Motivation Begins at the Bedside
Next Generation is a Brigham Clinical & Research News column penned by students, residents, fellows and postdocs. If you are a Brigham trainee interested in contributing a column, email us. This month’s column is written by Megan Sulciner, MD, who is a surgical resident in the Department of Surgery currently completing a research fellowship in a collaboration between the Division of Surgical Oncology and the Center for Experimental Therapeutics and Reperfusion Injury.
It had been several months since I last saw Mr. A. As I made my way up the 15th floor stairwell in the Towers, I remembered how the last time that I saw him, he was vibrant, with a boom in his voice whether it was 5:30 a.m. or 11 p.m. He was excited for his daughter’s wedding. And now, as I turned the corner out of the stairwell into the first room and I walked towards the bed nearest to the window, I heard him say, “Hey kid. Oh sorry, I mean doc!”
He was thinner, worn. Mr. A was a man in his 50s, born and raised in the Northeast. As a new intern, I first met him in the Post Anesthesia Care Unit to complete his postoperative check as he had undergone a resection of a large tumor. Outside of that, frankly, I don’t remember the details of our initial exchange. However, before Mr. A was discharged that first admission, he asked if he could tell me something that he hoped would not be “weird.” He said when he woke up from surgery he was sincerely wondering if he was dead, except within moments he recalls me leaning over his stretcher, smiling. He said he would never forget the smile because it told him that he was alive.
Since then, I have seen Mr. A on three separate admissions. In fact, when sitting down to write this, I realized I had written about Mr. A on each of those occasions. During Mr. A’s last admission, I asked how the wedding had been. Mr. A and his wife motioned for me to come sit beside them to review the photographs. I remember being between them, our feet hanging off the side of the hospital bed, looking at those photos and seeing a beautiful, happy family. In the midst of the discordant chime of the monitors and the creaking wheels of hospital beds rolling by, I had this very distinct realization that Mr. A existed outside of the rooms of the Towers. His life and his family’s life may have been hyper-focused on his diagnosis, his surgery, and his recovery every time I saw them at his bedside, but time outside of the Brigham marched on regardless. I am not entirely sure what about Mr. A has stuck with me, but each time he left a different room in the Towers, I wondered if I would see him again. Mostly, I worried that the next time I would see Mr. A, it would be because his tumor had returned.
Before my surgical residency, I had the opportunity to conduct research through a collaboration with Professor Charles N. Serhan, PhD, DSc, the director of the Center for Experimental Therapeutics and Reperfusion Injury here at the Brigham and Dipak Panigrahy, MD, an assistant professor in the Department of Pathology at Beth Israel Deaconess Medical Center. In our previous work, we found inflammation secondary to standard interventions such as chemotherapy and surgery could contribute to tumor recurrence. We then focused our attention on promoting the resolution of inflammation, the active process of returning to equilibrium after inflammatory insult, and the role of specialized pro-resolving mediators. Specialized pro-resolving mediators (SPMs) are mediators biosynthesized by polyunsaturated fatty acids that occur naturally in the body and help promote the resolution of inflammation. SPMs were first discovered in the Serhan laboratory. In our mouse models, we found the addition of SPMs could decrease tumor recurrence incidence. Our findings indicated that prevention of tumor recurrence in part requires the resolution of inflammation that is inevitably produced by standard cancer treatments.
One of the most unique aspects of being a trainee at the Brigham is the access to world-renowned experts in science and medicine paired with the unparalleled enthusiasm to advance medical research. Now, under the mentorship of Chandrajit Raut, MD, MSc, chief of the Division of Surgical Oncology, and Professor Serhan, and the respective support of the Department of Surgery and the Department of Anesthesiology, Perioperative and Pain Medicine, I hope to translate our previous work on tumor recurrence and the resolution of inflammation into patient outcomes. To that end, I consider myself incredibly fortunate to be at the Brigham.
When I had carried out our preclinical studies, I had yet to start medical school. Since that time, I am humbled and honored to have sat at the bedside of numerous patients as a surgery resident. The motivation to pursue discoveries and innovations that can impact patient prognosis now has many faces, and for me, one of them will always be at the bed right off the stairwell on the 15th floor of the Towers.