Week 1- Chase Webb

What a week! Entering a new environment is always a jarring experience, but this is especially true for the fast paced world of hospital medicine. Luckily my clinical advisor, Dr. Robert Kim in Cardiology, has been a good mentor and helped me learn from the experiences I have with him and well as find new people to meet and things to see. My first clinical day began with a presentation by a cardiology fellow on her recent cases of peripheral artery disease, which served as a nice academic introduction to some of the cardiovascular work I would see. After that, I spent the rest of the day with Dr. Kim in the clinic, seeing new or ongoing patients about their heart problems. After seeing a few patients with atrial fibrillation, Dr. Kim taught me a little more about the condition (unorganized beating of the atria that can lead to clot formation and elevated heart rate) and some of the ways it is treated (mainly by slowing heartrate overall and giving blood thinners to prevent clots from forming).

The next day I spent the morning again in the clinic seeing patients. That afternoon, Dr. Kim took me to the cardiac catheterization lab, where I met many people including Dr. Christopher Liu and Dr. Luke Kim. I watched them perform a variety of procedures, including an angiogram, PFO closure, and a Watchman deployment for atrial appendage occlusion. There I had a great time being able to ask questions of the nurses, techs, and fellows in the control room. Thursday morning I got to go to with CCU and round with Dr. Irina Sobol, seeing some of the sickest cardiac patients. Later that day, I had my first day in Jingli Cao’s lab in the Cardiovascular Research Institute. His work looks at heart regeneration in zebrafish at the cell and molecular level. With his postdoc and graduate student, I got to watch imaging of transgenic zebrafish embryos and help extract adult zebrafish hearts.

Coming from a research background, the two most interesting things I have seen so far are the ambiguity that physicians work with and the amount that quality of life and patient sentiments play into treatment decisions. For example, I assumed the processes for prescribing the dosage of a drug to a patient worked almost like a flowchart; a patient experiencing X symptoms weighing Y would get Z dosage. However, in many cases dosage depends much more on how the patient has previously responded to that drug and how aggressively both the doctor and the patient want to deal with the condition. Additionally, how a patient tolerates the side effects can influence treatment. Some patient’s may be deeply affected by the same side effects that another patient does not even notice, though both experience them at the same level. Though not clear to me now, I believe it will be interesting to reflect on this at the end of the summer to see if I better understand how physicians make these decisions and if there are ways we as engineers can intuitively understand them to ensure the treatments we develop not only treat the disease but also fit into this amorphous environment.