Interview: Northshore University Health Systems

First impressions: When I first got an invite from "Northshore University Health Systems" I had no idea what program it was until I learned that it used to be called the Northwestern McGaw program (which is what it still says on ERAS). This year they changed sponsors from Northwestern University to the University of Chicago, and so they dropped the Northwestern name and became "Northshore." Yesterday I flew to Chicago and then rode the CTA (aka the "El") to Evanston, where the main teaching hospital is located. Evanston Hospital was only 3-4 stops away (via the Purple Line of the CTA) from my hotel, so the day before my interview, I went there to see what it was like and found this:


Pretty nice, right? I like all the greenery around the hospital.
Pre-Interview Dinner: None, so I took the train to Chinatown for some cheap beef noodle soup and spent about 15 minutes at an anime gift shop ogling at plushies and action figures before deciding to buy a poster for a fellow Bleach friend and fan.
Interview Day: There was some snowfall this morning which put me in a happy mood (this is fine powdery snow, not sleet like we have at home). At the hospital, there were 10 of us total, of which I was the only one from the "South" (everyone else was from Illinois, Nebraska, North Dakota, New York, to name a few). There was one girl from UNE-COM so we chatted a bit. We met the chairman and the program directors who were all extremely friendly and welcoming, and everyone asked me how I liked the weather here. There were four program directors and three interviewing faculty so they took turns calling us to their offices for interviews. My first interview was with an ER attending (don't know why they asked him to do IM interviews), and one of the questions he asked me was where I saw myself in 10 years. Sadly I wasn't able to give a clear response b/c right now I like all aspects of IM (general practice, hospitalist, possibly subspecialty), and I think I need to work on that answer. No one really knows whether the PDs prefer to hear that we want to specialize or go into primary care. The second interview was with the chairman, who immediately asked me if I had any questions for him. I asked him what he liked the most about the program, and somehow I got prompted into telling him how being a violinist set standards that have helped me succeed in medical school (i.e. working together as a team, practice makes perfect, etc.) which must have sounded totally cheesy. Still, I think I clicked better with the chairman than the ER doc; who knows how they'll rank me.

Whenever we weren't in interviews, we chatted with one of the chief residents as well as a future chief. I asked about cost of living and they said the salary might not let you buy a house, but you can rent a decent sized apartment for sure. "Of course, living in Texas is cheap," said the future chief. *sigh* Don't I know it. When most of us had finished our interviews we went to an intern conference in which an endocrinologist grilled the interns on diabetes drugs and their effects on the body. She made an interesting point that patients on metformin should take calcium supplements or else they'll end up with VitB12 deficiency; that's something I've never heard of before.
Noon and Beyond: Afterwards we had lunch with several residents before going on a tour around the hospital. Let me just say, the hospital is nice. There are concierge services and everything is computerized; the nurses' stations are large just because there aren't any paper charts cluttering the desks. And there are computers everywhere; Evanston Hospital has been paperless since 2003 because they have an EMR that works. More importantly, all the residents I spoke to are genuinely happy at the program, with my tour guide (a CCOM grad) saying it was probably the best in the area. The tour finished at 1:30 pm, and I managed to catch the next train back to the hotel and pick up my luggage. Sadly the next southbound train left just as I was hurrying toward the station, so I had to wait for the next one. I left at 2:15 and didn't get to the airport until 3:45 (the train made a lot of stops along the way), and my flight was at 4:15 so I was running through the airport like a madwoman just to make it on time. *sigh*
Overall Impression:
Pros: Top teaching hospital, very DO friendly (at least 5-6 residents each year come from CCOM), good location (just north of Chicago, near Northwestern University), friendly faculty, decent fellowship placement, opportunities to rotate at University of Chicago, 100% EMR
Cons: 50% private attendings (which may or may not cause disagreements with patient care), possibly long commutes to 2nd teaching hospital 30 minutes north of Evanston, not sure if I want to live in Chicago (can't decide based on a one-day visit)

