medical school at George Washington University School of Medicine, had a 6-year residency in Urology at the New York Presbyterian Hospital and then Dr. Scherr pursued a Fellowship in Urologic Oncology at Memorial Sloan Kettering Cancer Center for two years. He now has a practice in the urology section of the New York Presbyterian Hospital and was named one of the tri-state's best doctors by 2009 New York Magazine. My impression of him is that of a very smart and professional doctor who also flaunts a very friendly aura. He maintains a close relationship with his students and enjoys joking quite often which is also reflected in his residents/fellows. That being said, let's head into the meat of of this blog - which is what I have learned and seen this week.

I have watched four surgeries this week, the first two were on Wed. and were open partial nephrectomy meaning the removal of a part of the kidney in an open surgery. Both patients had renal tumors and were generally older adults: one female and one male. The female patient had a growth on the top of her right kidney - the surgeons made a small incision on her right side and pushed aside the mesentery to reach her kidney to remove the tumor mass. The male patient had an endothetic tumor in his left kidney, which was unexpected, forcing them to use a sonogram to locate and remove the tumor; after which they reconstructed the kidney. On Thurs. I watched a retroperitoneal lymph node dissection on a 21 year old male patient who suffers from malignant testicular cancer which had metastasized into his lymph nodes. This was an incredible long surgery ~6+ hours that was very difficult due to the fact that the tumor mass was enmeshed with the ureters and important vasculature. Eventually they were able to establish what I believe to be clear margins on the tumor mass with biopsies to aid in the removal of the actual tumor but not the whole mass which would have been very dangerous for the patient. Finally on Fri. I watch an open radical cystectomy initially meant to be an laparoscopic radical cystectomy on an older women who had cancer in her urethra. They discovered too much scar tissue in the women limiting laparoscopic mobility and so had to switch to open surgery. The surgery was a little gruesome to watch as they had to remove the woman's entire bladder along with her anterior vaginal wall and urethra. They had to create a conduit for the woman's urine to leave her and so removed a part of her small intestine with one end attached to her urinery tracts and the other leading out to a hole in her abdomen called the stoma (the urine will have to be collected in a bag).

For the rest of the week I watch my mentor interact with patients at his office, meeting with new one and old ones to determine what treatments they need or how they have been faring post-op. I saw a few cystoscopies looking for tumors or injuries inside the bladder and one 2D CT scan on a patient with a urinary tract replacement to determine if there was leakage (there was none). I have discussed a potential research project with my mentor and he want to create an artificial bladder made from synthetic materials. It sounds like a very ambitious project and we will have to discuss it more at length before we can get started, assuming it's feasible and within our research capabilities.

In conclusion, it was a very interesting week for me and I have immersed myself in some aspects of clinical urology. I noticed that when seeing patients it was very important to have patience and be very professional especially given some of the panicked states of many of them. I have also discovered that it takes an incredible degree of stamina to be a clinical medical doctor; in the case of my mentor I watched him perform a 6 hour surgery in the morning and then right away meet with some patients. He even told me that he usually does not finish until 7-8 in the evening, which is amazing considering that he gets in everyday at 7:30 am. For myself it may take me some time to get use to the fast pace lifestyle of doctors and being in the operating room during surgeries.

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