MD Anderson DoIM: Day 1
This entry will be very different from basically everything else I’ve written. Not only will it be more of a blog in the sense that I’m writing what I personally experienced and did, but also because it really isn't about dermatology specifically…
This summer break, I had the opportunity to attend a 3-day MD Anderson program called the Division of Internal Medicine (DoIM). For each day of the program, I plan on documenting everything we did and what I learned from it. I was originally planning to write about skin cancer, since the program revolved around the foundations of cancer; however, throughout the program, I heard from several medical professionals, which gave me greater insight into the medical field in general. So this is the first of three entries about my experience!
Each day of the program, I was dropped off at the T. Boone Pickens Academic Building. When all nine high schoolers arrived, they took us to a conference room and sat us at a long wooden table. That’s where we would stay for the majority of the day.
The first thing we did was watch a video on lab etiquette and safety, covering hazards, eyewash stations, emergency showers, appropriate clothing, and other basic safety information. After that, we were introduced to an internal medicine doctor, Dr. S. She introduced herself and mentioned that she'd been working at MD Anderson for two years. She then showed us another video about MD Anderson. It explained what MD Anderson is, what they focus on, their values, and their patients; it featured professionals talking about the hospital itself.
Then Dr. S pulled up slides about MD Anderson and cancer, and began our short lesson. I was really shocked that "MD" doesn't stand for "Medical Doctor." It actually stands for Monroe Dunaway Anderson, the businessman the institution is named after. She explained that he established the M. D. Anderson Foundation with about $300,000, and after he passed away, the foundation received the rest of his fortune, which grew to about $19 million. That money became the financial foundation used to help establish what is now MD Anderson Cancer Center. She also added that around 27,000 faculty members work at MD Anderson here in the Texas Medical Center.
We moved on to the three pillars of cancer treatment: chemotherapy, surgery, and radiology. These are the main ways to treat cancer. She also talked about immunotherapy, a newer treatment that is still evolving. As the name suggests, immunotherapy basically involves training our immune systems to fight cancer. She mentioned that Dr. Jim Allison, a scientist at MD Anderson, received the Nobel Prize for his contributions to immunotherapy.
Then she talked more about cancer itself. Cancer is essentially uncontrolled cell growth. These cells don't stop dividing because the checkpoints in the cell cycle aren't functioning properly. Since those checkpoints fail, the cells continue growing, which creates a tumor. Normally, apoptosis, or programmed cell death, removes these mutated cells. If that process doesn't work, the abnormal cells continue growing, leading to cancer.
After a short snack break, we moved on to case studies. We got to look at 3 fictional patient cases that listed the symptoms observed, test results found through a CT scan, MRI, mammogram, and/or biopsy, and questions that we had to answer using this information. They were very easy, but a great way to learn the basics. Some key ideas that I learned from this activity were:
Cancer symptoms can involve multiple body systems at the same time, making diagnosis more challenging than simply matching symptoms to one organ.
Doctors use both a patient's symptoms and diagnostic tests together to determine the most likely diagnosis.
MRI, CT scans, and mammograms can reveal suspicious masses, but a biopsy is the test that confirms whether a mass is actually cancerous.
Brain tumors can cause symptoms throughout the body, including headaches, nausea, blurred vision, fatigue, and balance problems.
Morning headaches associated with brain tumors occur because cerebrospinal fluid (CSF) builds up overnight while lying down, increasing pressure around the brain.
A patient's age is an important factor that physicians consider when developing a diagnosis and treatment plan.
Lymph node involvement is a major indicator that cancer has spread beyond its original location and is no longer localized.
Once cancer has spread to nearby lymph nodes, surgery alone is often no longer the best initial treatment option.
Chemotherapy can treat cancer that has spread because it circulates throughout the bloodstream and reaches cancer cells throughout the body. This is also why hair loss is a side effect—chemo targets other rapidly dividing cells, including hair follicles.
Blood in a patient's sputum (the mucus coughed out from the lungs) can occur when a lung tumor invades and damages nearby blood vessels.
The suffix “-itis” in medical terminology indicates inflammation, such as in bronchitis.
Not every lump is cancerous; physicians must distinguish between benign (non-cancerous) conditions, such as fibroadenomas or cysts, and malignant (cancerous) tumors.
One of the dangers of breast cancer is that early tumors are often painless, causing patients to delay seeking medical attention.
Painless lumps can be signs of uncontrolled cell growth, making early awareness and screening really important.
Early detection significantly improves treatment options by identifying cancer before it continues to grow or spread.
After the case studies, we had lunch. We went to the cafeteria, and the facility in its entirety was very clean and organized. There was a small café area with refrigerated sandwiches, sushi, and other options (I ended up buying the sushi). There was also a much larger cafeteria nearby that looked like a traditional cafeteria with different stations serving a variety of food options.
After lunch, it was time for the tour. We started walking through the hospital using the sky bridges that connect the different buildings. As we walked through them, I was reminded of an airport. They even had smaller cars used to transport patients and guests that looked identical to those you see in airports. We entered the first building, and the facility was immense. We walked back the way we came and went to another building the sky bridge connected to. We saw a few fish tanks and grand pianos, and finally arrived at a mini museum.
Considering we were taken to only 2 buildings of the entire MD Anderson Texas Medical Center institution, not even half of it, I can't imagine how the people who work there don't get lost.
