scenes with a neurosurgical resident

A DAY IN THE LIFE:

DR. MARC MOISI, NEUROLOGICAL SURGERY RESIDENT STORY AND PHOTOS BY DENNY ANGELLE

Like any big city, Houston wakes up gradually: first glimpses of daylight glint off the top-floor glass of tall buildings, and people begin to find their way to work. Even as Houston opens its eyes, people are flowing through The Methodist Hospital like the day’s first coffee.

Dr. Marc Moisi pulls on a white lab coat over his blue scrubs. He has been at work since 5 a.m., making rounds and seeing patients. Moisi is a neurological surgery resident in the third year of his graduate medical training. He has received his medical degree, now he is training to be a neurosurgeon. Moisi goes to the room of a patient who has had back surgery. After washing his hands, he snaps on a pair of gloves and begins to change the bandages on the patient’s back. “It looks good,” Moisi tells the patient. “How is the pain?” The patient still has some pain when he stands. The doctor assures the patient he can be discharged after staying one more night. That seems to reassure both the patient and his wife. Moisi reminds them the attending surgeon who performed the procedure would be checking on the patient later in the day. It’s all about the patient: Moisi doesn’t say it, but he knows it, lives it, breathes it. What he does say is, “I really love what I do. Some people may say it but they don’t believe it. But I really do love this kind of work.” Moisi is 30 years old. He is from Queens, New York, a graduate of New York University and

Columbia University. He served his internship at Weill Cornell Medical College and chose the program at Methodist because of the reputations of the physician-teachers here.

AT A GLANCE

18 Number of Methodist sponsored ACGME* accredited programs

Blood Banking/Transfusion Medicine, Cytopathology,Family Medicine, Hematology (Pathology),Internal Medicine,Neurological Surgery, Neurology,Neuropathology,Obstetrics and Gynecology,Orthopaedic Adult Reconstructive Surgery,Orthopaedic Sports Medicine,Pathology (Anatomic and Clinical),Plastic Surgery,Selective Pathology (Hematopathology),Selective Pathology (Ophthalmic),Selective Pathology (Surgical),Surgery (General), Transitional Year

2Number of Methodist sponsored non-ACGME accredited fellowships

Minimally Invasive Surgery,Mohs Dermatologic Surgery

150 Number of Methodistsponsored residents

More than 200 residents are at Methodist at any given time.Over the course of a year,between 600 and 800 residents rotate through.

Other institutions whose residents rotate through The Methodist Hospital:

Baylor College of Medicine,University of Texas Health Science Center at Houston, University of Texas Medical Branch at Galveston,University of Texas MD Anderson Cancer Center,SAUSHEC (San Antonio Uniformed Services Health Education Consortium — the military programs),University of Kentucky, University of New Mexico,Louisiana State University

* American Accreditation Council for Graduate

Medical Education is responsible for post-MD medical training in the United States. took a look at who the leaders of the neurosurgery program are at Methodist — starting with Dr. Robert Grossman (chairman of Neurosurgery), who is at the top of his field and neurosurgeon Dr. David Baskin, the residency program director — and I realized if I came here I would be learning from the absolute best,” Moisi says.

Born in Romania, Moisi’s family moved to New York when he was about two years old. His parents are engineers, and for a while Moisi wanted to be one too. He earned his engineering degree, but the field of medicine captured his imagination. “Deep down, I always wanted to be a doctor,” he says. Now he is the first physician in his family.

“My parents are proud of me, sure,” he laughs. “They are happy I got my engineering degree.”

“I CENTER FOR MEDICAL EDUCATION Over the past three years, Methodist has turned itself into a top center for medical education and research. The hospital now trains 150 future physicians in 18 accredited residency programs. Neurosurgery residents like Moisi practice under the supervision of physicians from the Methodist Neurological Institute (NI), which has a staff of 13 neurosurgeons, 10 neuroradiologists and eight neurologists. Physicians at the NI performed more than 3,500 major neurosurgeries and 400 neuroradiological interventions last year. “This is an impressive center where physicians see all kinds of patients,” Moisi says. “The doctors here are the best of the best. Many of the faculty physicians trained here too, so you can see there’s a tradi-

“The doctors here are the best of the best. Many of the faculty physicians trained here too, so you can see there’s a tradition of excellence in this field and it’s the reason I came to train at Methodist. I think I’m very fortunate to be taught by these physicians.”

tion of excellence in this field, and it’s the reason I came to train at Methodist. I think I’m very fortunate to be taught by these physicians.”

Moisi’s residency track is seven years. He will devote one year to research — he is still deciding what his research focus will be, but he thinks it may involve working with Grossman to study spinal cord injuries. He may also spend some time in pediatric neurosurgery at either Texas Children’s Hospital or in New York.

