Week 3

After spending three weeks at the Mayo Clinic, I can positively say that in order to be a doctor one has to be emotionally durable. I continued to visit more of Dr. Steidley's clinic patients this week; however, two of them stood out to me that I want to talk about.

The first one was an elderly man who had recently been diagnosed with the disease I've been studying. While most physicians diagnose it four or five years after someone gets it, his physician was able to diagnose him with it in a month. I was personally happy for him since I thought that he could get a liver transplant and he could live a longer life. But he can't. Since he was too old, he couldn't be a candidate. I don't know what he can do now knowing that his only treatment option available for him was just gone.

The second one was a teenager who was around my age who had several serious health issues (again I'm being vague because of HIPAA sorry). In his case, Dr. Steidley knew that he most likely wasn't going to make it. I only got to see his patient information and I didn't even know him. Yet, I was heartbroken to see someone who had his whole life ahead of him only to be cut short. I actually saw him again when I was on break, I nodded him and he nodded right back. His family was with him also and despite the gravity of the situation, his family was somehow optimistic. They didn't let the fact that he would be gone in the near future plague them.

The two people were at the extremes in the spectrum of age, yet they were going to meet the same end soon. I'm not sure how Dr. Steidley or any of the other doctors don't get too preoccupied with these types of patients like I had been in the past few days. Maybe emotional resiliency naturally comes with the job, maybe they've gone through it too much and know how to handle that baggage. Either way, I don't know. One thing's for sure, having to interact with these two patients bolstered my resolve to become a doctor. I kept thinking to myself that by the time I get through college and medical school and residency and a fellowship that medical knowledge/technology would advance to the extent where I could save these types of patients. It might seem a little silly, but that's just something I've been thinking about that I felt I should share.

With regards to my Senior Research Project, I just started working on my hypothesis, background, and methods section for our publication. I will be meeting Dr. Mauer next week to discuss our project, what he may want, and what we can do. I'm both excited and nervous to meet him, since there's a lot riding on this. I'll update what'll happen soon.

Week Two

My second week at the Mayo Clinic Hospital has been engaging and eye-opening.

This week was my first one where I had the chance to meet Dr. Steidley's out-of-state clinical patients, whereas previously I met patients who were in the ICU (Intensive Care Unit). The more time I spend with Dr. Steidley, the more I get to observe his bedside manner with his patients. I mention this because in the three days that I was at the Mayo Clinic, I have met people from all over the country with each person expressing strong emotions with his or her respective heart condition. From dignified optimism to harrowing despair, I witnessed it all. What was even more remarkable to see was Dr. Steidley's response to each patient. Be it hilarious humor or sincere sympathy, he knew exactly how to console each person, so that when he or she left the room the individual would return home in high spirits.

In the time that I wasn't meeting out-of-state patients, I attended conferences or continued to develop my project.

A conference I thought was astounding was one that discussed the latest technology regarding Stem Cell Engineering for Diseased Tissues. Presented by a doctor from the Rochester Mayo Clinic, he talked about using skin cells from a baby to cultivate stem cells that could then turn into any desirable tissue. The tissue would then be placed into whatever organ and would replace the diseased tissue available in said organ. The significance was that it was now possible to cultivate stem cells without taking them from an embryo, thereby eliminating the controversy regarding the usage and destruction of embryos. I found this advance in science to be (in the truest sense of the word) incredible. The only problem that scientists have now is that this procedure only works for a small subset of a large group of people, so now the issue scientists face is how to make it work for everyone.

A few weeks ago, Dr. Steidley mentioned the possibility of getting a paper published. Now I can say that the possibility is becoming a reality. Yesterday, he and I started on a proposal publication for THAOS. The Transthyretin Amyloidosis Outcomes Survey (THAOS) is a multinational, longitudinal, and observational database that compiles data regarding Transthyretin Amyloidosis for clinicians and patients. Its goal is that through combined knowledge and dedication, effective treatment options for the destructive disease will develop. Even though it was established in 2007, it has only published two articles. However it has a strict rule that each publication has to be original in that the topic has to be something different about amyloidosis, otherwise the Executive Committe won't approve the publication. Our paper is about Myocardial Contraction Fraction and how it may be used for determining patients with Cardiac Transthyretin Amyloidosis. We've already filled the basic information, now we just have to create our hypothesis, determine our methods, elucidate our results, and elaborate our discussion. I look forward to the upcoming weeks, as we work with the patients at the Mayo Clinic to see if MCF is a viable volumetric index for detecting this deadly disease.

