Week 1: Manav Surti

    The start of immersion has been very exciting and nerve-racking. There were many logistics to figure out, as access to certain portions of HSS and WCM requirements had not yet been granted. Despite having to figure out security access, badge acquisition, and general hospital locale, the start of the week was very eventful. On Monday and Tuesday, I was able to shadow Dr. Gomoll in the clinic as he conducted patient consults and follow-ups. It was very cool to be able to see some of the products I read about in research articles being implemented in patients, especially hyaluronic acid injections, as well as osteochondral allografts from donor tissue to repair defective articular cartilage of the femoral condyles. It was interesting to see a clinician's point of view regarding this. It was especially interesting to probe Dr. Gomoll's brain on what doesn't work about viscosupplementation, the act of injecting lubricious material into the joint space in order to restore mechanical function and lower pain (essentially WD-40ing the knee cartilage). It was very easy to see the connection from all of the cartilage lubrication articles I have read this past year, that materials are cleared from the joint space within days, but to see that directly relate to the clinic was eye-opening. I was also able to see some very complex patient cases. Some patients had very large cartilage defects, while others had many issues with the surrounding ligaments, or their menisci. I tried to start guessing what types of defects the patient had from the MRI images before Dr. Gomoll started to walk the patient through the MRI. Dr. Gomoll was able to tell almost immediately what was wrong with the patient and why they had pain, even though every single case was very unique. From my two days in clinic, I was able to start building cognition and patterns about what to look for on the MRI, and what could be hurting the patient, as well as the difference between native articular cartilage, and an implanted piece of cartilage. 

    As Dr. Gomoll was in an operating room that was inaccessible to me (outside of HSS guidelines) on Wednesday and Thursday, I tagged along with Jada and Smrithi to see some of their clinician's procedures relating to the heart. I saw a transesophageal echocardiogram (TEE), where a huge probe is inserted into the patient's esophagus to see ultrasound of the heart. The software was also able to detect flow direction, and I saw mitral and tricuspid regurgitation, where the blood that was sent to the ventricle from the atrium flowed back in because the valve wasn't shutting properly. The primary reason for the TEE was to evaluate the patient's recently implanted Watchman device, which closes a portion of the left atrium to prevent blood clots from entering the bloodstream. 

    On Friday, I participated in the HSS-CAMEO retreat that brings biomechanics research labs and PIs from Cornell Ithaca to HSS clinicians and orthopaedic surgeons. This was an informative meeting where I was able to convey my research to some clinicians who don't normally focus on cellular signaling or mechanobiology. I also got some connections from these clinicians in relation to shadowing other surgeries in the weeks to come. 

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