2:06 p.m. Giving patients a voice. "Here she comes!" says otolaryngologist Gaelyn Garrett, medical director of the Vanderbilt Voice Center, as she removes a large polyp from an Indiana man's vocal cord. The growth had plagued the high school music teacher for months, eroding his voice to a low rasp. Peering at his voice box through a microscope, Garrett uses scissors with blades an eighth of an inch long and other small-scale devices to delicately tease out the polyp from its cover of skin and then presses the loosened skin back in place. As opposed to the traditional and still-practiced approach of grabbing the growth and snipping it off, this technique minimizes scarring, which could put an end to singing. Polyps usually are caused by too much yelling and other kinds of "voice abuse," so patients often work with speech pathologists after their surgery to learn how to be kinder to their vocal cords. The teacher jokingly blames his polyp on his students, whom he has to ask loudly and often to hush up.
3:51 p.m. Personal bond. Robert Manlove sits on a couch in an office at the Vanderbilt-Ingram Cancer Center. Diagnosed with non-small cell lung cancer four weeks ago, Manlove, 70, has been feeling some knee pain—a potential sign the cancer has spread. But David Carbone, his oncologist and director of Vanderbilt's arm of the National Cancer Institute's Specialized Program of Research Excellence in Lung Cancer, tells him that just-taken X-rays show no new mass. It's positive but not an absolute assurance, he says; this cancer is stealthy and the treatments imperfect. Manlove will begin chemotherapy today. Born and raised in Nashville, the patient sits, pensive, for a few moments. "There is real anxiety associated with having a terrible disease," Carbone says, "and starting on a new treatment and not knowing how well it will work." He reveals his own cancer history to Manlove—a battle with lymphoma that required radiation, chemotherapy, and removal of part of a lung. Manlove is moved by the revelation from an empathetic physician impelled to share a common bond with a patient.
Day 4
8:26 a.m. Saving trauma patients. The usual way to treat badly injured patients who are rapidly losing blood is to pour saline solution into them—"blow them up like the Michelin man," says trauma surgeon Bryan Cotton. But he found that some patients can be saved with a cocktail of red blood cells, platelets, and plasma. The death rate for patients who received "trauma exsanguination protocol," or TEP, is nearly 75 percent less than for those who got usual care, Cotton and others recently reported in the Journal of Trauma. "These are people that are coming in with predeath vital signs and lab values," he says. He recalls a farmer who was hemorrhaging and had no pulse after a bull whacked him into a fence and split his liver. He was eating normally two days after TEP treatment and ready to go home a day later.
10:26 a.m. Personalizing medicine. Imagine the teardrop of a mosquito. "We work with those size cells," says Richard Caprioli, leading the way into a laboratory that may someday revolutionize the treatment of disease. Inside the sun-filled room at the Mass Spectrometry Research Center, which Caprioli directs, researchers and pathologists are using mass spectro-meters to analyze patient biopsies in order to bring the understanding of disease to a new level. The device reads the tissue's "molecular fingerprint" by blasting out charged molecules from the sample. The mix of molecules indicates specific kinds of cells—those most likely to become malignant, for example. "Targeted therapy for specific patients is what it's all about," says Caprioli—to be able to predict which patients, based on their molecular makeup, will develop disease and will benefit from certain treatments. Patients who won't benefit will be spared the risks and side effects of a drug that won't help them.
