In March, I met with my research mentor, Dr. Bloomston, who is a surgical oncologist at the Wexner Medical Center. We decided that my project would focus on a condition called non-alcoholic fatty liver disease, or NAFLD. Specifically, I would look at the development of this disease in patients who underwent a surgery known as the Whipple procedure (formally known as pancreaticoduodenectomy). First, I did a lot of reading to familiarize myself with NAFLD and the surgery. I reviewed as many papers as I could find that were similar to what my project focused on. Then I compiled a spreadsheet of all the data I wanted to collect and received a list of patients whose charts I would review. I accessed the patients’ charts while working in the office for fellows the surgical oncology fellowship. At first I collected mostly demographic data and would make a note if a patient met any of the exclusion criteria (such as Hepatitis B/C, or alcoholism). While some charts very clearly showed the data I was looking for, other charts were not as simple. Many times I had to comb through several physician’s notes to find what I was looking for. Also, part of my study included taking values from CT scans that patients had before and after their surgery. Finally, I collected lab values from before and after surgery. While I only had fully completed data on 27 patients in time for the STEP Expo, I’m continuing to work on this project and hope to have data on at least 100 patients completed by the winter.
This is my second chart review-based project I have worked on – the first I completed when I was senior in high school (also done with Dr. Bloomston as my mentor). I think with a few more years of college level science (biology, chemistry, organic chemistry, genetics, etc.) under my belt, my understanding of and appreciation of surgical and medical oncology has grown tremendously. Not only have I learned more about the diagnosis and treatment of cancer, I’ve also gained valuable insight into the career as a physician. To some, combing through a patient’s medical record could seem boring or tedious. Perhaps thinking, “I’ve never met this person… what does this matter to me?” But I was so fascinated with each chart I read. To me, each chart told a story. Not necessarily the patient’s personal story (aside from a brief mention of their spouse or career) but a medical story – the progression and battle against their disease, which more often than not, was pancreatic cancer. After diagnosis and an initial clinical visit, surgeons would make their assessment and plan the surgery. In the weeks following the operation, the charts showed the patients recovering, in some cases a very long and difficult process, sometimes with complications. Some ended on a good note, some charts ended very abruptly, noting a phone call with a spouse delivering the news of the patients passing. Each patient had a different story of his or her disease, each inspiring to read. But in addition, I had a clear view into the mind of the doctor. What their impressions were upon examination, and after an operation. I learned what doctors pay attention to, what they think during an exam, and what their thought are afterwards. It was so intriguing to have a small window into the mind of someone who has years of medical knowledge. It gives me something to strive towards and strengthens my determination to pursue a career in medicine.
One thing that really interested me as a result of this project was variety of chemotherapy drugs that were used after surgery to help kill the rest of the cancer if it was particularly aggressive or metastasizing. I found myself looking up different drugs on the internet, looking and their structures and molecular mechanisms of action. I’m sure that my interest stems somewhat from what I’ve learned classes like organic or biochemistry. In fact, I decided to pursue research like this further – I’m now working in a cancer research lab at the biomedical research tower, looking at cell signaling between tumor cells and the surrounding environment. I haven’t made any definitive decisions about what I plan to do after I graduate, but I think I’d be very happy doing translation research, work that starts in the laboratory and is eventually applied to patient health. I would love nothing more than being able to treat patients based on basic science research that I could also do. There are physician-scientist training programs that offer this, but I’ve got plenty of time to decide. For now, I plan on continuing my work and learning as much as I can.