Author: rohan_sachdev

June 6th, 2019

I can’t believe today was my last day at Dr. Graham’s clinic. I had become close to many people in Dr. Graham’s clinic including the man himself. I’m going to miss the look on Vanessa’s face and the puff of air followed by a slight nod whenever I asked her if Dr. Graham was behind on his schedule. I’m going to miss the long conversations I had about the NBA finals and Drake with Konan, Dr. Graham’s newest scribe. I’m going to miss learning about fencing and the Mormons living in Utah from Dakota. I’m going to miss all the cool procedures Ms. Susan performed and let me watch. I’m going to miss seeing the long lines of staff members waiting patiently for Dr. Graham to finish his patient visit and step out of the room. I’m going to miss the conversations I had with various staff members while I used to eat my lunch in the break room. I’m going to miss the constant air conditioning I felt as I waited for him in his room. In short, I’m going to miss so many things that made this clinic so unique which was the people. It was a delight to meet so many new faces and hearing about their stories and learning about how Dr. Graham had impacted their life as they are on the way to recovery. I’m going to miss Dr. Graham interrupting my lunch break so that I never missed out on seeing any of his patients. I’m going to miss the smiles he brought to the faces of countless faces and the pure joy they felt when he said, “I went to sleep well last night after reading your report. I’m going to miss Dr. Graham’s most famous catch-phrase: “I kid you not”. But what I’m truly going to miss the most is the knowledge I was able to gain while shadowing him for the past two weeks. I hope that one day I will be able to make good use of all Dr. Graham’s teachings with hopefully get to learn so much more from him.

June 5th, 2019

Today was a very exciting day for me from the perspective of gaining knowledge. In the morning, I was able to witness Ms. Susan (Dr. Graham’s Physisican Assistant) perform a bone marrow biopsy in order to obtain a sample of bone marrow tissue to evaluate the different types of blood cells as well as the structure of the bone marrow. Ms. Susan showed amazing composure as she numbed both in the outer and inner layer of the skin before inserting the needle through the skin and into the bone to obtain a sample of the bone marrow. I was amazed by how quickly and accurately Ms. Susan performed this procedure which lasted only 10 minutes from start to finish. The patient was numbed well as she didn’t seem to feel a 5-inch needle being inserted into her body as she continued to have lively conversations with Ms. Susan. The patient was also extremely fit, which meant her bone structure was superior to other patients her age, making the bone marrow biopsy a little more complicated, but nothing Ms. Susan couldn’t handle! The procedure ran smoothly and the patient was very appreciative that they told her to lie on her back so that she didn’t witness a giant needle being inserted into her body. Ms. Susan also praised me for being able to witness the whole procedure without passing out, claiming she had seen far too many high school boys pass out on her while she performed the bone marrow biopsy.

Afterward, Dr. Graham took time out his schedule to sit with me and chart my family’s pedigree to determine my risk of cancer. I had learned a little bit about crafting family trees in 9th-grade Biology (shoutout to Dr. Bartling)! Dr. Graham gave me a quick crash course on Genetics just as a refresher and explained how they create pedigrees for every single patient in the clinic. Then the focus switched over to Dr. Graham’s expertise: breast cancer. He introduced me to the Gail Model also known as the Breast Cancer Risk Assesment Tool which uses seven different variables to calculate your 5-year risk and lifetime risk of breast cancer. Here is the link to the risk calculator from the National Institute of Cancer to check out: https://bcrisktool.cancer.gov. Then, he told me about a very famous study conducted in Houston from 1992-1998 to determine the accuracy of the Gail Model. They took a group of women ages 35-78 and divided them into two groups. One group received the placebo while the other group received Tamoxifen (a very popular drug to treat breast cancer and even prevent it). The Gail Model predicted that out of the 6,700 patients receiving the placebo, 176 would get breast cancer and the actual number was 178. For the 6,700 patients taking Tamoxifen, the Gail Model predicted half as many to get breast cancer with an estimate of 89 and the actual number was 87. This is why the Gail Model is one of Dr. Graham’s favorite tools to determine your risk of breast cancer.

I learned so much today and can’t wait to see what’s in store for tomorrow!

June 4th, 2019

Dr. Graham came back from the annual ASCO (American Society of Cancer Organization) in Chicago, so I shadowed him throughout the day. I learned a lot from Dr. Graham today, so I’m going to share some of this knowledge. In the morning, around 9:30, Dr. Graham received a call from one of his patients currently undergoing chemo and radiation. She called to inform him that her temperature was 100.4 °F. The patient is more susceptible to illnesses because this regiment reduces her white blood cell count in half, and her current temperature can dramatically increase to 104 °F in less than an hour. Dr. Graham pondered about her situation and told her to come to his clinic instead of going to the ER. Despite his packed schedule, he told her he’ll be able to accommodate her in his day. Dr. Graham hung up the phone and explained me that because her health records were fine and she just had a mild fever that he saved her from paying $3,000 – $5,000 for an ER visit compared to $150 – $200 for a clinical visit. In these types of scenarios, you have to consider the severity of the patient’s situation and more importantly the cost of going to the ER vs. going to the clinic. Had the patient’s situation been much worse, Dr. Graham would have advised her to go to the ER, no questions asked.

