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Day 8/ Last Day– Duke Work Experience

Today was day 2 of the GMP FACT inspection. My day started out rather slow because the inspector was not there when I arrived. Thus, I was able to shadow a coordinator whose job was to keep parents of potential clinical trial participants updated. I watched as she answered emails with questions from the parents. Much of the work was repetitive, often involving repeating the same information back to recipients. Many of the people who contacted the coordinator were very well informed. I learned that there are websites as well as facebook groups that are created to inform the public about these trials. Because Duke has a policy where they cannot voluntarily reach out to patients, the people interested in these studies have to proactively seek out such opportunities.

In the afternoon, I shadowed Dr. K as she and her team received the results of the GMP inspection. Though I had heard from others that this particular inspector was very thorough, I can only agree with the others. The inspector had caught onto every detail. They even went as far as to examine the labels of storage bins, saying that they needed to be dated and timed. Afterward, I observed as Dr. K ordered a prescription for a patient. This particular patient needed an antibiotic for an infection. Based on the patient’s weight and age, Dr. K calculated the dosage needed. I ended my day by helping sort through old patient files. Most of these files were from past clinical trials and needed to be sorted as a backup.

Overall, these past days were very enlightening. I was able to see the whole process of caring for a patient and am inspired to learn more about the medical field.

This was an interesting bit that I noticed in Dr. K’s office. Because she travels a lot, she collects the name tags that she receives from all over the world.

This is their logo.

Day 7– Duke Work Experience

Today was the first day of the GMP FACT inspection. Therefore, I was in the North Pavilion building for most of the day. Throughout the day, the inspector would go through the lab, making notes of what the lab did or didn’t do correctly and evaluating the various documents that a lab is required to have. The day started off with a general introduction of the lab, which Dr. K presented and an overview of the staff associated with the lab. They then moved on to the storage units where they keep supplies used in the lab and made sure that labels were correct, as well as whether the temperatures and humidities were fine for each room. In the room with the liquid nitrogen tanks, the inspector made sure that the safety of the workers was handled well and that the FDA had approved the tanks for use. They then moved on to the sterile part of the lab, which I did not participate in.

This was one of the liquid nitrogen tanks used to store cells in. It is similar to the one that I saw on Day 2.

I instead went with Dr. K to visit radiology in the main hospital. There, we reviewed a patient’s MRI from the day before because there had been some inconsistencies. I was able to learn the different ways the readers could manipulate the images so that they could get a clear picture of every part of the brain. After I got back, I learned the process of which charts are filed in the office. One of the assistants of Dr. K showed me how to write letters to the patient informing them of their next appointment and how to update patients’ charts online. I then was able to attend a Skype meeting with a patient who had recently developed strange symptoms. I listened in on what the family’s pediatrician could do to help the child and how the family should monitor the child. To wrap up my day, I attended a meeting discussing the details of the current clinical trial.

Day 6– Duke Work Experience

This morning, I started my day in the stem cell lab, watching the thawing of MSCs (Mesenchymal stem cells) for a trial that the department is currently doing. The thawing took around thirty minutes, although the actual work with the cells only took around 15 minutes. I learned that after testing the sample for viability and number of cells, multiple signatures were required to allow for it to be infused into the patient. These cells did not take as much time to thaw as the cord blood cells because they only require dilution before being ready for infusion.

This was the image for the test for cell count– Live cells versus dead ones

This was the final product in the lab, all they have to do now is sign the papers

In the afternoon, I shadowed Dr. Kurtzberg in the outpatient clinic. Most of the patients were here for follow-ups and a couple had been transplanted many years ago. It was wonderful seeing Dr. K interacting with her patients, many of them who now have had her as a doctor for many years. The check-ups mostly involved asking patients questions about their latest concerns. I learned that asking the right questions to get the answers that a doctor needs is very important. While today was my last day in the clinic, I will be able to learn more about the more technical side of medicine in the next two days.

Day 5– Duke Work Experience

I started my day by attending a weekly meeting in the Duke OCU building. In the meeting, there were several patients that were discussed and a team in Florida called in as well. After the meeting, I rode over to the Children’s Health Center with Dr. Page to shadow Dr. Martin, one of the attendings. In the clinic, I observed follow up visits for three patients and then learned to read their lab results.

In the afternoon, I headed over to North Pavilion and observed in the Carolina Cord Blood Bank. There, I watched the freezing of cord blood as well as the various tests that the lab did on the blood to make sure it was viable. Similar to the stem cell laboratory, sanitation was very important. Lab coats were a must and shoe covers were also very important. As seen in the picture, all the lab technicians would work at lab stations with hoods to keep the blood sample as clean as possible. Seeing the whole process of the cord blood transplant really allows me to value the work of those that often are not recognized.

