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Monday, January 24th, 2011
Preparation for my Princeternship really began last night when I climbed in bed at 9 p.m.  In order to beat the morning rush into the Texas Medical Center, I was out the door by 5:30. It was overcast and rainy, but that certainly didn't drop the number of patients visiting the hospitals. Despite the dreary weather, Dr. Debra Palazzi ('92), was energetic and eager to begin her morning rounds at the Texas Children's Hospital. We headed straight to a conference room to receive the weekend report from the attending who had been on call. There, we learned about all the patients we would be visiting throughout the day. Their ages ranged anywhere from two months to 18 years old and their lengths of stay spanned from a few days to three weeks. 

Dr. Palazzi introduced me to her current team: Jill, a second year resident, Angela, a nurse practitioner in cardiology, Kemi, an intern, and Rebecca, a fellow. They were kind enough to introduce me to their patients throughout the day. The amount of enthusiasm and dedication that they showed to each patient was amazing--I almost wondered if Dr. Palazzi had told them to act super excited, but she joked, "I wish I had met with my team before rounds to tell them to act normal!" We saw a premature infant with meningitis and polydactyly, patients with ulcers, cystic fibrosis, toxic shock syndrome, and numerous infectious diseases.

Their work seemed very much like detective work--fellows, interns and residents viewed new consults and then presented them to the rest of the team. Together, they hashed out the details of the case, reviewing a patient's medical and social history. Based on the patients symptoms, different tests would be run to check for the presence of different bacteria. Combining their own assessment of the patient with lab results allowed the team to collaboratively reach a decision for the next steps. What drug regimen would the patients be on? Was a hospital stay necessary? If so, for how long? All of these questions were answered and discussed with the patients and their parents.

The saddest case for me was a young girl with leukemia and Listeria, a gram-positive bacteria that can contaminate food, causing a potentially lethal infection. She was noticeably upset and complained about being bored in the hospital, wanting to leave as soon as possible. I was really impressed to see how Dr. Palazzi interacted with the patient and all the other children. She always ended the discussion by asking if the parents, and more importantly, if the patient had any questions. As long as the patient was old enough to talk, Dr. Palazzi made a pointed effort to see if they had any questions or concerns. (See photo on right: one of the kids let me take a picture of all the flowers, cookies, and balloons that had piled up in her room during her stay. Thankfully, she was looking better with each day, and she'll probably need a truck to bring all these gifts home).

Besides a lunch meeting from 1:00 - 2:30, we were shuttled up and down different floors within the hospital and bustling in and out of patient rooms, learning about new consults, and reviewing lab results. It was a hectic day, but everything was fresh and exciting. I left the hospital feeling charged for day two!

Tuesday, January 25th, 2011
I began the day by visiting some patients with Rebecca before meeting with Dr. Palazzi and the rest of the team. As I could already tell from day one, each patient was a unique case which ensured that the doctors were never bored. Since several of the patients had been in the hospital for an extended period of time, I got to see many familiar faces as we continued rounds. It was great to be able to follow up on patients. The young girl I met the day before, in particular, seemed to be in a much better mood: "Can't you guys skip all the other kids and just stay with me?"

In between seeing the patients, we went down to the labs for "micro-rounds" where we learned about the science behind potential infectious diseases. We got to see Gram stains and actual bacterial colonies from patients we had seen earlier. It was interesting to see where all the tests were being completed. There was a lot of discussion about Chediak Higashi syndrome, a rare inherited disease of the immune system, that Rebecca was convinced one of the patients might have. We left the land of microscopes, soft-agar, and petri dishes to see some human faces. 

The last case of the day was particularly heart-wrenching; a little girl who had three teams working on her: infectious diseases, orthopedics, and cardiovascular surgery. All three teams wanted what was best for the patient to occur and as a result, there was a lot of serious discussion. Day two concluded with just as much excitement as day one. At night, Alex Landon '12 and I made cards to give to all the kids the next day.

Wednesday, January 26th, 2011
Today was my last day, and I got a ride from Dr. Palazzi into the medical center. On the way, she talked to me about her experience at Princeton, medical school, and residency. Far from the horror stories that most people talk about when it comes to medical school, Dr. Palazzi was enthusiastic and reassuring. It was really helpful hearing her perspective. When we got to the hospital, we kicked off the morning with cupcakes and muffins since it was nearing the end of the rotation, and Dr. Palazzi would be meeting with a new team soon. We checked up on Ashley early in the morning to see how she was doing post-surgery.