Interview: UTMB-Austin

First Impressions: No housing provided, but they did sent out a list with hotels with discounted prices. Dina had an interview the same day as me so we shared a hotel room at the Ramada Inn near Highland Mall.
Pre-Interview dinner: None, so I went to Mimi's Cafe with friends from undergrad. Dina didn't arrive until after 9 pm because ob-gyn had a dinner.
Interview Day: The morning started off with the PD telling us about the latest changes with the hospital, namely the negotiations between Seton, UTMB, and UTSouthwestern for UTSW to take over sponsorship of the hospital b/c UTMB is currently having a financial crisis with the hurricane and all. But even without the hurricane there were already plans for UTSW to assume control; I knew of this way back in August. The PD seemed confident that the residency itself shouldn't be affected, only the name.

I interviewed with the PD and another hospitalist, and I don't know if I was able to impress the PD or not. I asked several questions about fellowships and UTMB-Austin's attempts to get them started at the hospital, as well as the impact UTSW would have once it takes over, but not much more. I did get a few questions about my time here (the PD said she was sorry she didn't get a chance to meet me in August, as she was on vacation part of the time), and I told both of them about a case of disseminated gonorrhea I saw at Brackenridge. My 2nd interviewer asked me about research from undergrad, and I stupidly said I didn't remember much about the project. Afterwards, we went to morning report and then snagged a team to go on rounds with. Another applicant, Yessica, and I ended up joining the post-call Red team; one of the interns, Joe, was someone I'd worked with on my very last day of my AI, and he sort of remembered me. The attending was Dr. D, the ID doc who always dressed casually; today was no exception since she had on boots and a denim skirt. I did see Dr. C during morning report and was surprised to see him in a suit. My whole 3 weeks with him, he always wore slacks and a polo shirt, never a suit. I wondered what the occasion was.

I never saw Greg or Zach (probably a good thing in the case of Greg), but I spotted Yan in the elevator and we exchanged cheerful hellos. "You're back!" she said. "For interviews?" Yup. After she left the elevator I explained that I'd done my AI here, and Dr. D said, "No wonder you look a bit familiar." During rounds we saw a group of people in white coats with SETON on the pocket walking around, and we wondered if they were board members inspecting the hospital. "No wonder Dr. C's wearing a white coat," said one of the interns (yup, he changed his suit for a white coat by the times rounds started), and Dr. D grumbled why no one warned her, as she was dressed way too casually. I called Dr. C's name as he passed by (our teams were going in separate directions) and he waved back, calling out, "Good to see you!" We finished rounding early so Yessica and I went to the 4th floor workroom and chatted with Ulka, the resident, about the program. Then one of the future chiefs, Manpreet, took us back to the IM offices to wait for Jeff (one of the chiefs) to take us on a tour. Knowing that we'd rounded with the teams, he showed us the ER, the library, the dining room (with Odwallas) and the clinics (which look VERY nice) before turning us over to two residents to take us out for lunch.
Noon Conference and beyond: Two residents, a third year named Rachel and a prelim intern named Justin, took us to the Brick Oven for lunch. I ended up sitting closer to Justin than Rachel, so I heard more about him telling the other two prelim applicants about what prelim year is like rather than Rachel telling the others about what categorical IM is like. Food was definitely good though; too bad I didn't know about Brick Oven in undergrad.
Overall Impression:
Pros: Austin, laid-back atmosphere, free breakfasts and lunches (Odwalla fridge, hehe), friendly people, "easier" program due to a cap of 18-19 patients per service, decent pathology.
Cons: Variable fellowship placement (depends mostly on the applicant; IMGs have more difficulty getting fellowships), questionable research opportunities, not challenging enough.

