GE Cardiovascular Ultrasound for Aortic Valve Replacement

This is my second week volunteering in the OR, and now that I come in the morning, I get a chance to see a wide variety of cases. This week I observed a part of an aortic valve replacement procedure. The surgeons were busy with their work, but the anesthesiologist showed me his ultrasound machine that, it turned out, was an integral part of the procedure.

GE Healthcare has created the Vivid Cardiovascular Ultrasound System that gives anesthesiologists unprecedented capabilities for evaluating the heart and other organs. The device used at this OR was the Vivid 4 model. It has a probe that is inserted into the esophagus to show the coronal view of the heart, and into the stomach to show a horizontal view. A large monitor shows the imaged region in real time, which allows to evaluate the mechanical function of the valves and the myocardium (heart muscle). For example, I saw that the aortic valve was opening very poorly, a condition called aortic stenosis. A very cool feature that adds to evaluation and diagnosis is doppler. This allows to monitor blood flow inside the heart. As seen in the image; the blood flow is color coded according to velocity (but it might be mass flow). The heart I saw, had a clear flow back into the left atrium as the AV valves were closing, which is termed ventricular regurgitation. Besides giving different viewing capability, this machine allows to make measurements. In this procedure it is important to determine the size of artificial valve to be inserted, and that was done by measuring the width of the aortic opening in mm.

image source: GE Healthcare (www.gehealthcare.com)

To make a final comment, I learned that contact lenses and OR environment do not mix. My eyes were getting irritated from the dry air and from smoke caused by bowie (if spelled wrong let me know) knife. Also, here are images of the three general planes used in medical imaging.

image source: National Institute of Technology and Evaluation

What $1.5 Million Will Get You

Today I got a chance to see a prostatectomy, and not just any old school prostatectomy but a robotic one. Using a da Vinci robot that costs a whopping $1.5 million plus all the costs of the retractors and cutters it uses, the urologists performed this delicate procedure in about 3 hours. As explained to me, the benefits are the greater control of laparoscopic devices that the robot provides. It makes it easier to sew the sites of incision within the abdomen, and also leaves less bleeding. In addition, the camera of the robot is 3D, which makes it easier to navigate and move the instruments around; the regular laporascopic camera is 2D.

What was interesting was the fact that the procedure wasn't entirely done by the robot, a resident was standing by the incision site and was holding a laparoscopic retractor to help out with the procedure. It was very cool to watch, but seemed a little excessive.

image: www.marketwire.com

Four Months Till Application

The official application will start in four months when AMCAS is up. In the mean time I am looking up schools. I have determined three main requirements: located in large metropolitan area (so Chicago, Boston, NYC), be affiliated with a large hospital (level 1 trauma, children's, and VA), and standard curriculum (none of that PBL and self teaching, I like old school lectures).
My main way to see the locations is through Google Earth, works great.

How I Studied for the MCAT

Things to keep in mind before you read my strategy. I took ochem1,2 and bio1,2 the year I took the MCAT. This, I think gave me a valuable advantage.

Period of study: June 1 - August 17 (~2.5 months)
MCAT test date: August 19

Materials Used
KAPLAN 2005 Science Review ($23.00)
AAMCAS official practice tests ($120.00)
Textbooks ("free")

The Breakdown

June 1 - July 15: Thoroughly reviewed each subject in the KAPLAN Science Review Book
study period: 9am-1:00pm; 5 days a week
I sat down and systematically reviewed every chapter in that book. Almost all the material is the most basic parts of the subjects covered, so its not a problem to understand if you took the courses. I used my textbooks to supplement some things, and learn material new to me.

July 17 - August 17: Reviewed each subject two more times.
study period: 9am-1:00pm; 5 days a week; Practice MCAT every Saturday for next four weeks

This I think was the most beneficial decision I made. I am now convinced that reviewing material is crucial. I went back and each week reviewed everything for two subjects. For example the first week I went over all of physics and bio, and the following week all ochem and chem.

I also started taking practice MCAT tests every Saturday. I did this under real test conditions, with correctly timed breaks and test times. This is where I learned how to pace myself and how to deal with the test. I also developed a timing scheme that I will talk about in a little bit.

My Timing Protocol

The MCAT score is here

MCAT scores are released!

I got 34M (11VR 12PS 11BS)

I feel amazing.