June 3rd, 2019

Dr. Graham was still at the annual ASCO (American Society of Cancer Organization) conference in Chicago, so I once again shadowed Ms. Vanessa, one of Dr. Graham’s Physician Assistants. Ms. Vanessa had a relatively relaxed schedule today with only a few patients to see for their regular check-up. However, she did have three Chemo-Ed sessions with patients who have three different types of cancers, so she let me sit in on the meetings. For those you don’t know, Chemo-Ed sessions are meetings where the patient and their family meet with the doctor to discuss the timeline for treatment, the different types of drugs/radiation that will be used, side-effects of the treatment and any other questions in general about this whole process.

Treating cancer is very difficult, but with all the advancements made in science and medicine, most types of cancer are curable which is a testament to the amount of progress we have made in the field of oncology. The regiment, as the doctors call it, included using chemo and radiation to shrink the tumor and remove any remnants of it through surgery. The patients were so kind and cheerful and maintained a smile on their face throughout the session. It was amazing to see how much courage these patients have to be able to undergo such intense treatment as chemo and radiation. Ms. Vanessa was so cordial throughout the session which made the patients very receptive to all of her advice about the treatment plan. The Chemo-Ed sessions concluded with a brief conversation with AJ, the insurance coordinator. It was a very gratifying feeling when AJ said 90% of their treatment will be paid by their insurance which only 10% will be paid by the patient’s family.

Through my five days of being at Waverly Hematology-Oncology clinic, I have noticed that being in the field of oncology is extremely challenging. Cancer has earned a reputation over the years of being particularly difficult to treat, which it is, but with all the advancements made in the field of oncology, more types of cancer are now treatable with little to no chance of resurgence, which is absolutely amazing!

 

May 31st, 2019

It wasn’t a very hectic day with fewer patients coming in for their appointments. Dr. Graham had gone to ASCO (American Society of Clinical Oncology) for the annual conference which is in Chicago this year, so I shadowed Ms. Susan, one of Dr. Graham’s Physician Assistant, for the day. Ms. Susan performed a thoracentesis on one of her patients to remove the liquid that was trapped in the thoracic cavity underneath the patient’s left lung. Ms. Susan numbed the skin around the area where the needle would be inserted, a let the needle do the work, as the liquid was slowly drained out from his body. It was a really cool procedure to witness and hope I’ll be able to witness more procedures like this. This was the highlight of my day as Dr. Graham had given me half the day off to go home, relax and unwind after 4 long days at the clinic this week.

Can’t wait to see what’s in store for next week!

 

May 30th, 2019

Today, I got to spend a lot of time with one of Dr. Graham’s scribes named Dakota. He graduated from Duke with a Bachelors in Chemistry and took a gap year to work as a scribe for Dr. Graham as a way of gaining more exposure in the field of oncology before he applies for medical school. Dakota told me that his experience as a scribe for Dr. Graham has cemented his interest in oncology and is the reason why he plans to specialize in this field. It was great talking to him and gathering new perspectives on the route to becoming a doctor.

Throughout the day, I would shadow Dr. Graham, like I had the past couple of days, as he met with his patients. Most of Dr. Graham’s patients were here for their routine check-up to monitor the status of their cancer treatment. His patients were always so happy to see him, as he was greeted with warm smiles. Dr. Graham would discuss the reports with them, priding them for their continued effort, and giving them comfort that their cancer would soon be eradicated.

But today, I was exposed to something I had never seen before in my life. Dr. Graham walked into one of the rooms where a patient and her husband were patiently waiting. The lady stood up immediately and stretched out her arms and locked them around Dr. Graham’s waist as she gave him a tender hug. Dr. Graham pulled up a chair and sat next to them to discuss her report. I watched their conversation and held a smile on my face as Dr. Graham begin to dissect her report. As his eyes scanned through the report, a troubled looked appeared on his face. The results that had come in were not good. Her tumor was continuing to grow despite the medication/treatment Dr. Graham had prescribed. I glanced over at the lady and found that tears were forming in her eyes as she had just come to terms with reality. Dr. Graham told Dakota and me to step out of the room. We waited outside and exchanged some glances, waiting patiently for Dr. Graham to come out and give us an update I remember a crack appearing in the door as Dr. Graham stepped out. His eyes too were watery as he ignored us and headed to the bathroom. I don’t know what exactly was discussed in the room, but I was taken back from everything I had seen as I began to digest what I had just heard. This was what I had never experienced before. The emotional impact of cancer. It saddened my heart as I tried to imagine what could have possibly been discussed in the room. Dr. Graham came back to us having freshened up a little and told us about his history with the patient. She had been with Dr. Graham for the past 10 years battling breast cancer and now liver cancer. He began to tear up more discussing this with us and sniffly said, “We’ve tried the best we can”. I didn’t say a single word to him and neither did Dakota as we both saw the other side of this acclaimed doctor. The human side of this accomplished individual. All of his successes in his 45 years in the field of oncology, vanished, because of one harsh truth. Life isn’t fair.