Interview: UTHSCSA

First Impressions: Like Scott and White, UTHSCSA is very generous to its applicants. They provide a hotel room for each applicant at the La Quinta Inn located not far from the hospital, and when you check in they also give you a gift box containing shortbread cookies, chips, and salsa (very San Antonio-ish) Even though I went to bed earlier, I still had trouble falling asleep; I don't think I sleep well on king-sized beds b/c there's too much room. Needless to say I was sleep-deprived in the morning but tried not to let it show..
Pre-Interview dinner: About five residents met us at Mamacita's, a Tex-Mex restaurant next to the hotel. The IM program paid the bill, which included the entree of our choice and a slice of cheesecake from the Cheesecake Factory to go. I sat near two applicants and two residents, but sadly none of us were particularly talkative. I ended up chatting with the applicant beside me (who was from Taiwan) most of the time.
Interview Day: One of the chief residents met us at the hotel lobby at 7:00 a.m. and we took the La Quinta shuttle to the hospital. We were escorted to a little classroom where we got breakfast and the PD spoke to us about the program. Then we went to morning report, where we had the most interesting case I've ever seen to date. A 58-year-old woman with metastatic breast cancer presented to the hospital with nausea, vomiting, diffuse abd pain, and lethargy for the past two days. The differential ranged from everything from gastroenteritis to bowel infarct to hypercalcemia (which some of the attendings were quite certain of, until the calcium levels were found to be low). Then the powerpoint went up with a picture of a snake at the bottom, and one resident behind said, "Oh, is this the one who eats snakes?" As it turned out, rattlesnake eggs are a folk remedy cure-all in Mexico, and the patient's husband had been giving her the eggs to keep her cancer at bay. As a result she developed Salmonella arizonae, a type of Salmonella not usually found in humans. Wow.

After morning report, half of us went on a tour of the university hospital and VA (me) while the other half went to their interviews. I recognized a TCOM grad (intern) at the VA. My interviews, I thought, went very well. My first interviewer, one of the assistant program directors, said that she liked my personal statement and most of the questions she asked me were specific to my application; we even talked about sudoku. My second interviewer was interested in my past as a violinist (he was impressed when I told him about caroling at Plaza), and we even chatted about Joshua Bell (famous violinist) for a few minutes. It was a very comfortable conversation with both interviewers and I went back to the common area with a smile on my face. Hopefully they thought favorably of me.
Noon and beyond: Lunch was catered to us and dessert was...pumpkin cheesecake, which I'd normally be happy about if I hadn't had the same pumpkin cheesecake at Mamacita's last night. I shared a table with two students whom I'd also be seeing tomorrow at Austin, and the resident at our table was very nice and helpful. I ended up liking this program more than I originally thought.
Overall Impression:
Pros: Top rated university hospital, diverse population and pathology, Spanish heavily spoken but nurses are good about translating if need be, good fellowship placement (UTHSCSA likes to take their own residents), emphasis on teaching and educatoin
Cons: Hospital appears old, no Spanish interpreters (yes, I worry about that), not sure if I want to live in San Antonio

