Week 1 - IR doesn't mean infrared here

I’ve been fortunate enough to not have spent a lot of my life in and around hospitals. There’s something disarming about the blurs of black and green scrubs that flow by – the amount of people I see within the 5 minutes from my apartment to where I need to be in the hospital has me swimming through a sea of people dwarfing anything I’ve been around since moving to Ithaca. It can be paralyzing, especially as someone unfamiliar with their surroundings.

This initial confusion was my first reaction while I was transitioning to the immersion program here in New York City. I’m fortunate to have a clinical mentor, Dr. Bradley Pua of interventional radiology (IR), that has been more than willing to provide some structure to the craziness. I’ve spent the last week shadowing both him and some of his fellow clinicians of the IR department as they proceed throughout their day to day.

After dealing with administrative work throughout the earlier part of the week, I observed a full schedule of surgeries on Wednesday, working out of the CT-guided room. This was my first exposure to the world of IR – frankly, prior to meeting Dr. Pua, I wasn’t sure what made the radiology interventional (using image guidance to allow for minimally invasive procedures). The procedures exemplified the interplay of imaging and surgery to allow for minimal collateral tissue damage. An example case: a patient had previously presented with a renal cyst upon check up. The goal of the surgery was to ablate the cyst with a single incision, which was done by iteratively imaging with CT and moving a probe within the incision site until a final image confirmed probe insertion at the correct site. Upon confirmation, the probe was thermally activated, promoting apoptosis within the cells. All in all, I was able to see 3 surgeries within 8 hour, and truth be told, after the first couple, they start to seem a lot more mundane – the art seems to lie mostly in the precise movement of the probe, and less in the thought process.

Thursday and Friday, I had the opportunity to sit in with patient consultations with some of the nursing staff as well as Dr. Pua. I’m always amazed by the sheer body of knowledge they possess, as well as the ability to communicate in what can be tense situations. These are definitely the parts of the day that are most foreign to my day-to-day life in Ithaca.

Finally, I ended my week watching a procedure that used catheter angiography to guide a probe to the desired site of obstruction, and finally obstruct the desired area. Watching the surgeons guide the catheter using the X-ray was impressive – the blood vessels don’t appear contrasted in the imaging, so it’s as if they were trying to deal with looping a piece of string around invisible walls. Watching the catheter slowly crawl through the blood vessels reminded me of a bug slowly probing outward, feeling around for its environment to make a safe first step.

All in all, I had a successful first week. I’m excited to start working on my research project in the future, but we’ll see what direction that takes as the month progresses!