Clinical Immersion - Week IV

It's Independence Day

For the first time, my clinical experience at HSS finally involved aspects of medical treatment and surgical procedures for treating conditions pertaining to knees, hips, and shoulder. Given HSS' position as a center for orthopaedic surgery, most patients tend to come for afflictions that involve progressive deterioration of cartilage at bone joints, which is why most procedures that I observed revolved around the issue of replacement surgeries. The attending doctor for this week was Mathias Bostrom, who works on patients at both HSS and Helen Hayes and specializes exclusively on treating conditions associated with cartilage degeneration and artificial replacements. Given his schedule, I was not able to observe him until Wednesday, so my first part of the week was the usual imaging work at the MRI Center using the GE AW Server to quantify spectral HU variations across the trabecular microarchitecture of femoral condyles. The highlight for imaging this week was the fact that I was able to get in touch with Dr. Sirohey of GE to actually get data that related HU variability to location "x" across the femoral condyle, rather than the standard of keV voltage. By relating HU to location x, it's possible to use a discrete approach to determining what constitutes trabeculae and what does not. With three different imaging protocols for eight images in total, work on these images is far from over (not to mention that there's also interest in seeing trabeculae under decomposed images as well as examining HU variation on cortical bone) but at the moment it has been postponed until next week.
Getting back to Dr. Bostrom, I was able to observe him interact with patients on clinical rounds on Wednesday. While I was not really able to interact or be of any actual meaning to these patients, I did make sure to keep the patients comfortable and let them know while I was not a doctor in training that most of my work as a graduate student was being done to help future patients. The patients themselves were gracious and calm, with most actually being glad to know that a new generation of professionals was getting trained for the future. The patients themselves were rather interesting as well, ranging from eighty to forty, couples to parent-children duos, New Yorkers to people from California. Perhaps the more relevant case to discuss was the one of a patient who had been exposed to an illegal fertilizer; the chronic exposure had resulted in debilitating conditions across the body such as sarcoidosis and bone maladies across the hip. The patient required multiple artificial replacements, not to mention extensive work on the spine. Surgery for the left knee will be most likely recommended in the near future. Other cases discussed were pre-surgery assessment of anomalies in bone joint performance, premature loosening of implants requiring a replacement, and a case of a possible bacterial infection on a knee replacement (known as osteomyelitis).
Thursday is Dr. Bostrom's surgery day, which meant for me to find scrubs and my way to the OR at 8:00 AM. Hopefully, I was able to tag along with Amanda Rooney for the day, finding the room just in time for surgery. The case was actually an anomaly; a patient that had a suffered a serious accident, resulting in a fractured hip that healed rather improperly: the femoral head had fused to the acetabulum, locking the joint in place. The surgery lasted almost five hours, which I was told was way longer than the standard artificial implant surgery, and involved a complicated cut alongside the posterior and lateral side of the hip. A team of anesthesiologists, the surgeon, three-four assistants at a time, an a duo of vascular surgeons was needed for the operation, which had to carefully break down the fused acetabulum-femur while avoiding major damage to the surrounding tissue. After the ordeal, insertion of the replacement was standard and the patient was quickly stitched and sent to recover. Next surgery was a minor replacement for an acetabular head, lasting no more than two hours.

Outside life continues for me (at least on the weekend). This past weekend I devoted myself to exploring activities rather than neighborhoods which ended in me going to historic Kings Theatre to watch a stand-up comedian, visiting the Battery Park area of Manhattan, and taking a look at parade festivities in Greenwich Village, which involved lots of walking. Just yesterday I had to chance to visit Fort Tryon Park in Washington Heights, taking also the opportunity to visit the Cloisters, a museum of art from medieval Europe; the day ended with getting dinner in the East Village. For the moment I am good with surgeries, but given my experience with Dr. Bostorm, I am looking forward to eventually shadowing Dr. Scott Rodeo in two weeks.

Restaurant of the week: Boulton & Watt