Interview: Scott and White

First Impressions: Scott and White is very generous to its applicants. They provide a hotel suite for each applicant at the Hilton Gardens Inn located across the street from the hospital for free, and when you check in they also give you a mug full of candy (which I've promised to give to Dina since the only candy I like nowadays is Hi-Chew). The beds are pretty comfy but the pillows were too soft; it took me a long time to fall asleep, and other applicants had the same complaint. I saw several family medicine applicants there too, including Liza and Clark.
Pre-Interview dinner: One of the chief residents met about 11 of us at the hotel lobby and drove us to a 2nd year residents' house via van. There was potluck BBQ so we ate our fill and then hung around chatting with residents. One 3rd year told me he'd trained at JPS for 2 years before deciding he liked IM better than FP, and he asked me about the new Patient Care Pavilion and what became of the old ICU and Tele units. Overall the residents seemed happy at Temple, especially with their training; >60% go into fellowship.
Interview Day: The residency coordinator met us at the hotel lobby (all 15 of us) at 7:10 a.m. and we got to the hospital via S&W shuttle. We went to morning report, where the program director introduced us geographically by school (all TX schools were represented except for UT-Houston, to the disappointment of one resident) before launching into a case of renal artery stenosis, which was engaging and fun. Then we had a powerpoint about the program (which is provided online so I'd seen it before) before going to our first interview. I met with a hospitalist whose first question to me was, "Do you have any questions about the program?" She was very nice, but did not ask me many questions, and overall I didn't feel as though she tried to get to know more about me aside from confirming that I was a violinist (she used to play, too). After that interview we hopped on the van and traveled to the VA hospital and then drove around town so we could see neighborhoods where residents usually live.
Noon Conference and beyond: Interviewees were ushered to the front of the line and got to eat first. Today was Cardio board review, so everyone got a keypad and got to vote on answers that were posted on the overhead, CIL-style. I'm glad to say I got several of the answers right. Afterwards, a resident took us on a tour around the (new) hospital. I thought I walked past Delip near the cafeteria but he looked right through me so now I think it might have been his brother instead. After the tour, we had one last exit interview for any last minute questions but I was all questioned-out so it only lasted about 10-15 minutes. *sigh*
Overall Impression:
Pros: Large tertiary hospital, diverse population and pathology, Spanish not required, good fellowship placement, 100% board pass rate for the last few years, emphasis on education
Cons: Temple, less-than-satisfactory interview experience

Radiology: Catching up

Yesteray Dr. G and I spent a good 20 minutes (at least) on one X-ray of a femur that looked like it had a Codman's triangle as well as another bone lesion that have been fairly stable for the last year or so. The problem was making sure that it really was an enchondroma and not an osteosarcoma, so we pored through textbooks trying to find images to tell us we were right. Dr. J poked his head in and didn't seem too impressed, so in the end we agreed the findings were harmless but require followup. Other notable things I saw included a pericardial cyst and a hiatal hernia. We also had a 23-year-old girl come in with a fibroadenoma, but whether or not she wants to get it removed will be up to her b/c she doesn't have insurance. Technically she could always go to JPS, and while I'm sure the ob-gyns there would do a great job, I don't recommend it just b/c JPS takes forever to get things done.

Nothing really happened today aside from the usual scans. Dr. G and I have found more to talk about as far as whether or not we should take tests that'll tell us whether we'll get cancer in the future. With my family history I can understand not wanting to know, especially at my age, about future cancers, but I would like to know my chances of getting diabetes and whether I can beat that. A drug rep came to talk to us about a new type of gadolinium-based contrast used to enhance liver lesions, and they treated us to Marble Slab ice cream. Not just the small cup, either; they gave us the round bowl. The flavors offered to us were vanilla, strawberry, and cheesecake; I got cheesecake with strawberry fruit topping (hey, got to stay healthy somehow) while others topped their ice creams with whipped cream and chocolate syrup. Dr. J got seconds, and when we teased him about it, he said it was okay because he worked out earlier that morning. That was incentive for me to work out after dinner.

Tomorrow I'll be driving down to Temple for my 1st interview. Hope it goes well.

Radiology: Pharm Lecture and Hypoglycemia

Most Fridays at 9:00 a.m. the oncologists and radiologists get together to discuss their latest patients and come up with ways to treat them (it's called "Planning Clinic"). Dr. G and I went to the auditorium today (I saw Dr. A and he waved hello), but in lieu of a planning clinic, we had the chief medical officer of a pharmaceutical company called Tragara talk to us about the development of a COX-2 inhibitor that can be used to improve survival rates in certain lung and pancreatic cancers. Being a molecular bio major, I was used to seeing and interpreting the many charts and statistics included in the presentation, but when Dr. G was paged to read a mammogram, she never returned to the auditorium. Later she told me that all the research findings were way over her head and she didn't understand them well. Makes sense; radiologists don't need to know about the latest advances in cancer drugs like the oncologists do.

