a day-by-day
susu alkhalili
The majority of my day was spent working on my presentation for tomorrow, but in doing so, I got to reflect a bit on what my main takeaways were from my independent study. This is what I wrote up to be included in my presentation:
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I wasn’t expecting anything out of the ordinary today; I would just be shadowing the oncologist and winding down my independent study. Nevertheless, I was excited to see what the day had in store, as every day ended up bringing more and more surprises.
I was pleasantly surprised, yet again. A few blogs ago, I wrote about a woman who had a foot long tumor in her abdomen, that I had figured out about through her CT scans at one of the cancer conferences. Our very first patient of the day was this woman. You would have never have imagined that this woman had just gone through surgery to get a tumor of that grand size removed. She was an extremely pleasant, funny, short, older woman. She complained of no pain, and claimed that she was doing just fine. The doctor began to question her, and her daughter told us that her mother would not come into the emergency room for the mass, thinking it wasn’t a big deal and that she was just gaining weight. What the woman did come in to the emergency room for, however, was her swollen legs. Upon arriving at the hospital, the doctors told her that she had a giant tumor in her abdomen and referred her to oncology. She had surgery to remove the tumor, and the oncologist began preparing her for and informing her about chemotherapy and treatment from that point on. Today I began reflecting over my independent study as a whole, as it is coming to an end, and I am so grateful for the opportunities that I have been given by my sponsor. Not only was I able to shadow an oncologist and see what their work is really like, but I was also to understand that the roles of both the pharmacists and the nurses are at the cancer center. This independent study has shown me that oncology and medicine is something that I can seriously look into as my career path. I was extremely excited for today. I would be shadowing the oncology pharmacists, and pharmacy was always something that I had thought about pursuing since I was younger. Today I would finally get the chance to see what it is that pharmacists really do.
I was pleasantly surprised at all of the work that the pharmacists do. The pharmacy is at the back of the treatment center, behind the nurses’ station, so it is often overlooked. In fact, I didn’t even notice the pharmacy until I was hanging out at the nurses’ station all day on Tuesday. The pharmacists at the treatment center were in charge of making and preparing all of the chemotherapy drugs and infusions that the patients would be needing that day. Most of the chemotherapy drugs are mixed upon the arrival of the patient, however, which was something that I was surprised about. One of the pharmacists told me that it would be too expensive to make the chemotherapy drugs for the patients in advance. The pharmacist also walked me through the complex process that they had to go through when preparing the drugs for each patient. They had to complete exact calculations, and check their math several times before even beginning to consider mixing the drugs. This was understandable: giving a patient the wrong infusion or dosage could be life-threatening. In order to further avoid any potential life-threatening mistakes, two pharmacists also have to look over the calculations, the patient’s chart, and the drugs after they were created. This was similar to what the nurses had to do before giving the patient treatment. So, the drugs are checked by a total of four different people before they are given to the patient! I was able to watch as the pharmacists gracefully worked together to be both efficient and effective. While one pharmacist completed the initial dosage calculations and studies the doctor’s orders, another pharmacist prepared to mix the drugs. While it may not seem like it at first glance, the pharmacy was truly the hub of the treatment center. Without the pharmacists’ diligent work, patients would not receive the quality care that they deserve. I am extremely grateful today, as I gained insight into the work of a pharmacist. From what I have seen, I feel that I can now seriously consider pharmacy as a potential career path. My sponsor is spending the day at a cancer center out of town, so I couldn’t shadow today. Instead, I spent the day at Maumee Valley, where I began planning my intensive fair presentation. My goal for the day was to create a layout of what I’d be presenting, as well as other props I can bring in to accurately present breast cancer to my audience. I already spoke to my sponsor and he gave me a few ideas about different models I can bring in. For example, he is allowing me to bring in a few of the small, interactive books that he uses to explain breast cancer to his patients. He also gave me full access to his bookshelves, I am able to find many informational books on breast cancer. I also planned out the layout of my triboard, including some of the photos I wanted to include. The layout is as follows: Today I was able to plan out my intensive fair, which gave me the opportunity to gather up any questions that I may have for my sponsor in advance. For example, I am likely going to ask him to further explain the symptoms of breast cancer and how to detect it in advance.
9/4/2018 0 Comments day 10: the underrated healers Today I would get to hang out with the oncology nurses. I was excited as I had learned very much about the work of nurses. My goal for the day was to learn more about what nurses do and what their average day typically looks like.
