My day following Dr. Sharma's fellow

This post was written by Courtney Leach, Digital/Social Media Manager, Parkview Health. 

There are an estimated 200 billion stars in the Milky Way galaxy, where Earth resides. Among them, there are several suns. What makes a sun stand out among the stars, you ask? It’s the glowing mass’s role as the center to the solar system, the heart. The sun is the ultimate life-giving star, releasing energy that makes our every breathing aspiration and mundane function possible.

Scientists will tell you that at the core of any good energy system, you’ll find a fluid, flowing transmission and distribution of energy to where it’s needed most. Energy is, after all, defined as “the ability to do work”. Without it, there is no momentum or capacity for change, and so a strong sustainability plan is essential.

Arguably, one of the strongest examples of such energy in our health care system is the body of work we see from Neil Sharma, MD, PPG – Oncology, President of the Parkview Cancer Institute. Between performing cutting edge procedures in advanced interventional endoscopy and endoscopic oncology, fulfilling administrative duties, conducting progressive research, collaborating with peers and presenting cases, and connecting with patients outside of the OR, his hours are dedicated to our community and those beyond. When considering such skill and demand, however, the immense need for a capable set of hands to assist is fairly undeniable.

This brings me to the day I spent, just a few weeks ago, observing this bright, brilliant force of intensity and stamina for myself. It was this day I had the privilege of spending 10 hours with Dr. Sharma, and his surgical fellow, Saurabh Gupta, MD. Along with an expert exhibition on precision and endurance, what I got was a firsthand peek at the perpetuation plan for a vital arm of Parkview’s services.

With a rising need for care in his specialty, in 2016, Dr. Sharma began the necessary steps to bring an Advanced Interventional Endoscopy & Endoscopic Oncology Fellow to Parkview. While this seems like a simple addition to the staff roster, the qualifications are vast and particular, with most opportunities falling to academic medical centers. Requirements from the American Society for Gastrointestinal Endoscopy include (but are not limited to) a minimum number of volume for certain procedures, institution-initiated published research and sophisticated equipment. They are as thorough and meticulous in their criteria as the talented young physicians sending in their applications for these fellowship opportunities across the country, of which, there are only about 50.

I’d been forwarded an outline of these extensive qualifications prior to the day of my shadow. They were tucked in a folder in my backpack, their bullet points just moments from being outlined to me in practice, as I pushed open the door to Conference Room A at Parkview Regional Medical Center. It was just after 7 on a Thursday morning, and the Tumor Board meeting was in progress. Katelyn Engstrom, project coordinator, Parkview Cancer Institute, smiled and motioned for me to come grab a seat in the third row. There was a picture of a cancerous mass cast in a psychedelic pattern of blues and purples on the screen. The room, filled with nearly 30 surgeons and pathologists and radiation oncologists and medical oncologists and support staff, stared at the front of the room. Some nodded. Some took notes. A voice came in from the speaker, a physician calling in from Ohio.

The institution of the Tumor Board in itself is an essential advancement in cancer care. The collection of our health care system’s finest medical minds in relation to the disease, conversing and consulting and counseling means better outcomes, better communication and better treatment plans.

After the group had gone through the day’s docket, they quickly dispersed to go about the business of saving lives. Katelyn walked me over to meet Dr. Sharma first. As President of the Parkview Cancer Institute, you can imagine I wasn’t the only person needing a few minutes of his time that morning, but I didn’t feel neglected, either. The surgeon has a way of making every exchange, brief as it may be, feel sincere and deliberate. He exudes an abundance of confidence and moxie. An ambitious fire. Like a sun, with a bustling constellation swirling around him.

Next, Katelyn took me over to meet Dr. Gupta, my subject for the next nine hours. I would imagine, as fellows go, they don’t come much kinder. The pure decency and intention of the young physician were apparent immediately. As with any of these shadow scenarios, he was slightly baffled at the thought of being trailed all day, but obliged like any true team player would.

