This summer I had the unique opportunity through BRAVO! to travel to Limoges, France to participate in a study at the Centre Hospitalier Universitaire Dupuytren. Though I never expected it to be cakewalk, even given my familiarity with the French language, my experience this summer of total linguistic and cultural immersion coupled with the first-time exposure to the French research and work setting was much more trying than I had imagined, and much more enriching than I had ever hoped.

While in Limoges, I worked in collaboration with the surgery team of Marc Laskar, M.D., Department of Cardiothoracic and Cardiovascular Surgery, and the research laboratory of Michel Cogné, Ph.D., Department of Immunology, to elucidate the cause and clinical significance of one indication of neurological complications of cardiac surgery. The objective of the study was to investigate the correlation of High Intensity Transient Signals (HITS) measurements and platelet microparticle (PMP) formation in patients undergoing heart valve replacement in hopes of identifying the cause of these HITS. HITS are high-velocity echoes detected by transcranial Doppler ultrasonography that have often been reported following cardiac surgery using the extracorporeal bypass support and have been implicated in neurological disorders following heart surgery. The problem with HITS is that it remains unclear whether they are induced by gas bubbles or by thrombotic aggregates such as PMPs in the bloodstream. Thus the aim of this study was to test the hypothesis that PMPs were in fact the origin of HITS.

My responsibility in this study was the quantification of PMPs plus further measurement of platelet activation of patient blood samples via flow cytometry, while a cardiologist was in charge of measuring HITS. Flow cytometry was something I had been trained to do while working in the laboratory of Paul McDonagh, Ph.D., Department of Surgery and the Sarver Heart Center, University of Arizona, but the work at the French site gave me an opportunity to learn alternate methods of cell characterization using cytometric beads instead of fluorescent antibodies, and to expand my overall mastery of flow cytometry by working on different models of the machines as well. At the time I left the French research group, we had not yet completed the project due to problems encountered with the HITS protocol, and the group was still recruiting patients for this ongoing study.

Working in a foreign country was a new experience in and of itself. Differences in the French and American education system led the French to believe that I was at least a master’s student, and I sometimes struggled to meet the scientific and linguistic level of knowledge that the French group expected of me. Dissimilarities in the two healthcare systems were made apparent while working in a medical environment, and I perceived the French to be much more relaxed in their attitudes towards healthcare. And I thoroughly appreciated the two-hour lunches, although I could have done happily without the monthly four-hour journal clubs over dinner which lasted well until midnight.

My lab experience this summer also allowed me to rediscover some of the less glamorous but universal realities of lab life. Working for two supervisors of two different labs that have never before collaborated on a project, each with their own modes of operation and expectations, was easier said than done. And trying to avoid getting myself caught up in the inevitable tensions that arose between the two labs from time to time was certainly a delicate task. Finally, contending with the disappointment of the study not coming together as expected was also a rather frustrating experience, especially when not working with unlimited time. Such experiences, though maybe better without, added to the reality of the research experience and helped develop a greater appreciation of the work that actually gets done.

Life outside of the lab was also very memorable. Although Limoges, with a population less than half of that of Tucson, is not even comparable to the grandeur and enchantment of Paris, it is a city full of its own unique appeal. It was definitely not a city that, as one misleading guidebook hyped, enjoyed a great nightlife due to the substantial number of students from local universities that constituted the city population; I have no doubt that that author has never set foot in Limoges. Yet the distinctive architecture, the green pastures, the abundant porcelain factories, and the famed Limousine beef all comprised part of the city’s undeniable charm and make Limoges a very livable place. And managing to take a photo of Lance Armstrong on his bike during the Limoges stage of the Tour de France made life in Limoges an even more unforgettable experience.

As for the people, living in a dorm for first-year medical residents made making friends and meeting people much easier than I had anticipated, since everybody was happy to have a native English-speaking friend to proofread and edit his or her conference presentation or scientific publication which usually had to be in English. Despite current political strain between France and the United States and the strong anti-Bush sentiment permeating France, at no time did I ever feel unwelcome or in danger due to my American background. And politics aside, many were simply pleased to have an opportunity to test their own English language abilities.

The scientific, cultural, and linguistic immersion in Limoges this summer provided me an extraordinary academic challenge as well as an opportunity for scientific and personal growth while encountering new situations. The wealth of scientific knowledge absorbed and the cultural acuity gained alone made this experience more than I bargained for. But the self discovery that came from being displaced from one’s own comfort zone, and the self-confidence and maturity that developed from having one’s adaptability, resourcefulness, and personal limits and worldviews tested in an unprecedented way made this summer’s experience truly remarkable.

I would like to extend a heartfelt thanks to my two foreign faculty sponsors, Dr. Marc Laskar and Dr. Michel Cogné,
and equally to Carol Bender
and Genevieve Kenney for having made this opportunity possible, and finally to the NIH (NIH/MIRT TW00036) and the
Société de Recherche en Chirurgie Thoracique et Cardiovasculaire for providing the funding for this program.

Reina Watanabe, UBRPer in Dr. Paul McDonagh’s lab, Cardiovascular & Thoracic Surgery