Week 5

This week, I began branching out from the radiation oncology clinic and ventured out to the operating rooms of Greenburg Pavilion. Interacting with surgeons and observing their work has certainly been a very different experience than I'm used to. In previous weeks, I stared at CT and MR images, confused about where to look to find key features of the patient's anatomy. This week, I was presented with the patient's anatomy in full view, complete with the sound of bone saws and the smell of burning flesh. I watched the world-renowned spine surgeon Dr. Daniel Riew expertly shave down cadaver bones to fit into a metal cage that would replace several discs removed from a patient's cervical spine to relieve their nerve pain. I also watched Dr. Karim Halazun meticulously detach a patient's diseased liver from the bile duct, vena cava, and portal vein during a liver transplant procedure. Shadowing surgeons was also interesting because I saw how they thought about their clinical problems primarily at the length scale of the organ--that is, they tackled each case by considering how the different organs interact with each other, and what could go wrong when these interactions were disrupted. This was a very different way of thinking for me, as my research interests lie primarily in observing and tuning interactions at the cellular scale. I really enjoyed my experience in the OR, but ultimately I feel that radiation oncology is a better fit for my scientific interests. There is a great deal of research opportunity in uncovering how radiation not only promotes the death of cancer cells, but also modulates their interactions with immune cells.

On Thursday, I returned to radiation oncology to observe Dr. Ng perform a very interesting intraoperative radiation therapy (IORT) procedure, which is used as a breast conservation method to spare patients from getting a full mastectomy. This procedure involved the breast surgeon Dr. Alexander Swistel first performing a lumpectomy to remove the tumor from the patient's right breast. Following the lumpectomy, Dr. Ng then comes in with a high-powered radiation device that gets inserted into the tumor cavity to deliver a high dose of radiation in the area where the tumor used to be. To deliver the radiation treatment, the x-ray source is connected to a ceramic spherical applicator that is used to attenuate the radiation and shape the treatment field into a sphere. Together, the device can deliver a very high dose of radiation to the precise area surrounding the applicator, with very minimal radiation reaching surrounding healthy tissue. 

I ended the week shadowing another day in Dr. Ng's clinic. This time, we discussed further the treatment considerations for patients with pancreatic cancer, which is typically a very difficult type of cancer to treat.