Week 2 - Jon Albo

This week I spent time branching into stem cell transplants instead of only focusing on lymphoma. On Monday and Wednesday, I shadowed inpatient rounds with Dr. Ruan which was interesting to see the transition between the attendings for inpatient rounds. It was particularly helpful and insightful to see how she worked towards treating the patients compared to how Dr. Garcia did it last week. They both focused on getting the patients better and out of the hospital, but Dr. Garcia had a larger team and used input from the interns, residents, and pharmacists while Dr. Ruan mainly discussed with the interns and the patient's doctor to devise treatment plans. Since Dr. Garcia is not one of the lymphoma doctors but was still on the lymphoma service, I was able to witness the subtle but important differences between her decisions and Dr. Ruan's. The interns and residents have also been really helpful in explaining everything and always set me up for success which is super nice of them.

On Tuesday I had the opportunity head to Columbia with Dom and Sam to read out cases in the MRI reading room with Dr. Martin Prince. Dr. Prince taught us a lot about what he was looking at in the MRI's and reasonings for certain scans for certain patients. He went into a lot of detail explaining the intricacies of each tumor or growth that appeared and how they're impacting the patient. One of the cases we reviewed involved a patient that went into surgery to have gallstones removed, and now has some liver and kidney function issues. Dr. Prince showed us the scans and explained that he was looking to see any blockages in the liver that would contribute to these issues and explained why he came to certain conclusions for the report. After learning from Dr. Prince, I headed back to Weill and shadowed Dr. Leonard in lymphoma clinic for the rest of the day. Dr. Leonard mainly sees patients with indolent lymphomas which are slow growing lymphomas that most people can live with for their entire lives. There are a lot of medications for helping people live with these lymphomas when needed but if they start to grow and induce symptoms in the patient, they are really difficult to treat. Because of this, I wanted to explore a bit more of the treatments that are used for patients with difficult to treat cancers. To assist in this, Dr. Leonard connected me with Dr. Koen van Besien and Dr. Sebastian Mayer in stem cell transplants.

On Wednesday I shadowed Dr. Mayer in inpatient rounds in stem cell transplants and saw patients either gearing up for their treatments or trying to fight the negative effects their bodies were having. Dr. Mayer put a large emphasis on getting the patients out of bed to keep them moving or he was worried if they spent an extra day too long in bed they would lose their strength. Again, it was interesting to see Dr. Mayer's opinion on what was most important for his patients to get out of the hospital differed from Dr. Garcia and Dr. Ruan in lymphoma but how necessary all of their decisions were for the ultimate survival of their patients. 

I shadowed Dr. Mayer again on Thursday and it was nice to see some of the patients have immediate responses to the decisions he made with some feeling a lot better. Maggie also came and shadowed Dr. Mayer on Thursday which was nice to have a friend walking around and shadowing with. Dr. Mayer went into detail a few times explaining some of the decisions he was making based on some of the patients results which influenced how they'd respond to certain drugs. After inpatient rounds were done, I headed down to Dr. van Besien's clinic and shadowed him and his PA Grace where we met with patients who were at the beginning, during, and after of stem cell transplants and CAR-T cell therapy. Dr. van Besien was super helpful in breaking everything down for me and explaining each patient's situation before I met them. We went over specific details of their stage in the process, their response, and why certain treatment decisions were made the way they were. We talked extensively about graft versus host disease and how different each patient's reactions were to the transplants. In between seeing each patient and him explaining their treatments in great detail, we also went over to the hematopathology lab to review the smear slide of one of his patients. We looked at his red blood cells, white blood cells, and platelets and determined that the shape and amount of them looked great from his CAR-T therapy. We went back to talk to the patient and Dr. van Besien explained what we saw and how good the news was which was really cool and exciting to be apart of. He also took me over to watch some stem cell collections where he explained how a leukapheresis machine worked and talked with some patients while they were having their cells collected. Overall, I'm super grateful that I was able to learn from so many great clinicians and that Dr. Leonard connected me with Dr. van Besien and the stem cell transplant department so I could learn what's actually done to treat patients.


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