Week 1

  During my first week of Immersion at Weill Cornell Medicine, my clinical mentor, Dr. Jason Spector, was out of town. As a result, I spent my time shadowing other clinicians, familiarizing myself with the layout of the hospital, and introducing myself to his lab. 

I witnessed four major types of surgery: gastric bypass, breast reconstruction, hernia repair, and craniectomy. Gastric bypass surgeries reduce the working size of the stomach with the intention of helping the patient lose weight by reducing appetite. This is accomplished by creating a small pouch from the stomach and passing over the first section of the small intestine. 

The first breast reconstruction surgery was for a patient who was undergoing radiotherapy for breast cancer. Temporary inflatable implants were surgically inserted as placeholders while she undergoes therapy. After her treatment is complete, she will return for polymeric-based implants. This case was interesting to witness since I was not aware of inflatable, temporary implants beforehand. It is obviously beneficial for the patient since the cancerous tissue in the breasts are removed and are replaced with a cosmetically appealing placeholder under treatment is complete. The second breast reconstruction surgery was in conjunction with a tummy-tuck. Some of the fatty tissue from the tummy-tuck was repurposed to make the patient's breast implants. This method ensured that her breast tissue maintained a good blood supply while avoiding an immune response. Of course, there was also an added benefit of having a tummy-tuck at the same time. 

The craniectomy was done in the occipital region with the purpose of decompressing the vasculature. The patient was previously experiencing facial spasms due to increased pressure. As such, a small region of the skull was opened and a microscope-like device was used to zoom in on the blood vessels in the area. This device also projected the image onto nearby screens, allowing everyone else in the OR to see what the surgeon was viewing. While I did not take a picture of this, the image below looks similar to what was seen on the screen. Two blood vessels were overlapping each other in this region. To reduce the pressure, these vessels needed to be separated. Due to the small and fragile nature of the environment, one of the blood vessels was accidentally ruptured. This issue was quickly handled using a clotting agent- potentially a material similar to Tisseel or FloSeal- which covered the opening, and the surgery was wrapped up cleanly.

 

 While I do not have a research project yet, it was nice to become acquainted with the lab and to discuss research and future plans both inside Dr. Spector's lab and within my PI's lab. I am looking forward to working with this team in the next five weeks.

 Lastly, it was interesting to see the difference between the medical school and the hospital side of WCM. A simple door would lead you from one to the other, but there was a palpable difference between either side from the paint to the furnishing to the people walking within.

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