Cole Latvis - Immersion Week 7 - Cardiac Consulting

I spent my seventh week of immersion observing medical residents on cardiology consulting. This experience consisted of following the residents throughout their entire days including pre-rounds, rounds, and note taking. This was my first exposure to real patient interaction as my previous activities always involved some level of sedation for the subjects of medical care. Also unlike my previous experiences, the lessons I learned were not primarily technical in nature. The most fascinating aspect of following the residents was watching how they collaboratively piece together information to diagnose patients and develop optimal treatment plans. These plans go beyond simply considering the best therapeutic strategies, and considered how potential treatments would impact the lives of the patients. For example, a resident presented a case to the attending and concluded that the patient should remain in the hospital so they could receive cardiac CT as soon as possible. The attending responded by asking “Do you know how much a day in the hospital costs”? He continued that it costs ~$5,000 per day and brought up the fact that the test would not be completed until after the weekend. The resident's recommendation would both cost the patient a lot of money and force them to stay the in hospital instead of the comforts of their own home unnecessarily. The attending simply recommended the patient to be discharged and told then pursue the procedure as an outpatient. Similarly, there were many discussions regarding the “goals of care” different patients set forth that needed to be navigated in the crafting of a treatment plan. All of this was very interesting to witness coming from an engineering perspective, which typically fixates on technicalities and function, largely ignoring how technology interact with individuals on a social level. We look at how to solve a problem mechanistically and sometimes forget to appreciate that real people will interact with the technology. I believe this experience will inform my perspective going forward in my PhD, and I hope help me produce better version of my technology.

Aside from learning how doctors think, I more generally gained a better understanding of how medicine is performed systematically. When thinking about how my vascular grafts would be used in a hospital, I just had a vague conception that a person would present with a problem and then end up in the OR. Now, I have a clear picture of how a patient would go from arriving at the hospital, to diagnosis, to treatment, and have a much better idea of the perspectives and concerns of the patients. Overall shadowing the cardiac consulting team was one of the most valuable experiences of immersion so far.

I also worked in the lab this week. The goal was the generate some data that I can normalize my previously acquired aortic strain data to. However, this proved less straight-forward that I had hoped. My first thought was to generate measurements of wall thickness or aortic area changes. Unfortunately, there did not appear to be an easy or accurate method to obtain these numbers in the software. I was able to measure cross-sectional areas, but the program did provide a number with sufficient precision to be useful. Instead, I decided to find pre-recorded values such as pulse pressure and stroke volume. To my frustrations, I could only find stroke volumes from a small number of the study subjects, and it does not appear that blood pressure was recorded for the study. I have compromised to using blood pressure values recorded sometime after the study MRIs were preformed, although I am not sure how applicable this data actually is. Never-the-less I will see if normalization to these values yield any interesting conclusions.

This was a very interesting week and I look forward to seeing what I can accomplish during my last week of immersion!