In the museum, we got a recap of the founding of the institution featuring a picture of MD Anderson, the banker. The first part of the museum focused on the philanthropy and donations behind creating MD Anderson. There was a wall with images of each MD Anderson building. One in particular, called the Sheikh Zayed Bin Sultan Al Nahyan Building, was named after the man who donated $100 million. The building was built for worldwide cancer research because, as Dr. S explained, MD Anderson is renowned for its cancer research, so people from all over the world come to it. Dr. S then told us the story of an elementary girl whose image was displayed and how she raised $300 through a lemonade stand to donate to MD Anderson. Dr. S pointed this example out to illustrate that any donation, big or small, is still a huge contribution. It's not about the quantity; it's about the fact that you donated.
She also mentioned the partnership MD Anderson has with HEB and how, after checking out, they ask whether you'd like to donate one, two, or three dollars to MD Anderson. Though it may seem small, when thousands of people donate through HEB, it adds up to a lot of money. The rest of the museum included a timeline. There was a lot of emphasis on the philanthropy behind MD Anderson and all the people who help support it, including patients, faculty, administration, and the government.
Then we went back to the room, had a break, and did another activity. This activity was about a tumor board simulation. The tumor board is where medical professionals from different specialties involved in diagnosis come together to determine the best treatment for a patient. We got to simulate that process, and here are some of my key takeaways from that:
Cancer treatment decisions are made by a multidisciplinary tumor board, where specialists collaborate to develop the best treatment plan for each patient.
Every member of the tumor board contributes unique expertise, including radiologists, pathologists, surgeons, medical oncologists, radiation oncologists, and physical therapists.
No single physician has all the information needed to determine a patient's treatment plan; effective communication and teamwork are essential.
Biomarkers, such as PD-L1, can help guide treatment decisions, including whether immunotherapy may be beneficial.
Certain genes, such as EGFR and ALK, are also evaluated because they can influence which treatments are most appropriate for a patient.
The presence or absence of metastasis (spread of cancer) is a major factor in determining how cancer should be treated.
When nearby lymph nodes are involved, cancer is no longer considered localized, removing surgery from the treatment options.
Stage III lung cancer is commonly treated using a combination of chemotherapy, radiation therapy, and immunotherapy rather than surgery alone.
Patients may understandably ask why a tumor can't simply be removed surgically, making it important for physicians to explain why surgery may not be the safest or most effective option.
As the thoracic surgeon (my role in the simulation), I learned that my role was to determine whether surgical removal of the tumor was appropriate based on the patient's condition.
In the tumor board simulation, each specialist's perspective contributes one piece of crucial information to the overall treatment plan, similar to building a puzzle.
Overall, the simulation was a great exercise that showed me how much collaboration and cooperation occur behind the scenes in medicine.
During the last hour, we had a Q&A with some professionals who work at MD Anderson. Another internal medicine doctor came in to talk to us while there were three other professionals on the Zoom meeting. One was a hospital pharmacist, another was a nurse practitioner, and the third worked in administration.
The pharmacist explained that when she was in college, her sister had already graduated from medical school. Her sister really disliked medical school, said it was very difficult, and told her there were other good career options. Because of that, and because she already knew someone who was a pharmacist, she decided that pharmacology would be a good fit for her. Most people think of pharmacists as people who work at Walgreens, HEB, Walmart, or CVS. But she works in a hospital, helping determine the best medications, treatments, and medication plans for patients.
The next speaker was the nurse practitioner. He explained that he didn't really have the money or time to attend medical school, but he still wanted to work in the medical field. The other internal medicine doctor then explained how the nurses at MD Anderson are just as knowledgeable because they've been doing this work for such a long time. He emphasized that medicine and healthcare are a team effort, requiring good communication and understanding between everyone. Teamwork is incredibly important; everyone has a crucial role, and none of it would be possible without collaboration.
The last person worked in administration. She's involved with just about anything you can think of in administration. One thing I thought was especially interesting was that she helps book flights for doctors and other professionals who have to travel for work. Another thing the administration helps with is planning and preparing gatherings. Going back to the whole teamwork aspect of the medical field, they really value having gatherings during their personal or free time because it's important to maintain a good balance between work and personal life. When I heard this, all I could picture was all of them having a fun barbecue or dinner. This would be such a good experience to have—going to work and being surrounded by people you consider friends, people you trust, and people you have a stronger connection with than you might expect at a medical facility.
Finally, the internal doctor spoke a bit about himself and opened the door for any questions. One of the questions asked was, "As medical professionals who work with cancer patients every day, how do you tell someone they have cancer? How do you deliver such a life-altering diagnosis?" They explained that it's something you never really get used to. Even Dr. S, who has been doing this for two years, said she still leaves patients' rooms feeling emotional. She said it's simply part of your duty as a doctor. The other doctor added that it's an inevitable part of working in this field. That's why it's extremely important to have something positive to turn to so you don't carry that emotional burden with you. He mentioned hobbies, spending time outside, and listening to jazz as something he personally does to maintain a healthy mental state.
I thought that was really fascinating and reassuring. All of the medical professionals at MD Anderson, especially those who work face-to-face with cancer patients, seem very aware of the emotional impact of their work, and they're open about talking about it.
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