Work Hard, Play (almost as) Hard, Week 2

The New York City skyline from 
Williamsburg, Brooklyn at around 
sunset.
 As week 2 comes to a close, things have definitely ramped up, but all in a good way. My week consisted of three clinical areas: my project, shadowing Dr. Prince, and observing surgery. This week, Dr. Prince and I solidified my project direction, which we settled on organ segmentation. We then discussed the next steps in order to proceed. In essence, we figured that expanding our AI training set and thinking of different ways to train, modify, and implement the currently developed segmentation algorithm were the best directions for the week (Hopefully I will have some images for next week). Annotating segmentation images takes a bit of time in itself, and the general process is straightforward, so I'll switch over to some of the clinical highlights for this week.

This was the second Tuesday that I joined Dr. Prince at Columbia-Presbyterian as we read through many more abdominal MRI cases. It's interesting to see how radiologists read through each case. They switch between different slices, views (axial - looking up from the feet; coronal - looking straight at the patient's front; sagittal - looking through the patient's side), and contrast sequences quite rapidly . It's quite impressive to see how they seamlessly integrate this information into their dictation. On my end, watching their thought process helps me put together a picture of the human body -- a picture that I have already stared to implement in my own immersion project.


Waiting before entering transurethral
surgery observation
The second procedure was a surgery. I have become interested in trying to image energy transport in patients, so I have begun to shadow some procedures in both urology and interventional radiology. This week, I had the privilege to witness two minimally invasive procedures: removal of a bladder stone and a (partial) prostatectomy. What made these procedures truly special was that no knife was involved. Instead, the stones and prostate were accessed via the urethra and all removal was carried out with lasers. 

I got to start the day off by drinking as much coffee as I could, and then report to the operating room and find scrubs. Then I get changed in and wait for Dr. Te's arrival. At 7:30, he got me set up and had me wait another 10 minutes as he made some more arrangements elsewhere. Then came surgery time.

Everything flowed smoothly and everyone knew what they were doing -- they also knew what everyone else was doing. Once the patient was confirmed and all preparations were in order, the laparoscope went in, the surgeons identified the mass, and got to work on the task at hand.

The bladder Stone was removed by a special kind of laser: it is 

Some resected prostate (two large
masses) and removed bladder stone
from the described procedures

of shorter wavelength (higher energy) and dissipates in water. The laser tip is very small, so it makes the water rapidly expand, or explode if you like that kind of description, and this breaks off a small piece of the bladder stone. Urologists are careful not to split the stone in half, so they take extra care to ensure that they are not focusing in on one area too much. Once the boulder is reduced to rubble, the urologist washes out the reduced stone.

Urologists perform a "minor (my words, not theirs)"  prosthetectomy when the organ grows enough from BPH that the urethra gets blocked. You can access the tissue directly through the urethra and resect the obstructing tissue as you wish. Prostate resection works a little differently. Instead of using water to break it down, this laser propagates through water and gets absorbed by the prostate. The laser generates enough heat to locally vaporize the tissue -- acting like a medical light-saber of sorts. Once done, the urologist carefully removes the resected tissue and the patient may be able to urinate with more comfort. 

On top of shadowing exciting surgeries and working on interesting projects, I do have some downtime as well, especially on the weekend. For example, I got to explore Williamsburg, Brooklyn over the weekend with some of my cohort via NYC ferry (only $2.75). It was time very well spent and I can come recharged into the office Monday. The skyline view from the east river is something you should experience at least once, and the ride over is very pleasant and fast. Once in Brooklyn, you can enjoy Smorgasburg, an outdoor event that hosts many food tents to try from and is held all over the city, or you can visit any number of attractions in Williamsburg and the surrounding area. Some teachings from week two: Immersing myself in both the clinic and NYC has made this experience all the more special.

(Left) Manhattan's skyline from the morning Ferry. (Right) The vessel sailing through midnight.








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