Later we were called to the PET scan prep area (where patients are given some tagged glucose and told to rest for 45 min before the scan) because a patient was "having a reaction." When we saw the patient, he was sitting in the chair with sweat covering his entire face, and he did not look comfortable at all. His blood sugar was 89, but he was also a diabetic who hadn't had anything to eat for over 12 hours. The techs tried to give him orange juice but he complained that his stomach hurt, so they tried a piece of chocolate bar instead. Apparently that did the trick, because by the time a nurse practictioner and an oncologist came downstairs to see him, he felt much better and wanted to proceed with the scan. Apparently this was his first bout with hypoglycemia. Dr. G wondered why he didn't keep any sugary snacks on him in case this should happen, but I think he's learned his lesson.

Normally after injecting a patient with glucose they're supposed to stay still for up to 45 minutes so that their muscles don't use glucose (we only wanted the essential organs and tumors to uptake the glucose), but because he didn't move much, the scan was pretty good. And we soon found out what his problem was: his entire stomach lit up on the PET scan. It turns out he had a giant cell lymphoma of the stomach and the stomach wall was extremely thick. No wonder he had abdominal pain! Fortunately, said Dr. G, some stomach lymphomas can be treated with the same drugs used to treat H. pylori, so maybe he'll be spared from chemo (not too likely with the size of his tumor though). We called Dr. J to the room to see the scan but he wasn't too impressed b/c he'd seen it already (the patient's oncologist had shown him the CT yesterday). Ah well.

Radiology: Misidentification woes

I went back to radiology full time (meaning: looking at scans with Dr. G), and already it's off to a bad start. I've neglected my CT image studies so whenever Dr. G pointed to an object and asked me what it was, 4 times out of 5 I got it wrong. When she pointed at the thyroid I kept saying calling it the "thymus," and when half of it was missing, I had no idea what I was looking at. I mistook a giant lymph node for the IVC and couldn't tell the difference between a bladder and a uterus. *sigh* The list goes on. Tomorrow there's going to be a meeting between the oncologists and the radiologists as they discuss their patients and treatment plans. That should be interesting.

Our lady patient from Iowa has turned out not to be the perfect patient after all. I thought she was so on top of things by traveling to Texas every year for CT and PET scans, but we recently found out that she hasn't had a mammogram in at least five years. Apparently she figured that as long as her CT and PET scans were clean, there was no need for a mammo. Fortunately her oncologist forced her to get one before she left, though I can understand her way of thinking to some extent. Cheryl also shared the story of a woman who insisted on getting a breast MRI even though an MRI is NOT a good screening tool for breast cancer. She credited a MRI with diagnosing her cancer b/c she had a dimple in her breast and the tech had put the ultrasound probe directly over it (therefore finding the cancer) but to find tumors with U/S is like finding a needle in a haystack. Even Dr. J was unable to talk her out of getting the U/S, which was done for her peace of mind and not much more. *sigh* Where cancer is concerned, it's most important to keep the patient happy.