My second day visiting the Mayo Clinic was even more eye-opening than my first day.

I started today by shadowing Dr. Steidley again as he made his rounds. This time, I got the chance to listen to someone who had a heart murmur. I have to say, the patients at the Mayo Clinic are very receptive and supportive of me. They commend my endeavor to learn everything I can about the medical world, so that I can become a doctor.

Later that day, I worked with Dr. Steidley to calculate the Myocardial Contraction Fraction (MCF) of a patient. It was a relatively simple problem, as MCF is just the ratio of stroke volume to myocardial volume. Stroke Volume (SV) is calculated from a patient's Cardiac Output (CO) divided by the Heart Rate (HR) [SV=CO/HR]. Myocardial Volume (MV) is calculated from the cubed value of a patient's Left Ventricular End-Diastole Dimension (LVEDD) plus the Inter Ventricular Septum Thickness (IVST) plus the Posterior Wall Thickness (PWT) minus the cubed value of the Left Ventricular End-Diastole Dimension (LVEDD) [MV=(LVEDD+IVST+PWT)³-(LVEDD)³]. It took me about twenty minutes to solve the problem, as I later realized that I was dealing with two different measurements and my work wasn’t making any sense. I mention this story since it was a good lesson on living and learning, not to mention that it I thought it was pretty funny.

After I calculated the problem, I observed another open-heart surgery where Dr. Steidley inserted a catheter through a patient’s left ventricle. The surgery itself wasn’t even the highlight of my day. At the end of my day, I was allowed to sit in on a conference where the cardiologists at the Mayo Clinic were discussing which patients would receive the next heart transplant.  As an outsider, it was interesting to see the doctors consider all types of factors for their decision. They considered matters such as age, organ stability, finances, access to family and friends, and current lifestyle. It was also interesting to see how long patients had been on the waiting list. Some were placed on there just yesterday where others had waited as long as a year and three months to receive a heart.

The more time I spend with Dr. Steidley and the other cardiologists at the Mayo Clinic, the more invested I become in my Senior Research Project.

Today I officially started my Senior Research Project, by visiting the Mayo Clinic Hospital. 

However, earlier this week, I had the pleasure of discussing the new aim of my Senior Research Project with Dr. Steidley over dinner. Through good fortune, I gained the opportunity to collaborate with Dr. Mathew S. Maurer, a cardiologist affiliated with the Columbia University Medical Center. He has been developing a volumetric index called Myocardial Contraction Fraction (MCF) that gives a more accurate measure of ventricular function, compared to the traditional method of ejection fraction. He wanted Dr. Steidley and me to explore this type of research, specifically with the number of patients available at the Mayo Clinic. The significance of my project would be that by using MCF and a simple echo screening, we would be able to identify patients with cardiac amyloidosis vs. other forms of heart failure. To this end, I am learning Basic Statistics for the Health Sciences so that I may be able to obtain reliable data using this index. If I progress far enough, Dr. Steidley believes that I may be able to publish a paper detailing MCF's efficacy and possibly present it at a national meeting.

I mention all of this, so I can better put into context the incredible experience that I had today. For the first three hours of my time there, I had the opportunity to shadow Dr. Steidley as he made his rounds for his patients. I was able to meet his team (six to eight people) who expounded every medical device, every procedure, and every detail they felt I needed to know. As someone who has wanted to be a doctor from a young age, I was enthralled. The more they explained what each patient was going through, the more I wanted to learn about the medical world. Having the opportunity to shadow Dr. Steidley today was academically enriching and personally special. 

After he made his rounds, I was able to witness a conference where a Fulbright Scholar from the University of Pennsylvania discussed HFpEF (Heart Failure with preserved Ejection Fraction) and the research he conducted with advanced cardiac biomechanics. His research idea was astounding and his presentation was engaging.

Near the end of my day, I got the opportunity to witness an open heart surgery. Where some people would be disturbed or grossed out by the medical operation, I was intrigued by everything that Dr. Steidley and his team were doing. It was in the viewing room that a medical technician explained to me what the team's progression step-by-step. I was already interested in cardiology, but this experience gave me a glimpse into the commendable profession of cardiac surgery.

Overall, I had an excellent first day at my site. Everything that I was able to do today strengthened my desire to become a doctor. I look forward to working with Dr. Steidley over the next ten weeks and applying the knowledge I will have gained to good use.