In Between Two Worlds

The engineering major is thought by most to be a rigorous, nerdy, and with few options for deviation; something that I learned to be true. In my mechanical engineering department I quickly learned that the advisers didn't know a single thing about pre-med, they didn't even know who the school's pre-med advisor was. This being with the fact that the son of the department head is pre-med. Normally engineers don't do minors/second majors simply because the course load is large. Then there is the fact that engineering students hate science, as indicated by their hatred of general chemistry and physics. Because of these things our department simply never had experience with students who were interested in medicine.

I was in uncharted territory, a mechanical engineer doing pre-med. The main task and a big worry was to determine how much time would be required to fit pre-med classes into my schedule. After all was said and done, and a couple of months of playing with the schedule, I determined that I would need an extra two semesters on top of my degree. This brings me to an important point, it is not possible to be a pre-med engineer and do everything in 4 years. The amount of courses doesn't fit into that schedule, and when you add volunteer/lab work then it becomes impossible for even the most hard working. So for a while I was stressing out about going for an extra year, as if that would hurt my chances of admission. Eventually I figured out that this was not a problem, and the main thing is for a student to be ready.

Any engineering degree covers chemistry and physics, but biology and organic chemistry are left out. I ended up taking biology and organic chemistry my junior year, along with 6 labs and 3 engineering courses. Yes, I had 6 courses fall semester and 7 courses spring semester. This schedule was in my opinion very difficult, simply because of the number of labs and classes I had limited time to study. But I pulled through, and got As in both Ochem's, so you see it can be done.

Over the last couple of years I have come to feel as the anomaly of our department. I didn't really want to be an engineer, but I wasn't doing science either. I had to constantly deal with the problem of not having fellow engineers who were going through the same problems as I was. I also found myself to feel uncomfortable revealing that I am doing pre-med, being afraid of the ridicule of the engineering nerds. I can vividly remember the questioning looks I got in my mechanical design class when I would come in carrying my ochem book.

Volunteering

Getting the volunteer position wasn't hard at all. After I got my scrub card and TB test, I went to search for the OR. In our hospital the OR takes up almost all of the second floor, it has 36 rooms along with ICUs , pharmacy, etc. The hospital has the layout of a large X, making navigation difficult. As I entered the second floor, a strong smell that most associate with the hospital hit me, and I have to say that I liked it. I went to the large scrub machine and chose large bottom, large top out of fifteen different variations. Then I went to the changing room and quickly learned that a large is more like a XXL. Because the scrubs are unisex, you might have some 300lb woman wear a brand new pair of L size scrubs, that become XXL after she takes them off. My volunteering assignment was in the anesthesia work room; a place where anesthesia support staff work and supply all the rooms with needed equipment. In the first few weeks I quickly learned that for every surgeon there are at least three support people, making the OR a busy place. My assignment was to make packets of forms, and connect IV tubes to IV bags. Volunteering in the OR is the best kept secret in the pre-med crowd, because students are allowed to be in the operating rooms. It is perhaps the closest that you will come to seeing real doctors do real medicine; I have had more than a few cases of blood splash on my scrubs during some amputations. The other positions are mainly paper work.

The first week I mainly did manual labor, but on the second week I saw my first surgery. I kept a journal of my experiences and here is my entry from that day:

Procedure: (1) Gastric bypass laparoscopic
Notes: This is my first surgery ever. I was really nervous before coming in. When I entered I saw a large man lying on the table asleep. His stomach was covered with iodine. And I thought that’s it, they are going to cut him open, and I will faint. But nothing like this happened. The surgeons came in, made some incisions in his stomach and then inserted long tools. IT turns out that these types of operations are done with little invasiveness. When the lights were off, the cord from the light going into the stomach looked super cool. The nurse anesthesiologist was awesome, and we talked a lot. I got to sit right next to the patient.

Was I nervous during the first time? Of course I was, the anesthesia tech that took me into the room sensing that I was a little pale, told me to sit down on the floor if I felt sick. Everything in there was unfamiliar; new smells, surgical tools, racks with gowns and sutures...all new and exciting.

The experience of volunteering that first month can be compared to the first roller coaster ride, lots of anticipation followed by a spike in the heart rate. In the four week period I observed a heart beating in the chest during valve surgery; a double-lung transplant performed by a famous transplant surgeon; and a grizzly tumor that destroyed half of a man's face. Pretty big stuff for a 19 year old kid.