Week One (Jason Chang)

Having lived in the suburbs of DFW my whole life, much of my first week was spent adjusting to big city life on the Upper East Side. I just finished my research project for my undergraduate advisor on the day before my flight to NYC, and with that entire week being packed with heartfelt send-off meals and pep talks from my mentors and friends, it has been a tiring and sentimental first week for me since I am still processing a few major life changes. I am anxious to be participating in the immersion program with the rising second-year BME PhD students since I have yet to begin my lab rotations and choose an advisor, but I am excited to explore NYC and gain first-hand clinical experience working under my mentor, Dr. Halinder Mangat, in the Neuroscience Intensive Care Unit (ICU) at Weill Cornell Medical College (WCMC).

Dr. Mangat and the other clinicians in the Neuroscience ICU monitor and treat patients with a wide range of neurological disorders, including stroke, seizures, subarachnoid hemorrhage, and other traumatic brain injuries (TBIs). On my first day, I met with Dr. Mangat to discuss my summer research project. As a neurocritical care specialist, Dr. Mangat's research focuses on using electroencephalography (EEG), an electrophysiological technique used to record electrical activity from the cerebral cortex of the brain, to correlate cerebral activity to different levels of consciousness in critical care patients. This work can improve how clinicians manage ICU patients suffering from acute brain injuries. Specifically, the first part of my project will involve signal processing and spectral analysis in MATLAB to analyze EEG data collected from ICU patients. This work is being done in collaboration with Dr. Peter Forgács, a neurologist and epilepsy specialist at WCMC. Luckily for me, current and former students in Dr. Forgács' research lab have already written a significant amount of well-documented code for general EEG analysis, so I can focus entirely on my own part of the study. Although I have a limited background in neurology, I am already learning a lot from reading literature and textbooks on the fundamentals of EEG technology. Additionally, I have been joining daily morning rounds in the Neuroscience ICU with the on-call attending, a fellow, residents, nurses, and WCMC medical students completing their clinical rotations.

Prior to immersion, my understanding of the rounding process was based on what I had seen on TV shows like Grey’s Anatomy and House. As it turns out, the length and structure of the rounding process can vary considerably between specialties. In the Neuroscience ICU, the residents first present each patient’s condition, recent vital signs and/or scans (typically an MRI, CT, chest x-ray, or Doppler ultrasound), functional and cognitive assessments, treatment plan, and relevant overnight observations. Since WCMC is a teaching hospital, the fellow and attending usually ask a lot of questions to have the residents and medical students rationalize different treatment options and interpret the scans while checking for higher-level understanding. With patients constantly coming in and out of the Neuroscience ICU, the nurses on duty often bring up new symptoms or complications that may have developed. Even though I am just observing, I often get lost in all the medical terminology associated with various lab results, medications, and conditions. However, I began feeling much more comfortable after I realized that these clinicians, who have spent several years learning and working in a clinical environment, occasionally come across terms that even they are unaware of. Nevertheless, I wanted to have at least a minimal understanding of each patient’s status rather than getting lost in every other word, so I have been writing down all of the terminology I am unfamiliar with and borrowed a book on neurocritical patient care from Dr. Mangat. Despite there only being 14 beds in the Neuroscience ICU, this process usually lasts for three hours before the clinicians begin rounding in the patient rooms, which is likely due to the unpredictable nature of neurocritical care requiring a thorough workup.

The Neuroscience ICU includes both pre-op and post-op patients, with many of the patients being comatose (i.e. a deep state of unconsciousness due to severe brain injury). During patient rounds, the clinicians will sometimes perform a series of motor and pupillary responses to check for neurological function. Afterwards, the fellow and attending discuss the patient’s progress with family and/or friends in the room and answer any questions that they may have. Honestly, meeting the people behind these patients and interacting with their family and/or friends has been the most challenging part of my immersion experience so far. Many of these patients suffer from chronic neurological conditions that make them susceptible to seizure activity and other symptoms. However, there are also patients with severe brain injuries who have little or no history of neurological symptoms that are now in critical condition. Whether their visitors are accustomed to these frequent hospital visits or lamenting the deterioration of their loved one’s once seemingly healthy body, it is absolutely heartbreaking.

Aside from reading and morning rounds, I have been dealing with a lot of administrative work to get my WCMC login credentials to use my office computer. I share an office space with two wonderful clinical research coordinators, Carla and Ryna, who have been helping me acclimate to my new work environment. I finally received my CWID and password on Friday afternoon, so now I will be installing MATLAB on my computer to begin familiarizing myself with the code from Dr. Forgács lab.  On Friday mornings, all of the Cornell BME PhD students meet with Dr. Min, Chairman of Radiology at WCMC, and Dr. Martin Prince, a Professor of Radiology at Cornell and Columbia Universities. Dr. Min, Dr. Prince, Dr. Yi Wang (who is on sabbatical leave), are in charge of the immersion program. Dr. Min and Dr. Prince introduced themselves and had each of us talk about our clinician mentors and summer research projects. Both Dr. Min and Dr. Prince are pioneers in radiology and have developed cutting-edge technologies and techniques that are now used regularly in clinical settings, and I extremely grateful that they are making themselves readily accessible to maximize the benefits of our immersion experience. My research background and interest is in orthopaedic biomechanics, so Dr. Min mentioned that he may be able to arrange for me to observe some orthopaedic surgery procedures in WCMC this summer!

Now that I have my CWID and WCMC login credentials, I am looking forward to getting started on my project next week. Until then, I will continue reading through the papers and textbooks that Dr. Mangat gave me so that I can have a better grasp of how to approach my work in the upcoming weeks.