Around noon, the residents and I headed to the Citywide Meeting on Infectious Diseases in which representatives from different hospitals presented their most interesting cases from the previous week. It seemed to be a great forum for different doctors to discuss alternative treatments and for medical students to see collaboration amongst hospitals in practice. Following the meeting, Dr. Palazzi and I made social visits to hand out cards to the patients. Several of them were really excited, and it felt great adding some color to their rooms--not that the Texas Children's Hospital isn't colorful enough (all the walls contain artwork done by children and the elevators are color coded).

After reviewing some new consults and checking on new patients, we wrapped up the day by saying goodbye to the team. Dr. Palazzi was kind enough to drive me home again. We talked about everything from her visit to Taipei (my hometown) after freshman year at Princeton, the Nude Olympics at Princeton, to her life outside of medicine--she used to be an international competitor representing the USA for taekwando! Over the last three days, I have learned so much from Dr. Palazzi and her team. Seeing the dedication they have shown to each patient has given me an example of the type of doctor I hope to be someday. I am so appreciative of the time and patience they showed me in answering all my questions or simply sharing their advice. I hope that I'll get to visit Dr. Palazzi again sometime soon!

When I arrived at 10 am Wednesday morning at Planned Parenthood Federation of America, I was met by the alumnus sponsor of the Princeternship, Ms. Susan Zilber ('76). She was friendly and disarming, and greeted me and my fellow Princetern, Teguru Tembo, with a schedule of the events for the day. The day began with a meeting with Elizabeth Nunez, the manager of Human Resources, who gave us an overview of the structure of PPFA and its relationship with the 85 affiliate organizations and approximately 850 clinics nationwide.

After receiving a brief overview and access badges, we were off to speak with Destiny Lopez about her work as Director of Latino Engagement. Although 25% of the population served by Planned Parenthood is Latino (which is similar to the demographics of the United States), there is strikingly limited involvement of Latinos in community organizing or advocacy for PP. Thus, there is a discrepancy in representation of the served population in advocacy numbers and PPFA is trying to change that.

Next, we met with Elizabeth Talmont and Montsine Nshom who were a part of the Consortion of Abortion Providers Services. Planned Parenthood may be synonymous with abortion services to many people, we found out that abortion services are actually only 3% of Planned Parenthood's services. Additionally, there is not access to abortion services across all affiliates, so PPFA has set long-range requirements for the services that each affiliate must offer (not every clinic within an affiliate though).

After a nice lunch break with Susan, we learned about the evaluation and accreditation process for affiliates nationwide with Deborah McHugh followed by an introduction to Development operations with Beth Friedmann. Development work entails the coordination of donors and donations. The current big project is a streamlining of PP funding with the Collaborative Fundraising Initiative, which will create a pooled fund for donations to both the federation and affiliates and will cut down on paperwork and duplication.

The last meeting of the day was with Jeanne Ewy, the Managing Director of PPFA-International, a sub-division of PPFA, not to be confused with International Planned Parenthood Federation (IPPF). PPFA-International currently works mainly in Latin America and Africa and provides support and expertise to help develop family planning services abroad with the goal of building system capacity so that the support can be removed eventually.

After a packed day in the office, I headed home with plenty of reading material for the train back. Perhaps the most surprising fact of the day may have been that less than 80% of employees of PPFA were female (all employees polled believed the number to be higher)!

When I applied for the Planned Parenthood Princeternship I was a bit nervous. I walked into their New York City headquarters with only a spotty idea of what it might be like to work in the nonprofit world. However, I learned so much in my two days tenure that I feel I left with a much more complete view of work outside the corporate sector. I am grateful to my Princeternship host, Ms. Susan Zilber ('76) for this opportunity.

Everything from the introductory video that Elizabeth Nunez, the Internship coordinator, showed us, to the meeting with Jeanne Ewy, a member of the International Department, to the casual lunch conversation with some new employees, was not only informative but also entertaining.

I applied for this Princeternship because, while I've always wanted to work outside the country and in a health-related field, I had only recently developed an interest in working in the nonprofit world. Planned Parenthood's focus on resolving global health issues specifically made it seem like the perfect place for me to wet my feet to work outside the corporate sector.