Moisi expects to complete his residency in 2012, when he will be 34 years old.

Most of his days are a mixture of making rounds to see patients, performing surgery, attending some educational sessions and lots of reading and study.

Residencies require long hours at work, and surgical residents can see their workday stretch into the night.

But the Accreditation Council for Graduate Medical Education, which accredits Methodist’s residency programs, limits work hours for resident physicians to 80 hours a week and a straight shift is limited to 30 hours.

“It’s a good rule — tired people tend to make mistakes, and this is not the place to be making any kind of mistake,” Moisi explains. Most days he arrives at Methodist between 5 and 5:30 a.m., and goes home between 5 and 6 p.m. He will be “on call” from the Emergency Department and can go in after hours to handle patient care emergencies. He lives about a mile and a half from the hospital — when called he can be at the hospital within minutes.

He can see as many as 30 patients in a day and will scrub in for as many as three surgeries.

IN THE SURGICAL SUITE

Today Moisi is scheduled to perform surgery alongside Dr. Paul Holman, a neurosurgeon on staff at Methodist. The patient needs a lumbar laminectomy to decompress nerves in her back, and the doctors will further strengthen her spine by fusing some vertebrae.

Moisi heads up to the third floor of Methodist’s Dunn Tower, where the operating rooms are located. He hangs his lab coat on a row of hooks bearing many more white coats and picks up a paper head covering and mask for the sterile operating room.

he surgical team is already in the operating suite, prepping the patient. Moisi checks the imaging and the patient’s medical information. He will first assist general surgeon Dr. Patrick Reardon who will open a path to the patient’s spine. Then Holman will step in to work on the vertebrae. They plan to strengthen the spine using parts of cadaver bone, which will be reinforced with screws.

Moisi and the other surgeons will each wear a pair of optics — glasses with special lenses inset to magnify their work and a light attached to illuminate the field. Moisi puts the apparatus on his head and washes his hands. In the surgical suite, he and the entire team wear lead vests for protection when an X-ray is used; a dark green surgical gown goes over all of that.

Wearing a bright red cap, Reardon comes in and begins work. When he is done, he steps away and Holman approaches the patient. He will call for a number of scans to check the progress of the work; the entire surgery will last about six hours.

SOLVING MEDICAL MYSTERIES

Taking a break between surgeries and seeing patients, Moisi reflects on the work he has done and the work he hopes to do in the future.

T“Every year there’s something new on the horizon. … some new technology that will help in the treatment of disease, and we, as residents, need to stay on top of that,” he says. “But on the other hand, medicine is totally an art and it’s firmly in the hands of people who will use this technology as the tool to find out what’s wrong with a patient.” He compares his work to that of a detective. “Every patient is a new case,” Moisi says. “Some are straightforward, others are a bit of a mystery. You talk to the patient, you use your powers of observation and come to a conclusion only after you gather as much information as you can.”

“EVERY YEAR THERE’S SOMETHING NEW ON THE HORIZON. TREATMENT OF DISEASE,ANDWE, ASRESIDENTS, NEED T

Then, the technology — the machines — can help the doctor confirm what he or she suspects is wrong with the patient. “Helping other people doesn’t always mean taking them into surgery,” Moisi continues. “You have to be relentless in getting to the source, the cause — the doctor may not always be right, but unfortunately, the disease is always right.”

The daily interaction with patients as well as with other physicians and health care workers appeals to Moisi the most. “Compassion is the absolute most important attribute you can have as a physician,” he says. “It becomes second nature to remember to treat everyone with the same respect and compassion — you treat them as though they are part of your own family.”

MEDICAL PERSONALITY

After surgery, Moisi checks on more patients. When he goes home in the afternoon, he relaxes a bit and does some reading.

“You always have to be on top of medicine, on top of the technology,” Moisi explains. “One way to do that is to be up on the latest articles, the things that are written about your field.”

As he explains it, he is slowly building a medical personality. Each attending physician he works with, each teacher he encounters, shares a bit of knowledge and experience that Moisi makes his own. “As Dr. Grossman says, you take a little from here and a little from there,” Moisi says, “and you slowly emerge with your individual medical personality.”

And the experiences of each day add to that character construction. “There are good days and bad days, like with any other line of work,” he says. “I could have those kinds of days as an engineer. But I’m a neurosurgeon. For us, for any physician, the stakes are much higher.”

… SOME NEW TECHNOLOGY THAT WILL HELP IN THE O STAY ON TOP OF THAT.”

“Compassion is the absolute most important attribute you can have as a physician. It becomes second nature to remember to treat everyone with the same respect and compassion — you treat them as though they are part of your own family.”