a day-by-day
susu alkhalili
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.
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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. 8/24/2018 1 Comment day 4: hematology research Today I am spending my day at Maumee Valley. I had a few meetings to attend at school, so I figured it would be the perfect day to do some more research, making it easier for me to understand what the doctor is explaining to his patients. The oncologist I am shadowing is also a hematologist, so he gets a lot of patients who are having difficulties with their blood. This often leads to the discussion of bone marrow, white blood cells, red blood cells, platelets, and circulation. My goal for the day is to gain a greater understanding of hematology, or the study of diseases related to blood, so that I can enhance my experience shadowing.
Blood is made up of both solids and liquids. The liquid is called plasma, and is made up mostly of water, salts, and proteins, while the solid is made up of red and white blood cells and platelets. The bone marrow is the “factory” in the bone that creates all of these solids. The function of the white blood cells, also known as leukocytes, is to protect the body against infections and invaders. These blood cells move throughout the body through the blood, attacking invaders along the way. Often, patients will come into the office with extremely low levels of white blood cells. This is known as leukopenia. These low levels of white blood cells can be caused by an infection disrupting the production of white blood cells in the bone marrow. On the other hand, red blood cells, or erythrocytes, are crucial for carrying oxygen and carbon dioxide to and from the tissues and lungs. Red blood cells are made up of folate, iron, and vitamin B12, all of which are crucial for their effectiveness. One woman who came into the office had low levels of red blood cells and was thought to be anemic (iron deficient in the blood). However, Dr. A explained to her that low red blood cell levels could be caused by several different aspects, including a deficiency in folate and vitamin B12, as well as in iron. He suggested that they had to run some blood tests to truly identify the cause of the low red blood cell levels. The function of platelets is to bind together when they find damaged blood vessels in the blood, forming blood clots. Thrombocytopenia is when there are not enough platelets in the blood, leading to easy bruising and frequent bleeding. Thrombocytosis is extremely serious and is when there are too many platelets in the blood, leading to excessive blood clots in the arms and legs and can lead to stroke or heart attack. Both of these terms (thrombocytopenia and thrombocytosis) are used a lot by the doctors, nurses, and patients in the office. Learning all of this medical terminology is important for me to truly understand what is going on in the office. Hearing these terms being used has already allowed me to learn them better, but doing more in-depth research will give me an even greater understanding. Due to this research, I am now more equipped to ask the doctor more inquisitive questions to take full advantage of my shadowing experience. I spent the day today at Mercy St. Anne Cancer Center. This center is different than the one I was at yesterday: this cancer center has a treatment area where patients come in and receive chemotherapy or any other treatments they require. I looked forward to seeing this side of oncology. I was also excited to see a bone marrow examination. Finally, I wanted to delve deeper into the effect of the physical environment on the patients.
When you first think about a cancer center, it may seem like an extremely sad place. I noticed that this was not the case with the two centers I had visited so far. The treatment center is decorated with bright wallpaper and beautiful, ceramic birds hanging from the ceiling. The hospital staff are all friendly and cheerful, making the patients’ experience much more pleasant, as a result. I noticed that the majority of the patients were very optimistic and in high spirits. This goes to show that the environment that they are placed in has a major impact on the patients’ treatment experiences and recovery. My favorite part of the day was seeing the doctor perform a bone marrow test. A bone marrow examination is performed when white or red blood cell or platelet levels are too high or too low, and a cause of these abnormalities needs to be identified. As the production of these takes place in the bone marrow, a doctor may extract a portion of the bone marrow from one’s bone to send for further testing. This was a very quick and common procedure that the doctor performed with grace. Because the patient remained awake throughout the duration of the procedure, a medical staff member walked him through what was going on and held a conversation with him until the procedure was completed. Small gestures like this likely make a huge difference both for the patient and the patient’s family, who are likely going through an extremely tough time. This was my first time seeing a medical procedure in real life, and I was glad that it was a pleasant experience for the patient, who was making jokes and laughing throughout and soon after the examination. After only the second day shadowing, I am already exhausted. Doctors have extremely busy schedules every day and they have to be at their best at all times to provide their patients with the best treatment possible. The benefits definitely outweigh the consequences, however. Doctors have the ability to directly change the lives of thousands of people. I can imagine that the satisfaction of knowing that you helped someone fight the battle against cancer is a feeling that sticks with you forever. These past two days of shadowing have shown me that no matter what I end up pursuing in the future, I want to do something that helps people. 8/23/2018 1 Comment day 2: physician or teacher? both. To be completely honest, before coming into the office today, I didn’t know what to expect. All that I knew about the job of a physician was learned through watching Grey’s Anatomy, and I figured that was far from realistic. I hoped to gain a basic understanding of how office visits worked for both the patient and the doctor. I also wanted to closely observe the interactions between the physician and the patient so that I could begin to understand what the environment was like, and some do’s and dont’s when it comes to speaking about a topic as sensitive as cancer.