During my visit, I learned about how Planned Parenthood utilizes a corporate structure that emphasizes accountability--specifically through its accreditation board-- with a nonprofit delivery of services to achieve a type of synergetic success that neither strategy could achieve by itself. I also found my meeting with Destiny Lopez, the Director of Latino Engagement, very helpful. She spoke about how Planned Parenthood takes into account how sensibilities change from culture to culture when engaging with clients. One example I remember is that Tupperware parties are used to create a space where Latinas can talk openly about sexuality and sexual health. 

I am also appreciative about the transparency and frankness with which the members of Planned Parenthood spoke to me. They told us about all the negative consequences that result from the opposition that Planned Parenthood faces. It never occurred to me to think that all the money Planned Parenthood spends defending itself should be viewed as opportunity cost. Every dollar spent fighting the slander and libel it is subjected to is a dollar taken from an HIV-infected girl in Ethiopia or a struggling teen mother in Mississippi.

I was also disappointed to learn about the negative effects that an adverse political climate has on Planned Parenthood's international mission. During a teleconference with Chloe Cooney from their DC office, Emily and I learned how foreign countries' health care systems end up being affected by American politics.

Princeternship Day 1

I met Dr. Erika Petersen ('96) on the second floor lobby at 5:45 in the morning on Monday.  It was early and we hit the ground running.  She had already had a trauma case to work on from earlier the morning and had been in the operating room (OR) already that day.  She greeted me and introduced me to the case at hand while we walked toward the OR.  I changed into scrubs before entering the sterile areas leading up to the OR.  We proceeded to enter the OR and I got my first taste of surgery.  We walked over to a computer and Dr. Petersen explained the basics of reading a CT scan and how what she did surgically would fix the problem.  I learned a lot here about how to read CTs and translate that into the anatomy of an actual patient.  I was immediately impressed by Dr. Petersen's knowledge; she answered all of my questions about CT scans comprehensively and even would go on to describe things related to my question, aiming to give me an immersive experience as possible.

After some prep with the CT scans, we went to a lounge to wait while other technicians were prepping the OR for the next patient.  I asked Dr. Petersen about the path she had taken to become a neurosurgeon and she described her experience at Princeton, subsequent time in health management consulting, and then her return to medical school to become a neurosurgeon.  Soon, we were ready for surgery.

The first patient had a cranial stenosis (or narrowing) of one of the canals in one of the vertebra that allows the nerve to pass from the spinal cord to the location it innervates in the body.  To fix this, Dr. Petersen and her resident put a plug into the vertebra in question to give it extra support such that it won't crush the nerve and then put a titanium plate across the vertebrae in question and its neighbor above.  This would relieve the symptoms the patient was complaining about by allowing the nerve adequate space to function properly.  This first surgery introduced me to the mechanistic workings of an OR.  It is a team of medical professionals all in place to do key tasks to support the surgery going on.  I realized the dynamic nature of a neurosurgeon's job, interacting with a variety of individuals to solve medical problems in actual people.  For this prospective neurosurgeon, it was an awesome experience.

After this first surgery, we went to rounds to check on all of Dr. Petersen's patients.  These people were mostly people Dr. Petersen had operated on the day before and she was watching them to monitor their recovery from surgery.  After rounds, we grabbed lunch in the cafeteria and went back to another OR lounge to eat.  I talked to Dr. Petersen about the health care profession some more and we started talking about her thoughts on health care reform, a subject I had been interested in since my PACE Center Breakout trip studying health care last Fall Break.  I especially appreciated Dr. Petersen's views given her fellowship in England in functional neurosurgery.  She trained there after her residency to become specialized in functional neurosurgery and she said that part of the reason she chose England was to see a socialized health care in practice.

The next surgery after lunch was fairly simple, but was definitely the most exciting surgery of the day.  A patient needed an antispasmodic medication to help with muscle tightness from an injury sustained the prior year.  Instead of taking a large amount of this medication orally, Dr. Petersen had decided to implant a pump that would supply the medicine directly into the spinal canal, helping to deliver the medicine in a very regular way.  For this surgery, I got to stand right at the patients head near the anesthesiologist, getting a front row seat to the show.  First, Dr. Petersen made an incision to put the tube into the spinal canal.  This process was similar to an epidural.  Then the abdominal cavity was opened and some fat removed to make a pocket for the pump.  Then a hollow rod was used as a tunnel connecting the back to the front.  This technique surprised me with its simplicity and cunning.  Instead of having one large scar where the pump cable would have to lay if Dr. Petersen had to cut front to back, this tunneling method simple reduced the scarring to only two small scars on the front and back.