The nurses that I was with today worked in the treatment area. They were in charge of giving chemotherapy, blood transfusions, or whatever else the doctor had ordered for the patient. The pharmacy created the drugs in a separate room, and, once they were ready, the nurses took the drugs and treated the patient with them. One major factor I noticed was that when giving chemotherapy treatment, the nurses must sign off on the treatment on the computer. To ensure that the patient was receiving the correct treatment, two nurses had to sign off on the treatment, both asking the patient for their name and date of birth, and looking over the drugs that were being given. This is done in order to avoid potentially life-threatening mistakes. I later noticed that this was also done in the pharmacy when it comes to doses and calculations for the drugs. The nurses were also in charge of taking vitals and sending blood for testing, which I had not earlier been exposed to with the doctor. There was a man earlier this morning who used his ringer to call over a nurse to walk him to the bathroom. She did so, and when he returned to his room, he laid his seat back completely horizontally and remained that way throughout his treatment. He later called over the nurse again to walk him to the bathroom, saying that he felt dizzy and like he needed to puke; as she did so, I left to go to the restroom as well. When I had gotten to the hallway, however, I heard the nurse yell, “I need help in here!” I quickly rushed back and saw that the man had collapsed, as two nurses struggled to keep him standing and awake. They called rapid response, and everyone rushed in to help the man. Eventually, and with much difficulty, they were able to get the man onto a stretcher; he was sent to the emergency room. The nurses and doctor speculate that the man had a reaction to the platelets he was receiving. Nurses are definitely underrated. One nurse jokingly exclaimed, “The doctors give all the orders and we do all the work!” I was definitely glad to be able to shadow the nurses today. They were all extremely fun to be around, and the day flew by. With the doctor, by the time we had arrived to visit a patient in the treatment area, the nurses had already taken vitals, sent the patient for testing, and gotten them started on chemotherapy. I had not really realized all that goes on behind the scenes before the doctor arrives, and I am grateful for the opportunity to get this exposure. 8/31/2018 0 Comments day 9: lots of insight I get increasingly excited to go into the office after every day. At the end of each day, I leave the office feeling like I gained some sort of knowledge to help me grow as an individual. Today, I knew that there was going to be another conference, and I looked forward to it. I hoped to learn more about the interesting cases presented at the conference.
At the conference, I got to see the cases of more patients recently diagnosed with cancer. One case in particular stood out to me. It was for a woman in her 70’s who came into the hospital with a 28 cm large tumor in her abdomen. That’s about a foot big! The woman was diagnosed with ovarian cancer, and had the giant tumor surgically removed. The most interesting part of this experience for me was seeing the CT scan. It showed the tumor putting pressure on all of the other organs in her abdomen, readjusting their positions. The fact that our bodies are able to have such large, toxic masses growing inside of them and still be able to function will always be fascinating to me. The patient that we saw directly after the conference also gave me another perspective on a topic that has always interested me. I always wondered why patients, especially younger patients, would not go to receive their treatment when they were ill and had the means to do so. This woman was the mother of three boys. She was an extremely pleasant woman. She had a job, but also had kidney problems. The morning of her appointment, her sons had missed the bus to school, and they then missed the cab that they had called. She was in a very overwhelmed state and seemed to be extremely stressed about balancing all of her responsibilities. When the doctor asked her to explain why her kidney function had begun to deteriorate, she explained that she had to miss her past two dialysis appointments. She told the doctor that she was so overwhelmed that she didn’t feel that she could come in. When the doctor explained to her how serious the situation was, and how she needed to take care of herself for her own sake and for the sake of her children, she said, in a frustrated tone, “This could kill me?!” The doctor explained that it could, and that she needed to keep up with her treatment as well as she could. Then, she said something that stuck with me: “They always think that when I don’t come in that I’m refusing treatment and that I don’t care about my health, but that’s never the case for me.” This put me in a different perspective and made me realize that there truly were more than one side to every story. Today was an extremely insightful day. I was given physical proof of how amazing the human body truly is, interesting me in medicine further. I was also given a glimpse into the life of a woman who was struggling balancing her health and all of her other responsibilities. While I did not expect to come to all of these realizations today, I am so glad I was given the opportunity to do so, as these situations will likely stick with me for years to come. 8/30/2018 1 Comment day 8: a personal connection My aunt suffers from multiple myeloma; this is one of the reasons why I wanted to explore oncology in the first place. While I knew that this was the cancer of the bone marrow that she is suffering from, I didn’t know much about it; she lives in Palestine and we only get to see her once every few years. One of my goals for my independent study was to learn more about multiple myeloma, as well as the treatment and diagnosis of cancer as a whole.
Today a man came into the office. It was the same man that had the bone marrow test done from last week. His results were back, and he was brought back in to discuss them. The man was diagnosed with multiple myeloma. As the doctor explained what this disease was, I found myself learning about my aunt’s condition. Multiple myeloma is a rare cancer that affects the bone marrow. I learned that it is diagnosed when the patient has >10% plasma cells (a type of white blood cell). The normal percentage of plasma cells is <5%. The patient who came into the office today had a percentage that was slightly above 10%, making this a low-grade cancer. Low-grade cancers are cancers that may not even require treatment, as they do not pose as a serious or immediate threat to the patient. The doctor explained that multiple myeloma can affect many other functions of the body, including calcium levels, renal function, anemia, and the bones (abbreviated by the acronym CRAB). If the myeloma was affecting any of these functions, the cancer would have to be treated. However, if none of these functions are affected, the cancer is instead called smoldering multiple myeloma (SMM). In the case of the patient, we were able to rule out the first three letters of CRAB, but more tests needed to be run to look at the function of the bones. As a result, the doctor ordered a PET CT Scan, which shows bone activity. Today I was given the opportunity to learn more about my aunt’s illness from an actual oncologist. He explained it in such a way that was easy for the patient to understand, giving me a basic overview of what my aunt was suffering from, including symptoms, diagnosis, and prognosis. 8/29/2018 0 Comments day 7: applying my knowledge I was only able to shadow for half of the day today; however, I was still able to learn quite a bit from this half-day. My goal for the day was to finally apply my hematology research from a few days ago to the conditions of the patients we would be seeing today, as I knew there were many patients with blood-related diseases coming in.