“I’m from a mountainous area of northern India,” he offered, as we walked through the hallway. “I went to medical school in India, before doing my residency in Chicago. I thought nothing could be busier than that. I came to Parkview as an attending in July 2016, and then started the fellowship in July 2017.” His wife is also a hospitalist at Parkview, commuting to Chicago on the weekends to work on her MBA. “I tell people all the time, ‘If you see my wife, tell her I said hello!’ But it’s only a year.”

“So, how did you find yourself at Parkview?” I asked.

“It was the sheer volume and advanced procedures being done here,” he said. “Neil has started so many things, and we are super busy. We do interventional inpatient as well as surgery so the pace is pretty quick. It’s intense but I like it. The more volume you do, the better you get.”

Then he had to make a phone call. The first of many, along with texts, he would tend to in my hours with him. He apologized, almost every time.

What Dr. Gupta might not realize, and what I was there to capture, is just how special his role is for our community and our health care system. By working so closely with Dr. Sharma, the fellow will gain experience through general GI procedures, inpatient service, ambulatory clinics, and devote time to research, in addition to garnering a first-hand education on all of Dr. Sharma’s advanced surgical techniques. Techniques like endoscopic suturing, where the procedure is done entirely through a scope, without opening up the patient. This means minimal discomfort for the person receiving care, but also a maximum amount of concentration and skill from the surgeon.

The technical torch can’t be passed fast enough, a fact that became clear as we reached the Endoscopy area of the hospital. Dr. Gupta opened his backpack, and it was filled with files. These were cases from the past few days he would need to review by morning, just one of the tasks attributed to his role.

I would venture to say a masterclass in multitasking is a bonus lesson from his time with Dr. Sharma. “The best learn from the best, right?” Dr. Gupta said. “He leads by example, which is easy to say and really hard to do. He does these high-risk procedures, and he’s just so good. He always has a plan, he’s always one step ahead.”

No sooner than the words came out of his mouth, did his mentor pop into the room to remind him of the importance of that very thing. It was time to look at the board. It was time to start the highly synchronized chain reaction of surgeries for the day, and Dr. Gupta’s role requires he set things in motion. After a quick Q&A between the physicians at the schedule board, my subject went about coordinating anesthesia and patient arrivals and transfers. I took these few minutes to chat with Dr. Sharma.

“You remember every detail of these cases. There are so many, how do you do that?” I asked.

“I’m invested. I hear the name, and I just remember the history.”

“How are you prioritizing all of your roles right now? With the Cancer Institute and your cases?”

“Yeah, I mean, if I take one phone call, it could lead to an hour’s worth of phone calls,” Dr. Sharma said. “So, I have to really focus on where I am.”

“Are you finding the fellowship helpful?”

“Yes. We get cases where people are preventing cancer, they have cancer, or they’ve had cancer. Dr. Gupta has a GI background, and he’s learning surgical endoscopy, so when we reach critical mass, the fact that I can hand off some of those cases, and we can work together on the more invasive procedures, is great.”

“I can tell there’s a huge need.” I added.

“The demand is growing, so I need to teach these advanced procedures. I feel like it’s important to pass that knowledge on. It’s good for our community.”

The demand was reflected in the schedule. Comparable to one you might find in nearly any busy OR, this document was a Rubik’s Cube of responsibilities. A byproduct of their dedication to care for those already on the board, as well as those coming in with an immediate need, the adaptability required to tend to each of these cases flowed in abundance.

You could say it’s the drive of the two men holding the tools. Or perhaps the masterfully coordinated team of support staff – nurses and anesthesiologists and techs. Or maybe it’s appropriate to say that the stars just align with this group, but however you spin it, they treated each patient, addressed every case. Efficiently. Thoughtfully. Thoroughly. And I don’t think this particular day was any exception.

One by one, I watched as patients were moved from procedure room to recovery. A trained time-lapse playing out before me. There was never a minute when Dr. Gupta wasn’t observing with captive eyes, or removing gallstones with practiced patience, or capitalizing on time between cases to catch an advanced technique at the hands of Dr. Sharma. It was a tireless revolving door of skill. And collaboration.