We finished the day with a few more rounds, checking on patients and then I left for home.  Dr. Petersen introduced me to her resident and another doctor and I was supposed to meet them early in the morning to go on the resident's rounds.  I had an early day in front of me.

Princeternship Day 2

This morning was earlier than the previous one, but the events of today more than made up for it.  I met a team of residents and interns in the neurology wing and the chief resident had each other resident or intern present each patient that the team had been taking care of.  While this might be seen as tedious or routine, it was very engaging for me because rounds are a critical part of the process of becoming (and then being) a doctor.  I got to see a variety of patients in a variety of conditions and any questions I had were answered by Dr. Ghandi, the resident that had been working with Dr. Petersen.

After rounds, I followed Dr. Ghandi until we met Dr. Petersen at a gamma knife conference later that morning.  On the way to the conference, Dr. Ghandi and I had to get consent for the day's surgery:  Deep brain stimulation to relieve Parkinson's symptoms.  The idea behind neurofunctional surgery is to implant some sort of medical device to alter the brain state in some way with the goal of producing a (hopefully) positive effect on a neurodegenerative disorder.  After getting consent from the patient, we continued on to the gamma knife conference.  Here a panel of doctors looked at prospective cases (various patients with various types of brain tumors) with the task of determining which patients would be good candidates for the surgery (i.e., which patients would benefit the most from it).  Gamma knife technology allows for precision ablation of certain tumors but there are many important factors to consider including location of the tumor and size, along with the type of cancer as some cancers are more resilient to radiation than others.  I appreciated the chance to sit in on this panel because it helped emphasize the collaborative aspect of the medical profession.

After the gamma knife panel, Dr. Petersen and Dr. Ghandi prepared for the DBS surgery.  The patient at hand had already had this surgery done once (but the electrodes weren't placed optimally) so first the old electrodes had to be removed.  Then, an MRI was taken of the patient to get a three dimensional image of the patients brain.  An external frame was placed around the patient's head with a metal ion solution that would show strong signal on the MRI such that a three-dimensional reference frame could be generated from the measurements.  The location of the right neural locus (the brain spot that had been damaged and was causing the Parkinson's symptoms from this disruption) could be calculated relative to this external frame and then the placement of the new electrodes (depth into the brain from the frame) could be calculated to see how far into the brain Dr. Petersen needed to go in order to hit the right target.  Cutting edge surgery!

After the electrodes were placed, each implant was tested by stimulation with a test device such that placement could be checked.  If the electrodes were in the right place then the patient should report a relief of symptoms when the test current was applied.  Dr. Petersen would go in another day once the electrodes had healed into place and connect another electric source that would provide the constant voltage required to suppress Parkinson's symptoms.

After the electrodes were placed, Dr. Petersen and I visited the family to update them on how the patient had done and answer any questions the family had about how the DBS technology would work once the new electrodes were up and running.  I was introduced to the personal aspects of medicine here.  At the end of the day, surgeons are working with real people with real lives and real family.  Patient care arguably becomes the most important part of medicine as a practice and being able to lessen the anxieties of a family and their concern for loved one can supersede knowing every last intricacy of the interior globus pallidus (although this knowledge is pretty important too!)

Princeternship Day 3

Today was spent in the clinic.  It was low key compared to the adrenaline rush of surgery in the operating room but was still quite interesting as it presented yet another important part of being a doctor:  solving medical puzzles.  Dr. Petersen and her nurse spent the day seeing a list of patients.  They grabbed a room with a couple computers for viewing MRI/CT scans of patients they were about to see and used that as a base of operations of sorts.  The typical process went like this:  Dr. Petersen would retrieve any records (primarily MRIs) the patient had and used this to get an idea of what the problem may be.  Scans were from all different parts of the head and neck depending and abnormalities in a certain area would correlate with a certain symptom that Dr. Petersen could use to diagnose the problem and then suggest a treatment.  After getting an idea of the patient's health, Dr. Petersen would go talk with the patient, ask them their medical history and a description of what was wrong, then perform a series of neurologic tests, such as having the eyes follow Dr. Petersen's moving finger, to determine function.  Damage to a certain part of the brain or spinal cord would hinder a patient's ability to, for example, move their arms up against resistance and in this way, Dr. Petersen could confirm any suspicion she had as to the problem associated with the symptoms the patient was presenting.

