In need of stem cells?

Posted by Jody at Tuesday, August 17, 2010

I am starting my first rotation at UofM in bone marrow transplant (BMT) with Dr. Frame.

On the first day, of my first rotation, I was quite nervous – I had no idea what to expect. All I knew was that I would be with two other students from my class which helped ease by nerves a little. My classmates and I were to meet Dr. Frame in the cafeteria. We all thought, “Here we go, our FIRST rounds ever.” When Dr. Frame came he sat down with us and explained how we wouldn’t be attending rounds until tomorrow. He explained that with no knowledge of BMT we would feel lost and overwhelmed. (However, this feeling of lost and overwhelmed lasted the entire first week). Dr. Frame gave us an overview of BMT, described the different types of transplant and the common diseases that needed transplant. I was able to understand beyond the basics (allogenic transplant = a donor and recipient, and an autologous = the patient’s own stem cells). We talked in detail about the actual process of transplant, and In the simplest terms (for either an allo and auto), the patient receives chemo in order for the primary disease to go into remission, next the stem cells are mobilized for collection (either the patient’s or a donor’s), the patient receives a conditioning regimen of chemo and then the actual transplant occurs.

After our quick overview of BMT, he gave each of us a list of 5 patients and told us to take the rest of the day to thoroughly learn two patients in detail. By 11am we were free to go. My classmates and I thought it was awesome; we’d go home, spend a few hours learning our two patients and be done for the day. Little did we know, that when Dr. Frame said, “take the rest of your day to learn two patients” he really meant the rest of the day. As I read the patient charts I had to continuously stop and look up almost every other word. There were so many terms and acronyms I had never seen before, things like “BK virus”, “ECP held due to bleeding” or “PCA (0.4/10/14)”. I literally spent the rest of the day trying to decipher the H&P and progress notes.

The second day came and finally we were able to attend rounds. Needless to say, even after my day of studying and researching I was still lost. Dr. Frame did a great job explaining the terminology we didn’t know and the different procedures. As the first week went on things started to come together, especially since there were discussion sessions at the end of each day. All students on rotations for oncology/hematology/BMT would come together for the last 1-2 hours for a discussion session lead by one of the preceptors. Each topic came with a reading assignment to help facilitate the discussion (or to help those of us who had forgotten the topic from therapeutics). The topics that were focused on were specific conditions commonly seen in cancer patients, such as, tumor lysis syndrome, febrile neutropenia, anemia, WBC growth factors, nausea/vomiting, and pain.

After the first week things really started to come together, which also made rounds even more exciting. Each day there was at least one patient with a new condition or problem that we had never learned about in school. However, this also meant we’d be hitting the books once we left the hospital – talk about a fast learning curve!