Jordan Lubkeman ’16, Dominion Fertility

Jordan-LubkemanDay 1:
Dr. John Gordon ’85 picked me up in the afternoon during his lunch break and took me to the Dominion Fertility office in Arlington, VA. When we arrived, he introduced me to the other doctors, nurses, and lab technicians. Everyone was very welcoming and friendly. He also gave me a tour of the office, which was comprised of much more than one typically sees on a visit to the doctor’s. There were also hundreds of baby pictures on the walls: smiles and happy faces that showed the clinic’s success in creating families. I then got to watch a few ultrasound inspections, where Dr. Gordon would inspect the thickness of his patients’ endometrial linings and the size of their follicles, if present. He was always sure to explain what he saw to his patients (and myself) which was very beneficial. Later, I got to watch Dr. Celia, the lab director, perform ICSI, intracytoplasmic sperm injection. It was very interesting to learn how a healthy sperm is selected for injection into the egg: many different morphological and physiological factors must be taken into consideration. After I sat in on a consultation that Dr. Gordon gave a new patient couple about possible reasons for infertility, the different sorts of treatment options that his clinic offers, and what the next steps in their treatment could be. He was very adept at explaining everything to his patients and answered any questions they might have. After, we went back to Dr. Gordon’s house because his family was very kind and offered for me to stay with them. On the drive back, we talked about reproductive endocrinology and how Dr. Gordon decided to pursue the field. At his house, I really enjoyed talking with his family and playing video games with his youngest daughter. It was nice to see that although Dr. Gordon is in the medical profession, one notorious for lengthy working hours, he still found time to spend with his family.

Day 2:
The next day, we got to Dominion Fertility’s Fair Oaks office at 7 am to start ultrasound inspections. Some of the patients were at the stage in their pregnancy where the embryo develops a heartbeat. Hearing and seeing the heartbeat via the ultrasound, as well as the joy on the patients’ faces, can only be described as magical. Dr. Gordon was truly creating families for his patients. We then headed back to the Arlington office, where Dr. Gordon had more consultations with returning and new patients. Dr. Gordon was terrific at tailoring the conversations to his patients. For instance, he used a lot more medical terms with a couple of doctors than with other couples who were not. We then went to a meeting with all the doctors and nurses to discuss all the patients and their procedures to make sure that everyone was up to speed on every case. After, I got to go back into the lab to watch Dr. Celia vitrify nine eggs, which was a very complex process that required a lot of care. We also talked about how Dr. Celia decided upon his profession and complex issues such as “embryo homicide,” where labs accidentally thaw embryos, and also about the dilemma of when patients whose embryos are in storage mysteriously disappear. Later, Dr. Gordon had more consultations with new and returning patients, and in between consultations he would phone patients to tell them their test results. He was incredibly busy, but never seemed to get annoyed, tired, or frustrated. At around 5 pm we went back to his house and discussed some of the ethical issues around IVF, why most clinics do not offer natural cycle IVF (Dominion Fertility does) and also life at Princeton.

Day 3:
On the third day, we started at the Fair Oaks office. Some of the patients who were undergoing follicle inspection had been seen on my first day, and it was amazing to see how the follicles had grown in that short amount of time. Lubkeman 4I also got to see Dr. Gordon perform a mock IUI, where he performs the artificial insemination procedure, just without the actual sperm, to ensure that the patient’s cervix or uterus are in no way blocked. After, a lady who was 12 weeks pregnant came back to Dr. Gordon to thank him. All of Dr. Gordon’s patients really appreciate his work. He then had some more consultations. One of them was with a Hispanic couple, and one of the nurses acted as a translator between the doctor and patients. It is really remarkable that the office is able to office this service as well to its patients. I also really enjoyed learning the Spanish medical terms for a lot of what Dr. Gordon was explaining to the couple. Dr. Gordon had many consultations with diverse problems and potential solutions. Fertilization and the achievement of pregnancy are such complex processes where so many issues can arise. I had no idea that even the average “fertile” female will actually only get pregnant 25% of the time when she tries to. Because the future of one’s family is such a sensitive topic, Dr. Gordon also had to be very knowledgeable about the emotions of his patients. While some tears were shed in a consultation, every patient left with a smile and hope for the future. After work, we went to Dr. Gordon’s medical book publishing company, a business he has on the side, to mail some of his books to buyers. He calls it his hobby, and it was nice to see that doctors really do have time for activities outside the office!