This is the cord blood that is being frozen in preparation for transplant

This is one of the machines that the lab technicians were very excited to have. It helps test the viability of the sample.

Day 4– Duke Work Experience

Today was a half day for me. In the morning, I rode to the Children’s Health Center with Matt, the bone marrow transport driver, and then walked up to 5100, the hematology wing of the main hospital. I followed Dr. Sun, the hematology attending, during her rounds. With us were three medical interns, a fellow, and a few other nurses. We were definitely quite the crowd! There were 8 or 9 patients that we visited and before each visit, I was able to hear one of the three interns present the patient. I realized that through this process, the interns were able to learn in the best way– through the first-hand experience. Dr. Sun would often ask them questions about the case, on how to best treat the patient or on circumstantial occurrences. Unlike the outpatient clinic, these doctors had more downtime and had fewer patients.

After rounds, I was able to visit the ICU. There, we followed up on a patient who had just gotten a transplant. We then headed over to the Bone Marrow Transplant Clinic and talked with some of the residents who were working. I learned about the difference between residents, fellows, and attendings. However, the residents told me that even though there are differences in positions, they all work as if they are the same level.

Because I wasn’t allowed to take pictures of 5100 (to ensure patients’ privacy), I took some pictures of the Children’s Health Center instead. This is a picture of the Aquarium in the Lobby. It keeps many kiddos entertained while waiting for appointments.

One thing about the Children’s Health Center that I found interesting is that they color code each floor. As you can see, even the elevators are color coded.

Day 3– Duke Work Experience

I spent the day in the Children’s Health Center shadowing doctors and nurses. In the morning, I first debriefed with the main doctor that I am shadowing, Dr. Kirstin Page, and then went on to observe 2 checkups and a PICC removal on a baby. A PICC is an IV line that is often inserted into a blood vessel in the upper arm. Like a central line, it is often left in place until all treatment is finished.

After lunch, I was able to watch an MSC infusion, which is a type of stem cell infusion. I then went on to shadow a nurse in the Valvano Day Hospital (VDH) who taught me how to order medications for a patient, start an IV, and time infusions for a patient. During this time, I observed how the nurses were able to work as a team, often covering for each other during lunch breaks and even staying after hours to help a colleague. Unlike the doctors that I have shadowed, they were able to have lunch breaks and had more interactions with patients. Today, I learned that the job of nurses widely differs from that of doctors even though they both work in the hospital environment.

When you first enter the Children’s Health Center Lobby…

Mini model of Duke Chapel in the Children’s Hospital

Day 2– Duke Work Experience

Today, I started my morning in the Stem Cell Laboratory. I was shown how scientists prepped donor cord blood cells to give to the patient. The cells were stored in a specially designed freezer, shown below. they were then diluted, centrifuged and then attached to IV cords. I learned that contamination was one of the main concerns when prepping cells, so after the centrifuging, the supernatant was kept to be tested for contamination. After the cells were prepped, I then rode with them to the Children’s Health Center.

In the Children’s Health Center, I shadowed another doctor and watched the cells that were prepped earlier be injected into the patient. In total, I was able to watch three of these infusions during the day. These infusions of cord blood cells are part of a clinical trial dealing with the brain that Duke is working on right now. Watching the whole process from the prepping of the cells to the infusion gave me a well-rounded experience in the medical world.

Day 1– Duke Hospital Work Experience

For Discovery Term, I will be shadowing doctors and nurse practitioners at Duke, more specifically, in the cord blood and bone marrow transplant department.

Today, I started my day in the Children’s Health Center. There, I was able to visit with four patients, two of whom were post-transplant. I was able to learn what factors determine a patient is doing well and what to look out for. I also learned that many of these patients came from very far away. Hygiene was very important. Because many of the children I saw in the hospital had compromised immune systems, hand sanitizer or hand washing was a must each and every time I entered and exited a room.

However, I learned that the paperwork that doctors and nurses did is just as important as seeing the patients. During downtime, I was able to learn how to read lab results and what chemicals indicate the function of each organ. I was able to see how different medicines affected the amount of different chemicals in the patient’s system and how the lab results would indicate whether the concentration was high or low. Many of the patients didn’t have all normal levels because of the various medicines that they were taking. Overall, today was a huge change in perspective for me. While I had always been on the patient side of things, I now have had the chance to experience the staff perspective.