As my great experience learning
with the inspiring people of the 14th 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...