Radiology: Ultrasounds and Mammos

Today I spent the day mostly with Cheryl, one of the radiology techs who specializes mostly in ultrasound and mammograms. We spent the morning in the U/S lab; among the cases I saw was a man with polycythemia presenting with a slightly enlarged spleen (and an incidental kidney cyst), a woman whose oncologist felt a breast lump (but U/S revealed nothing), and the lady from Iowa whose pet scan I saw yesterday. She needed her thyroid scanned b/c she had a family history of thyroid disease and currently has two nodules, of which one was biopsied this afternoon. (sadly I won't know the results). I also stopped by nuclear medicine to watch Mercedes prepare a patient (whose MRI I observed) for a MUGA scan, which measures ejection fraction. First you draw a sample of the patient's blood, tag the RBCs with isotopes, and then reinject it into the patient and follow the tagged RBCs to the heart. Then you measure the diameter of the left ventricle in systole and diastole to calculate the EF, which is great if it's above 50% (optimum). This is done prior to chemotherapy because chemo treatments have been known to cause heart disease, and the MUGA gets a baseline heart function to use as comparison later. This week is Radiology Tech week so we've been getting free breakfasts and lunches for the last few days. This morning the chef husband of one of the radiation therapy techs cooked custom omelettes for everyone, and lunch was Panera Bread. In the afternoon I was assigned to Marcy for mammography. The first patient was an 83-year-old lady with cancer of unspecified origin (though a note said it was bile duct cancer), and she had trouble getting to the machine b/c she was wheelchair bound. "Should I bring my husband in?" she asked, and we said we'd be okay (her husband's 85). Mammograms look painful; I'm not looking forward to those. Lauri actually commented that she doesn't want any of the current techs doing her mammos when the time comes. After her mammo, the patient had to wait in the hall for her bone scan, and I decided to keep her company by talking to her. We must have sat there for about 10-15 minutes just talking; the radiologists walked by a few times and I wondered if they thought I was slacking off by talking to patients instead of watching more mammograms (Marcy brought another patient to the room while I was talking). The patient was very nice though; she told me that her husband was a general surgeon with the US army and told me of all the places they traveled to, including Malawi (in Africa) where her husband was able to do all kinds of surgery he wouldn't have been permitted to do in the states (ortho, heart, etc). We had one more mammogram patient but when Cheryl asked if she was S.G., the woman somewhat rudely replied, "Yes." Then Tina pulled Cheryl aside to warn her that S.G. had caused some trouble at the front desk asking when she'd be seen after less than 5 min of waiting, and that she kept asking for a specific tech who just happened to be on vacation this week. It was agreed that I should not sit in on S.G.'s mammogram, and later Cheryl said that S.G. had once again asked for Nancy, the tech on vacation, but later grudgingly agreed to let Cheryl to her mammo. Tina flat-out called S.G. a b****, but Cheryl was more sympathetic. She said a majority of the mammo patients formerly had breast cancer, and every year they come to the center stressed and scared about the possibility that their cancer has returned. They wanted all variables (in this case, the lab tech) to stay the same so there'd be no room for error. Fortunately for S.G., her breasts looked fine. With that, my three-day tour around the departments has come to an end. I'm really glad I got to do this; since I understand the procedures better now, I think I'll be able to view each CT, MRI, and PET in a new light. I told Lauri that I enjoyed getting to spend time in each department (and meeting the techs), and she said she also wanted me to see understand that images take time to process, and that some doctors don't realize that when they complain about missing scans or XRs. She also told me that she gets at least one call a day from my classmates asking to do a rotation at the cancer center, but most spots are already full. January is a particularly popular month, and a friend was able to snag that spot several weeks ago. =) Tomorrow it's back to the dark rooms for me.

Radiology: PET scans, bone scans, and elections

Today I spent the morning in the PET scan area with Anthony, one of the techs. We had three patients total, and I saw each one of them through the whole process. For those not in the know, PET scans are used to look for tumors, and they're done by injecting radioactive glucose (the isotope is fluoride, pretty harmless and doesn't cause any allergic rxns) into a patient, waiting 45 minutes, and then scanning them for about 18 minutes. The patient is fasting, so any metabolically active structures will quickly uptake the glucose. Brain, kidneys, liver, heart, and bladder aside, any other focal lesion that lights up is suspicious for tumors. Because the dye is made of glucose, patients also require a finger-stick to check glucose levels before the procedure. If the blood glucose is greater than 200, then the patient has to reschedule. Fortunately none of our patients were diabetics. The first lady is actually from Iowa, but flies down to TX once a year to get scanned. She said her original oncologist back home didn't care for her suffering due to chemo, so she was referred to one of the breast cancer oncologists here (the one who reads all the scans). He gave her a fanny pack that administered chemo around the clock so that her side effects were less severe. Another lady had a huge pulmonary nodule, but it didn't light up as much as a tumor is expected to light up, so it may just be a fatty tumor instead of cancer. For the last patient, Anthony let me push all the buttons to move the scanning table and adjust the settings for the machine, which was pretty cool =)