Dr. Sharma is a sponge of experience constantly wringing out a shower of knowledge upon anyone within earshot. Whether it’s a recent research study he just read about, or a procedure he did last year, or a technique he’s perfected with time, he opens his mouth and something about his craft comes out. You wonder where he keeps it all. All that information.

If I were to pick just one from my time with them, I would say the duo’s signature maneuver is the endoscopic retrograde cholangol pencreatography (ERCP), in which they use a scope to enter the ampulla, a small opening in the small bowel which allows them to access the pancreas, among other organs. This is the path for many of the procedures done in the darkened rooms, the surgeon holding the instruments like a skilled gamer. “It’s challenging because you have basic anatomy, but everyone is personal,” Andrea Maggart, RN, told me.

Around 10:30, a second anesthesiologist came and the team was able to expand their efforts to cover the ever-growing caseload. Throughout the shift, Dr. Gupta exuded control as he moved from room to room, computer to phone, team member to schedule board. His constant companion was a folded up piece of paper he kept in his pocket. On it, he had the constantly evolving schedule for the day. He consulted it often.

With his mentor just a few rooms away, but also otherwise occupied, it wasn’t just Dr. Sharma teaching Dr. Gupta these advanced techniques. It was the entire team. The nurses in the procedure rooms were a wealth of knowledge themselves, offering pointers from past procedures and tricks of the tools. Everyone in Endoscopy is lifting up Dr. Gupta, helping him burn brighter.

By 1:30 p.m. my stomach was growling. The morning was a relay race ran with one unexpected nuance: lead. Because of the radiation used to take photos of the patients’ procedures, everyone in the room has to wear a lead vest, skirt and collar, adding up to a noticeable amount of extra weight. Just from observing, my back was aching and the bottoms of my feet felt tired. I was ready for a break from the heavy accessories and a quick bite.

When I returned, Dr. Gupta was getting ready to observe a new technique Dr. Sharma was performing with the help of some advanced technology created by Boston Scientific. He was able to identify cancerous cells in a patient’s esophagus using a special light, then remove the worrisome cells from the inside out. The cut came from two pedals at Dr. Sharma’s feet. This was the second time I’d witnessed him remove cancer from a patient that day.

Earlier he’d invited Dr. Gupta to step in and take a closer look at a unique form he’d found unexpectedly during a different procedure. While Dr. Sharma offered his hypothesis on the type of cell to the room, Marzena Muller, MD, a pathologist, examined the tumors under a microscope, eventually confirming his suspicion.

“My mother was a pathologist,” Dr. Gupta told her. “I appreciate the nuclei.”

He then graciously thanked Dr. Sharma for inviting him down, turned and walked to the procedure room just a few doors down to once again don his lead cape and get to work. This case would have him working diligently to remove a set of stubborn gallstones, answering my questions in the process. Every time I watched these surgeons insert a scope, it was like punching a ticket onto the Magic School Bus, going on a visual tour of bubble gum pink tissue and rimmed organs. In this case, my questions were about the stones themselves. Black stones indicate more pigment, and possibly infection. Yellow stones mean the composition is more bile and cholesterol. (In case you were wondering.)

He placed the instruments in the tub for sanitizing and disposal and came over to the computer to put in his notes.

“Do you feel a lot of pressure?” I inquired. “About absorbing all of this information and learning these intricate techniques?”

He smiled and released the most genuine laugh. “I hadn’t really thought about that, until you just said it!”

“Sorry,” I offered.

But given the determination and appetite for knowledge I’d witnessed in my time with him, I would venture to say his remaining months as Dr. Sharma’s fellow won’t bring anything he can’t handle. His fierce humility makes him immensely relatable and approachable, which can be just as important as the grit it takes to be the best, which I believe he has as well.

As I flipped through the pages of my notebook that evening, a few hours after we parted, the awe caught up to my tired head, practically jumping off the paper. The lines and lines of chicken scratch notes jotted down in the dark of the operating room. This day had been like being a witness to the finest, most tireless, most efficient energy system. It had been an education in unyielding commitment and thirst for the expert command of the craft. It had been like standing among the stars, just a stone’s throw away from the sun. 

 

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