Day 4:
During the last day, I got to observe more ultrasound inspections and hear more beautiful fetal heartbeats. Dr. Gordon also had more consultations with patients, many of who had visited other infertility clinics in the area without success and were hoping Lubkeman 1Dr. Gordon would be able to successfully treat them. It was interesting to learn about what makes Dominion Fertility different from the others: chiefly, their use of Natural Cycle (instead of Stimulated Cycle) IVF, where the patient produces one eggs by herself, instead of multiple eggs with drugs. This procedure, understandably, has a lower success rate. Because of the way the government makes clinics publish their success rates, offering Natural Cycle IVF diminishes a clinic’s overall success rate so clinics are less likely to offer the procedure. But often Natural Cycle IVF is the best solution because it is more financially attractive and doesn’t require fertility drugs. Dr. Gordon had been especially busy this day because one of the other doctors was at home due to illness and an inspector from the FDA had stopped by to make sure that their labeling procedures of patients’ sperm, eggs, and embryos met standards and that no disease transmission was occurring. Dr. Gordon was really working hard to balance the clinical, technical, and business aspects of his practice. Later, he performed an actual IUI and then a follicle retrieval procedure and I got to watch in the lab as Mark, one of the embryologists, found the eggs in the solution that Dr. Gordon had retrieved. After, we went to the Fairfax hospital where Dr. Gordon performed six hysterosalpingograms (HSG’s) – Where Dr. Gordon uses x-rays and fluorescent dye to see if the uterus or fallopian tubes of the patient are blocked in any way.  One of Dr. Gordon’s residents, Stacia, was also there. She was very helpful in explaining what Dr. Gordon was looking at in the X-ray pictures, and we also talked about her experiences as a medical student. Dr. Gordon performed the 6 HSG’s with remarkable efficiency – it took him under an hour to complete them all. But they were in no way rushed; he was very careful in carrying out the procedure, making sure that the patients were comfortable, and always took time to explain to the patients what he was seeing in their X-rays. After the HSG’s, Dr. Gordon drove me back to Union Station so I could catch a train back to Princeton.

I really enjoyed my Princeternship with Dr. Gordon at Dominion Fertility and would highly recommend the experience to fellow students. It was clear throughout every procedure and consultation that Dr. Gordon wanted to make sure that the patient was as informed as possible and that he was helping the patient in the best way possible. He practices medicine in a truly open and selfless way, and it was very inspiring to watch him work with this office and patients every day. If I decide to become a doctor, I will certainly try my best to practice with the same high care standards as Dr. Gordon’s. I am incredibly thankful that Dr. Gordon gave me the opportunity to learn so much about his life as doctor, ethicist, counselor, businessman, and father.

Jooeun Kang ’14, Dominion Fertility

Jooeun-KangEntering Dominion Fertility was like entering an entirely different universe. With pictures of radiating couples with their child and the beaming doctor visible at nearly every turn, the office environment made it very clear that this is a place where baby dreams come true.