In the afternoon I went to Nuclear Medicine and met Mercedes, the tech, who was doing bone scans. The way it works is that she brings patients in two hours prior to their scan to inject them with technitium, which works the best 2+ hrs after the injection, and in the meantime they either wait in the waiting room or get other procedures done (MRI, CT, etc). There was a period of time where we had nothing to do for an hr, so Mercedes and I just chatted about random things like the election, kids nowadays, cell phones, and bad patients (always a favorite topic). She'll be doing a MUGA scan tomorrow morning which I probably won't get to see (I'll be working in the ultrasound and mammogram areas), but I'll stop by and see the results for sure.

And of course, today was Election Day. I personally did not care for either of the candidates, and it was no surprise that Obama won. Time will tell whether the country made the right decision.

Radiology: CT and MRI

Today I rotated through two departments: CT in the morning and MRI in the afternoon. The two CT techs, Claudia and Tina, were very nice; Tina and I spent a great deal of time talking about our pets (and animals in general) while Claudia talked about her daughter who wants to be a pediatrician. I remember wanting to be a pediatrician as a pre-med, but medical school changed all that =) It was cool getting to see how the CT worked and how patients prepare for their scans (i.e. drinking lemonade-flavored barium to visualize the stomach and later getting an iodine contrast injection after their non-contrast CT is done. Patients who have had allergic reactions to iodine in the past are put on a "13 hr prep protocol" in which they start taking measured doses of Benadryl and methyprednisolone thirteen hours before their scheduled scan. It works pretty well in most people, but some people require as much as a 3-day prep before the doctors decide to go without contrast from then on. Most patients get three scans: one "scout" scan where the entire chest/abdomen/pelvis (whatever you want to visualize) is scanned, one non-contrast scan, and one contrast scan (the latter two with cross sections). Sometimes, if there are suspicious cyst-like lesions in the liver or kidney, there is a "delayed" scan done to see if it takes up the contrast dye (cysts take up dye). Most of the CT scans I saw today were benign, which is good for the patients.

There was only one patient scheduled for MRI in the afternoon (but she needed two separate scans), so I went with Marcy, the MRI tech, to the waiting room to take the patient to the MRI. As it turns out, the MRI machine isn't even in the building; it's housed in one of those one-room temporary structures outside the building. The patient was a woman with stage II breast cancer (recently diagnosed) who'd undergone a bilateral mastectomy with metastasis to two nodes. She also had a history of falling, so in addition to a head/neck MRI she was also getting a lumbar MRI to assess for nerve compression. The MRI was a very loud machine with a tiny tunnel. The patient's head was covered with a cage-live device at one point; if that doesn't make one claustrophobic I don't know what does. Fortunately she was given Ativan before the procedure and handled it nicely. As we waited for the scans, Marcy told me about breast MRIs and how they can be used to detect breast masses that haven't been spotted yet. She said that just because only one breast has noticeable cancer doesn't mean the other one is cancer-free, and showed me several breast MRIs to make her point. That definitely makes me worried, since I don't think breast MRIs are the norm in cancer detection just yet and I'm sure there's many women out there who could benefit from it (but don't get them done).

After the MRI, Marcy took the patient around to all the other departments so she could see how small their tunnels were (CT, DEXA, PET scan) in case she got claustrophobic again. I sat in on the end of a PET scan before going back to CT, where Claudia proceeded to show me some of the more interesting scans they've had like an intussuseption, bone mets in the sternum (looks like a knob sticking out of the chest), and one where the peritoneal organs were totally riddled with mets. =( Cancer is nasty business.