From the D to DC, from the Bedside to the Benchtop

Posted by Bernie Marini at Wednesday, October 12, 2011

Wow. These last two months have been a whirlwind. I've been so busy that I haven't posted in a while, so I'll try to summarize two months of rotation into one blogpost. Hard to accomplish? Probably. But the Detroit Lions are 5-0, the Tigers are clawing to stay alive in the ALCS, and the Wolverines are undefeated. I'd say anything's possible at this point (haha! See what I did there...).

CABG Patch Kids
My second rotation was my institutional rotation at the Detroit Medical Center - Sinai Grace. Institutional rotations typically have a bad rap for being boring. However, this was certainly not the case. Because I had also completed my Institutional IPPE at the same site, they were extremely flexible with allowing me to see basically anything that I wanted - within reason, of course. (That's one rotation tip for any P3's, 2's, 1's, 0's (is that pre-pharmacy?). If you want to do something on rotation, just ask. They will likely say yes. If you are not getting everything you want out of your rotation, tell them. They will likely accommodate you.)

Because Sinai-Grace is well known for having an extremely busy and exciting emergency room (for students, not so much for patients), I decided to shadow and help the ER pharmacist for a couple of days. Because the ER is typically slower in the mornings, and I wanted to get the full Sinai-Grace ER experience, I started around 10 AM and left at 1 AM. That's almost two full shifts! I was really tired the next day, but it was truly an awesome experience (again, for me it was great. For the patients... eh, probably not an ideal Friday night).

Another great experience I had on rotation was when I spent the day in the OR. For a good chunk of the day, I was able to hang out with the anesthesiology residents and watch a coronary artery bypass graft, or CABG. It's truly an amazing surgery. Several surgeons work simultaneously; it's like a well-choreographed dance, but with scalpels. The heart is chemically stopped to allow the surgeons to operate on the heart and a cardiopulmonary bypass machine (or a "heart-lung machine") takes over. Clearly, the institutional rotation at Sinai-Grace is anything but boring.

Au Bon Pain? Or "Oh Bone Pain"!

For my third, and current rotation, I am at the National Cancer Institute (NCI; part of the NIH) in Bethesda, MD, just outside of our nation's capital.

Julie and I outside of the ASHP headquarters in Bethesda

My initial impression of the NIH campus in Bethesda: WOW... I was seriously blown away on my first day as I strolled nervously past the National Library of Medicine (yes, that NLM - the world's largest medical library... i.e. PubMed!) towards the clinical center (where NCI patients are treated). The size of the NIH medical campus in Bethesda is about the size of UM's central campus. The clinical center is nearly as big as UM's University Hospital. And every patient is a cancer patient.

The National Library of Medicine

My rotation at the NCI is unique in that it combines elements of research with some clinical experiences. Every Monday, I get to shadow an oncology fellow in the clinic. Every patient in the clinic is on a clinical trial, so patients are monitored closely for recurrence of disease and toxicity from the treatments. The lab that I am working in primarily studies prostate cancer, the leading cancer in men and the second highest cause of cancer-related death in men. The lab studies everything from the pharmacogenomics of cancer to molecular biology to the pharmacokinetics of anticancer agents. I've worked in a lab in undergrad at UM, but I've never experienced research that is so closely related to what is happening clinically.

Let me clarify this with an example. When a patient comes into the clinic with an unexpected side effect or toxicity, serum samples are sent to the lab, where analytical chemists and other researchers can determine drug concentrations using HPLC and Mass Spectroscopy (Oh no... time to dig out those Medchem notes!) to find out if the patient's drug levels were outside of the normal range. If they were, new questions arise. Is there a genetic polymorphism affecting the way that patients are metabolizing the drug? Is there an interaction with another agent? Can we modify the structure of the agent to minimize toxicity and maximize efficacy? These are just some of the ways that clinical trials "at the bedside" at the NCI make their way back "to the benchtop", or vice versa.

As you can see from the lack of me blogging this month (and answering emails...), this rotation has kept me extremely busy. I'm currently writing a review article on bony metastases in prostate cancer. When I'm not in the lab doing benchtop research, or working on my review article, I can usually be found in the coffee shop studying for the oral quizzes my preceptor gives me every Friday on a different cancer. The name of this coffee shop is "Au bon pain", which apparently means something like "place of good bread" in French. I don't speak French, so for me, it sounds ironically like "Oh bone pain..."

The rotation at the NCI has been an amazing and emotional experience so far. Seeing patients and their families deal with the struggles of cancer can be overwhelming. When my wife was diagnosed and treated for a glioblastoma in 2009, we needed all of the support we could get. Walking through the clinical center, seeing patients and their families stay strong throughout difficult times truly puts things into perspective. The worries of everyday life that usually circulate in my head - "I hope I do well on my quiz", "I wish I had known that answer on rounds", or "I really hope I get a residency" - seem small in comparison to their worries and concerns. It makes me think about how lucky I truly am. I am lucky because my wife is healthy right now... My family is healthy... I am healthy... Many people are not this lucky, and experiences like this remind me not to take life for granted and to "not sweat the small stuff", as my Mom always says.

Sometimes you've got to have a little fun!