Each day in Dominion Fertility began with the busy bustling of patient’s getting their ultrasounds or intrauterine insemination procedures done before heading back to their workplaces. As a pre-MD/PhD student, I was excited to see how research and medicine is synthesized in the context of infertility. Entering the embryology lab made me feel at home with its incubators and large microscopes. Whether it was an embryo implantation procedure or an egg collection procedure, it was very clear that the small size of the laboratory belies its importance in the fertility clinic; it is where the ‘magic’ of conception happens. The main procedure done inside the lab is the Intracytoplasmic sperm injection (ICSI), where the sperm is physically injected inside the mature egg with a fine needle. Dr. John Gordon ’85 explained how amazing it is that this procedure works, since it is quite different from nature’s way of having the sperm head penetrate through the egg’s outer ‘shell’ and fuse with the egg. When I heard that nobody knew why it works, the researcher inside me immediately wanted to find out. I asked the embryologists whether they conducted any research, and it seemed that they were more focused with figuring out the best conditions for the egg and embryo maturation process that would yield the best results. These precious seeds of life that are taken care of in the lab are surprisingly tiny—its vulnerability and beauty reminded me of the reason I was drawn to medicine in the first place: the intricate machinery of life that somehow makes us who we are.

Another unique aspect of this experience was the amount of administrative power that Dr. Gordon has since Dominion Fertility is a private clinic, while all my other research experiences were in large academic centers, such as the NIH. Dominion Fertility had another office in Fair Oaks, so a fair amount of time was spent on the road. During those times, Dr. Gordon and I were able to talk about a variety of topics from the problems of health insurance to the ethical problems that arise as doctors try to cater to patients’ needs. But the most informative conversation I had with him was about medical malpractice. I used to believe that medical malpractice is there to protect the patients from incompetent or greedy doctors who seek to profit from the vulnerable patients who know no better, and if I practice medicine with the kindest intentions, focusing on the patient’s needs before my own, I would not have to be concerned. It turns out, I couldn’t have been more wrong. Dr. Gordon told me of cases where the patient was aware of the risks involved in a procedure through both the doctor and the consent form, yet had sued claiming that their consent had been coerced and that they were being manipulated by the doctor. In another case, a patient deliberately sued the doctor even when he did nothing wrong as a way to gain quick money. Dr. Gordon himself was not able to evade these ‘med mal’ suits, and showed me the medical news journal where the majority of the content was discussing different med mal cases. It was clear that malpractice suits are a painful yet ubiquitous experience for all doctors, some specialties more often than others, regardless of the quality of medicine they practice. This was the reality of physician’s life that I wouldn’t have perceived otherwise, and contrasting the doctor’s side of story with our own family’s experience as patients who at times felt injustice in our treatments gave me some food for thought.

And of course, I loved observing Dr. Gordon’s interactions with the patients, whether it was a new consultation, a returning couple expecting their second baby through IVF after a successful childbirth, a frustratedKang 2 couple rejected by other fertility clinics, or a couple that are nearing the end of their options. By the third day, I could recite Dr. Gordon’s consultations verbatim. The repetitive lifestyle of a specialty used to be what made me uncertain about committing to medicine. The actual number of procedures that are done in a fertility clinic may be limited, but each day is far from monotonic. Shadowing Dr. Gordon made me realize that no two cases are ever identical, simply because we are all human. Every patient comes with a different history, a different background, and in the case of IVF, different sets of life philosophies. Being a doctor is not about just diagnosing the condition of the patient, it is about helping them through the journey of recovery. This is especially important for infertility because sometimes even the doctor cannot pinpoint the exact cause of a certain couple’s infertility problems, because there is a myriad of variables that all need to line up perfectly to result in a healthy baby.  For some, the journey may be convoluted, physically and emotionally draining, and end up in a redefinition of a family, but Dr. Gordon with his humor and easy-going character, made the patient sure that he was going to be there with them through it all.

I am very thankful to Dr. Gordon for these enlightening three days in Dominion Fertility. It made me realize how much I love the human-to-human interactions, whether that is between colleagues or doctor and a patient. Even during my short stay there, I felt the strong sense of community, as exemplified by Dr. DiMattina’s surprise birthday party thrown by the entire staff member on my last day of Princeternship. It reaffirmed my growing realization that good science/medicine is done through teamwork. Such lessons of human interactions, of decision-making, of comfort and of guidance are those that I would not have gotten anywhere else. I cautiously dream of being in his position one day, at the frontier of a new technology or knowledge so radical that it redefines how we have been thinking of life and death, and show some future Tiger the mysterious beauty of it all.