Alex Hauschild - Shields Oncology Research Rotation - Week 8 (the final week)

           Back two weeks ago when ABC news came in to interview Dr. Carol, we got to do a couple shots of us in the clinic. I managed to make it into the final cut: http://www.wsoctv.com/news/news/special-reports/9-investigates-cancer-mystery-huntersville/ngpwT/?__federated=1 (at 2:27)

As my great experience learning with the inspiring people of the 14^th floor clinic of Wills Eye Hospital winds to a close, I am at a loss for words. Oddly enough, this is the first time I have ever worked doing anything where I only wish that I could stay longer and do more work. As I look back at all the experiences I had this summer and all the people that I met, I believe I made some powerful connections and managed to find not only one but two welcoming homes in the process: one at Wills and another at the apartment of the Kleinbergs whom I stayed with all summer. I only want to thank all who made this possible including my wonderful mother and astute teachers Drs. Peretz and Crider whose keen guidance helped me find a place with the Shields, the Shields and associates who put up with all the students for two months while we learned all that they had to offer, Teri who opened her home to me and taught me the basics of cooking gourmet food, and of course the med-students who helped me understand everything when I was first starting and helped me write my poster and article. The list goes on as to all the people that I could thank, but one thing is for sure: I will never forget the summer of 2014.

                My final week in review: Monday – nothing new, just the usual retinoblastoma, uveal melanoma, nevi in various shapes and forms, and another sad case of melanoma that required enucleation. Of course research was also done on all days.

Tuesday – other than the typical scarring and loss of vision because of radioactive plaque treatment and other secondary problems associated with treatment, we managed to see some paving stone retinal degeneration which was very cool.

Wednesday – In the morning, I went around with Dr. Jerry Shields seeing patients and saw some pretty interesting stuff. One patient we saw had a multifocal melanocytosis of the uveal tract with multiple melanocytomas very interesting but luckily completely benign. Another was a highly unusual variant of hyperplastic limbal epithelium which presented as a small white elevated mass on the edge of the cornea. The final case that was of interest was one of only four patients in the entire system of patients that the Shields treat whose cancer is unclassifiable. “This tumor just defies diagnosis” said Dr. Jerry Shields. Needless to say that it is beyond rare to have the Shields come up empty handed, period. I went down for some time in the OR after that to watch some EUAs. Just the normal stuff really, typical retinoblastoma cases that are either new or are coming in for a follow up to be sure that everything is fine.

Thursday I started the day by bringing in some donuts from the best donut shop in Philadelphia – Federal donuts all of the students pitched in to get some stuff for the clinic staff and doctors. We even brought some down to the break room in the OR so that the doctors could snack on them as well. In Dr. Jerry’s OR (which I started in) I saw a removal of a conjunctival lesion and a very long removal of a lacrimal gland cyst. After watching a plaque with Dr. Carol, she decided that she would introduce us to some of the other surgeons and lend a few of us out. I had the opportunity to watch Dr. Maguire of the Wills retina service perform some surgeries in his OR. The first was to fix a macular hole. The surgery went something like this: first a vitrectomy was done to remove all the vitreous from the posterior chamber and replace it with balanced solution (similar in molecular composition to the vitreous). Kenelog is then injected into the posterior chamber to help visualize the hyaloid membrane adhering to the macula. This membrane is then carefully removed and suctioned up. Indocyanine green (ICG) is then injected to stain the internal limiting membrane (ILM) which is then carefully removed. After removal of the ILM, the solution in the posterior camber is replaced with high pressure air forcing the macula back together. The air is then replaced with SF₆ gas to preserve the anatomy of the eye and help it heal. While the gas is in the eye, the patient will not be able to see, but this will resolve in 2 weeks time when the vitreous starts to return. I then went back to Dr. Carol’s OR to see an aspiration of an iris cyst – kind of self-explanatory. I left just as the enucleation was beginning and returned to Dr. Maguire’s OR to watch another macular hole surgery.  Once the surgery was completed I thanked him for letting me observe and went back to Dr. Carol’s enucleation and made it just as they were pulling out the eye. We all crowded around a small prep-table as the doctors opened up the eye to harvest tissue samples from the tumor. It was quite a sight: 17 people crowded around one table with nothing on it but a very out of place looking eye. It should be noted that the table was no bigger than a common student’s desk. Shortly after that, I counted 21 people in that room. To say that this was an exciting day would be an understatement.

Friday was my final day. I spent the morning helping the fellows with research (mostly pulling charts and entering data). I left to have lunch with Teri, the nice graduated-resident-of-Wills that I was staying with for the summer. I came back to do some more work before a few of the remaining students suggested that we all get our eyes dilated and have a full workup by the photography department. Just a few of the photos taken:

Apparently I have a spot of pigment on my right iris...

The back of my right eye

The retina (as shown by the cake like layering), the fovea (the little dip in the middle), the Choroid (the bulging sponge like mass under it), the orbit under that, and the optic nerve to the far right. This is the macula of my right eye.

 We took our last photos as a group with the Drs. Shields and said our goodbyes. Dr. Carol gave me some great advice on applying to her alma mater: The University of Notre Dame. Exciting things including the strongly implied fact that all of the students who worked on the massive project would be given author status on the publication once it goes to print in about a year or so. She also said that any EXP-ers would be welcome to spend the summer doing something similar and I would be welcome back anytime… She actually said that she expects me to come back for another summer sometime again. Something tells me that my experiences in medicine are only just beginning…

Dr. Carol (center) and the students, 5 not pictured.

                As I finished writing this, I was actually offered another research job by Dr. Levin in the pediatrics department working on redefining convergence insufficiency. For reference, the study that I was working on for most of the summer had 1200 patients in it, and with 20 people working on it for 4 hours per day, it got done in about 2 months. In truth, it still has more work to be done on it. Comparatively, my the pediatric study is fairly large, encompassing some 800+ patients and with only 3 people working on it, something tells me that it will take a very long time to complete...