I don’t want to end this blog on a sad note, so…. later that day after all of this had settled, we celebrated Dakota’s one year at the clinic. Dakota will be leaving and going back to his lab at Duke to do research while he applies to medical school. I wish Dakota the very best in his future endeavors.

May 29th, 2019

My day started at 7:00 today when Dr. Graham invited me to one of his meetings where he would be giving a presentation to other oncologists at WakeMed to discuss the different treatments he uses for his patients with breast cancer. There were many topics discussed during the meeting, but the main topic was about how to evaluate a tumor and prescribe the right kind of treatment. It was very fascinating when he showed images of how the tumor had spread through the patient and how his specific treatment had remedied the patient.

I met one of Dr. Graham’s Scribes named Vanessa who had gotten her bachelor and master’s degrees and was planning on applying to medical school next year. She talked about her journey and how she really enjoys working under Dr. Graham because of how much she gets to learn from him. All of this knowledge had sparked her interest in the field of oncology and cites that as the reason she wants to attend medical school.

Throughout the rest of the day, I would shadow Dr. Graham as he met with his patients. Dr. Graham is such as an amazing individual with a wealth of knowledge and experience and it was a pleasure to be able to follow him around and see him work. He has a very personal relationship with all of his patients and truly cares for them which was evident through his light-hearted and amicable conversations. He told me that he wants his patients to understand the science behind his diagnoses. Dr. Graham met with different kinds of patients from lung cancer to breast cancer to gastric cancer. Most of his patients were here for a regular check-up and for an evaluation of the treatment he had prescribed to eradicate/palliate their cancer.

One of Dr. Graham’s patients had ovarian cancer caused by a BRIP-1 mutation in one of her chromosomes. Her father didn’t have this mutation, but her mother was carrying this mutation as a recessive trait. Dr. Graham found out that this patient and her two sisters were also carrying this mutation and were at risk of ovarian cancer. It was really cool to see Dr. Graham give this crash course on Genetics for his patient and me to understand.

Overall, it was an amazing day with so much knowledge to digest.

Can’t wait for tomorrow!

May 28, 2019

For the next couple of days, I will be shadowing Dr. Mark Graham at his clinic Waverly Hematology-Oncology.

I arrived at Waverly Hematology-Oncology and was greeted by one of Dr. Graham’s Physician Assistants named Susan Blumenthal. Dr. Graham was exceptionally busy today because of Memorial Day Weekend so I didn’t get to shadow him, however, I was able to shadow Ms. Susan. First, she took me on a tour around the clinic and introduced me to all of the staff. She told me about her responsibilities as a Physician Assistant and how she assists Dr. Graham with his patients both in his clinic and at WakeMed Hospital. Ms. Susan told me that Dr. Graham has 4 Physician Assistants (3 for the clinic and 1 for hospital) and 2 Scribes, all of whom are there to help this very busy man. Ms. Susan has been under Dr. Graham for almost 10 years so she is able to work independently to handle the patients.

In the mornings, Ms. Susan normally meets with patients that are about to start or are currently undergoing cancer treatment. She reads through their reports and checks in with them to see how they’re doing. It was nice meeting all of these patients who were all so friendly and cheerful. One of the patients was a very kind old man who was very social and had a great sense of humor. I really enjoyed talking to him about his experience at Dr. Graham’s clinic. After meeting all of her patients, she and I ate lunch in the breakroom and she told me about her journey to becoming a Physician Assistant.

After lunch, Ms. Susan headed over to the Survivor Clinic where she meets with patients who have successfully undergone cancer treatment and are here for a regular check-up. I got to meet many more patients, who very all so sweet. Ms. Susan told me that she had been seeing these patients for more than 10 years so she has a special bond with each of them. All of the patients loved Ms. Susan and I could really see the special bond they had forged over the years.

Overall, I was very impressed by Ms. Susan and how she manages her responsibilities as a Physician Assistant and it was great meeting the entire staff of the clinic.

Looking forward to tomorrow!