Sunday, August 1, 2010

Week 7 - Ruiz

This week I had the opportunity to attend a lot of really interesting lectures and debates. Monday started off with a Plastic Surgery Mortality and Morbidity lecture on Breast Reconstruction, given by Dr. Ascherman. The lecture content helped me understand breast reconstruction a great deal more because Dr. Ascherman overviewed the entire process from start to finish – pre-op planning, timing of surgeries and common methods used, and types of implants (autologous vs. synthetic) that can be applied – during which Dr. Ascherman highlighted critical pitfalls or challenges that could arise during the entire process. I also learned how to distinguish TRAM, latissimus dorsi, gluteal, and perforator flaps, in addition to learning exactly what incisions to make (and where to make them) in order to cut these flaps out of the human body. The accompanying anatomy diagrams in this lecture really helped clear this up in my head. We also discussed the pros and cons of different styles of permanent breast implants (i.e. smooth vs. textured, saline vs. silicone, round vs. anatomical shaped, etc.). Later in the week I also attended a general surgery lecture on craniofacial trauma. It was a really comprehensive (albeit information-packed) review of maxillofacial trauma and reconstruction strategies. I learned that these patients are some of the most difficult to repair *correctly*. It was a bit sad to see all the sample images of “failed” craniofacial trauma reconstructions – but these images did succeed in convincing the audience that craniofacial traumas are serious challenges to even experienced surgeons. For instance, there are a lot of things to consider in facial traumas, such as: getting proper CT scans, considering possible facial nerve injury, preventing parotid duct lacerations, assessing orbital injuries, and properly positioning metal hardware to repair zygoma (cheek) or nasal fractures. I also found time to finish my final draft of my project analysis of injectable dermal fillers, in addition to observing a few surgeries: breast augmentation, removal and replacement of metal hardware from the skull of a woman who had had cancer in a portion of her skull, and an aortic valve replacement surgery.

Although this is the final week of our Summer Immersion, I can confidently say that the insights, skills, and lessons learned from this experience will continue to enrich my career and perspective for many years to come. Not only was I able to observe a variety of surgeries in the OR across a range of departments (plastic, pediatric, cardiac, etc.), but I was also able to witness grand rounds debates, accompany the residents during patient rounds, attend general surgery lectures, visit the ER and NICU, learn to perform MRI scans and other diagnostic tests, and watch patients progress over the 7 week period from a highly invasive surgery to an almost completely healed state. My mentor, Dr. Grant, was an amazing teacher - I could not have asked for a more knowledgeable and enthusiastic guide to help me along my first steps into the clinical world and to help me understand the trials and tribulations of patient care. Moreover, my experience was slightly different than that of my peers because I had the opportunity to visit both Cornell and Columbia medical hospitals and interact with surgeons and residents in both locations. What few of us may realize is that different hospitals do things differently with regards to patient care. Yes, there are institutionalized rules and standards that must be followed…but if you pay attention, you will see that there are numerous subtle differences in the way hospitals design their residency program, the way ER nurses screen walk-in patients in the ER, and even in the way residents and surgeons go about performing surgeries in the OR (in terms of what instruments they prefer to use, how they position the patient, how they plan their incisions, etc.).

Lastly, I would like to thank everyone in the BME department, Cornell Medical Hospital, Columbia Medical Hospital, all my friends, and my clinician mentor Dr. Robert Grant, for supporting my adventure into the clinical and applied side of Biomedical Engineering. Overall, this Summer Immersion was a wonderful, eye-opening experience!

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