Our first patient of the day was a consult, meaning the patient was coming in to the office for the first time. She explained to the doctor that she had an elevated white blood cell (WBC) count, and she was concerned about this. When the doctor was asking her routine questions that he needed for her charts, the patient told him that she had suffered from depression due to a bad breakup, and, as a result, had lost about 100 pounds in a short amount of time. The doctor asked her if she had been taking any steroids, as this can typically lead to an elevated WBC count, but she stated that she had not. Dr. A found that in previous years, her WBC count had always been elevated; this meant that it was unlikely that she had leukemia, as, at that point, she would have been in much worse of a condition after so many years. However, there was no way to be sure without more information, so the doctor recommended that she had some more blood work completed, in order to rule out cancer, before proceeding. My prior research on the components of blood and hematology allowed me to have some background information on the roles of white blood cells. As a result, when he was explaining to the patient the role of white blood cells, and what an abundance of white blood cells can mean for her health, I already knew what he was referring to! Today showed me the importance of doing research in advance. I was able to identify what was wrong with the patient, even before the oncologist explained to her her condition! This gave me a great sense of satisfaction. I will likely continue read up on more of the common diseases that we see at the office, such as lung cancer, pancreatic cancer, and, of course, breast cancer. Today my day was spent focusing on breast cancer. My goal for the day was to further understand the causes, diagnosis, and treatment of breast cancer. The doctor was willing to sit down with me in between his extremely busy schedule to talk about breast cancer and its effects, which provided me with great insight that helped me better understand this (unfortunately) common cancer. The doctor what cancer in general was. Normal cells go through a process called apoptosis, which is a programmed cell death. Cancer occurs when cells do not go through apoptosis, leading to the development of a tumor. He then explained that the vast majority of his patients were breast cancer patients. He also stated that women have a 12% chance of developing breast cancer in their lifetime. There are several different treatment options for breast cancer, however. In the past, the oncologist explained, patients with breast cancer had to go through a mastectomy, or the total removal of the affected breast. However, it was found that radiation therapy, combined with a lumpectomy (a less invasive removal of only a portion of the breast), provides the same results as a total mastectomy. As a result, many patients decide to take this route toward recovery. Early detection of breast cancer is important for treatment and recovery. Thus, women are advised to get annual mammograms beginning at age 45 or 50, as cancer in women younger than 40 is very rare. Dr. A definitely wasn’t kidding when he said that the majority of his patients have breast cancer. However, most of the patients we saw today were on the route to recovery, many of whom were in remission for years, and were on the path toward being completely cancer free; complete remission is when all signs and tests show that the cancer has disappeared, and after about 10 years of being in remission and yearly screenings to ensure that the cancer has not returned, a patient can be considered cancer free!
I really enjoyed focusing on a certain type of cancer, today. Breast cancer is so complex and there is still so much more to be learned about it; yet; it affects thousands of women every year. As a result, I feel that I want to focus on breast cancer for my independent study presentation, seeing that most of the patients we see have been affected by this cancer. Today was not as eventful of other days have been. I wanted to look more into patient-physician interactions and relationships, but it was tougher to do so, as it was a slower day. Instead, I was given the opportunity to look at different scans used to detect a tumor. We spent part of the day attending a cancer conference, where different patient cases are discussed with other oncologists. I was given the opportunity to see different CT scans, brain MRI’s, and PET scans, and I learned a bit about how to evaluate these different scans. While the scans below are not the same as the ones that I saw, they serve as good examples of what these CT scans may look like. For example, the scan on the left is of a healthy chest with no lung cancer, while the scan on the right shows a lung with a tumor in the right lung. Also at the conference, I was able to hear different oncologists’ viewpoints on certain patients’ conditions. This made me realize that the cancer treatment that a patient may depend on the oncologist they are seeing. While this may not be the case for standard and more common conditions such as leukemias and breast cancer, other more rare forms of cancer have more than one treatment route that can be taken (which may be equally as effective). This is why it is very important for oncologists to fully discuss all options with their patients, including the benefits and consequences of each.
Despite the fact that today was a slower day, I was still able to learn something from shadowing at the office. I have never had previous experience looking at different scans of real-life people, but I was given the opportunity to do so today. I also think that the fact that today was a slower day was beneficial for me to understand that the schedules of doctors are different every single day. Some days doctors may have schedules full of seeing patients all day, while other days (though rare) they may have meetings to attend with not as many patients to treat. |
AuthorSusu Alkhalili, senior at Maumee Valley Country Day School. ArchivesCategories |