“You got to see lots of different personalities today,” was the first thing the doctor told me after we had finished with his rounds for the day. He was right. Some of the patients that came in liked to crack jokes and were more light-hearted, while others were more reserved and didn’t like to talk much. I also noticed that some patients brought family or friends with them, while others came to their office visits alone. For example, the first patient that we saw this morning was a pregnant woman who attended her appointment alone. However, our last patient for the day was a woman who had just been diagnosed with stage III breast cancer, and all six of us piled into the exam room. A common theme I noticed among a lot of the patients was that they often came into the office looking for answers. Many of them felt that their previous doctors did not fully explain their sickness, leaving them confused about the medicines they were being given. The most surprising part of my day was observing just how much teaching Dr. A had to do throughout the day. He sat down with each and every patient and thoroughly walked them through their treatment options, the reasons behind their sickness, the scientific aspect of their sickness, and the prognosis. He always ended up drawing out diagrams, whether it was of a bone or an esophagus, writing down key words. When whiteboards were not available, Dr. A would write on the disposable paper covering the hospital beds! Three different patients (Yes, I counted!) said the same thing afterward: “That makes a lot more sense now!” When I asked Dr. A about this, he told me that a lot of the times doctors have so many patients that they just gloss over the problem with their patients, not taking the time to walk them through. He told me that the patient fully understanding what was going on was extremely important. My day overall was extremely hectic, hopping from exam room to exam room. It had many up’s and down’s as well. One older man was told that he might have esophageal cancer that could have spread to other parts of his body, while a woman came in for her annual checkup who had spent nine years cancer-free! Today, I also realized how important it was to completely explain concepts to the patients so that they fully understand the risks of certain treatment options, the reasons behind diagnosis, etc. However, this can be utilized outside of the medical field, and I will likely apply this to whatever career path I choose. I also found that Dr. A tried to maintain a light-hearted environment, making jokes every once in a while. That way, they felt more comfortable to ask any questions they had. Overall, my first day shadowing an oncologist was full of several different emotions, but I look forward to what the next few weeks hold. 8/21/2018 0 Comments day 1: housekeepingToday, August 21, I am spending my day at Maumee Valley, where I am figuring out the nooks and crannies of my independent study. I will be shadowing an oncologist with the Toledo Clinic starting Wednesday, August 22nd. I have laid out some of my goals for my independent study:
1. Observe the interactions between patients and doctors. Applying these new skills to my everyday life, I will be able to listen to and empathize with others more readily. 2. Figure out if oncology (and medicine, in general) is something that I want to pursue as my career. I will be able to ask the oncologist in-depth questions about his occupation, seeing that I will be shadowing him for three weeks. 3. Learn how to manage my time wisely. Doctors have very busy and tight schedules, and they have to manage their free time extremely well. I will be able to apply these skills to my school routine, better preparing me for my senior year. |
AuthorSusu Alkhalili, senior at Maumee Valley Country Day School. ArchivesCategories |