I got to see a wide variety of people, several of whom had traveled from fairly far areas of Arkansas to come visit Dr. Petersen in Little Rock.  I got to hear theirs stories and gain a little bit of insight into their lives.  The clinic experience in this way helped to put a "face" to medicine, reinforcing the holistic approach to patient care that is essential to being a successful physician.  I highly recommend this internship for any interested in the medical field and especially if you have any interest in neurology or neurosurgery.  I have a much better idea of the demands (and rewards!) of being a neurosurgeon and this experience has helped me confirm my decision to go into medicine.  This Princeternship was highly rewarding and provided a lot of insight into the medical profession.  It was immensely interesting and furthermore, simply just a lot of fun!

DAY 1
I arrived in Little Rock on Sunday evening and met Dr. Erika Petersen ('96) not far from the University of Arkansas for Medical Sciences (AMS). Dr. Petersen described to me over dinner some of the operations she was scheduled to perform that week. She also discussed her experiences at Princeton as an undergraduate and I thought it was interesting to find out that she majored in history. In fact, Dr. Petersen explained that medical schools often look for students that show diverse academic experience and in this respect she was glad she had majored in History at Princeton. I was happy to hear this since although I want to go to medical school after Princeton, I want to major in Ecology and Evolutionary Biology as opposed to the typical pre-medical subjects like Molecular Biology and Chemistry. Toward the end of dinner Dr. Petersen was paged to go into the hospital to perform an emergency shunt surgery on a little girl since she was on call that night.

DAY 2:
I woke up early to meet Dr. Petersen at 6:40 a.m. so that I could accompany her to visit the patients that she would be operating on that day. It was interesting being on the other side of the line so to speak since up until then I had only experienced doctor-patient interactions from the perspective of a patient. I also realized that although it is necessary to answer any questions concerned patients and family members may have, with the large number of patients needing to be visited in a short space of time, one cannot take too long speaking with any one patient simply because of time constraints.

It was an especially busy day for Dr. Petersen. She was due to perform three surgeries: a deep brain stimulation operation, a shunt operation, and a disectomy. Fortunately, Dr. Petersen had suggested websites for me to have a look at before watching the operations so that I could understand what was going on. The first operation was quite quick and involved an elderly man who had had a deep brain stimulator installed to stop his tremors. The battery had run out and needed changing.

Dr. Petersen and I grabbed a quick bite to eat before she was due to perform the next operation. She told me that one of the most useful pieces of advice she had been given when going through training was to eat whenever you have a chance, sleep whenever you have a chance, and use the restroom whenever you have a chance because you never know what might come up. I certainly came to see the value in this advice as I spent time shadowing Dr. Petersen!

The shunt operation took longer than Dr. Petersen had anticipated as it took some time to locate the source of the problem. Then it was straight on to the next surgery which was a disectomy. This operation ended up taking 3 hours and I realized that to be a neurosurgeon, indeed any kind of surgeon, you have to have a high degree of stamina and concentration. Dr. Petersen told me that she performed surgeries that took much longer than this, up to 10 or more hours long.

That afternoon I accompanied Dr. Petersen to check on how the patients were doing after their operations. It was remarkable how the elderly man's tremors had almost completely stopped just from that relatively simple operation. Dr. Petersen remarked that successes like that help to overshadow the trials and tribulations often encountered in surgery.

DAY 3
I got up very early to meet the residents at 5:30 a.m. to do the morning rounds with them. Most of the residents were first or second year residents and were very helpful in answering any questions I had as we went around visiting the patients and taking note of any changes in their condition. Again, there were a very large number of patients that needed seeing to in a short space of time because after that the residents had to attend a meeting which was partly a review of the recent board examination they had taken as well as a meeting with the other UAMS neurosurgeons to discuss current cases and get each other's opinions and input. Throughout the trip it was very clear to me that as a surgeon you have to be able to converse and work with a wide range of people, from patients to nurses to specialists in other fields of medicine.

After the meeting Dr. Petersen was scheduled to perform two spinal cord stimulation operations. These operations were unusual because both patients would be awake for the duration of the operations because Dr. Petersen needed to be able to talk to the patients and ask them questions in order to determine the exact correct placement of the devices being installed to ameliorate the pain the patients were experiencing. Here I witnessed what a tough job surgery can be since the patients were unavoidably nervous and wanted to get the operation over with as quickly as possible, yet Dr. Petersen had to be very careful to place the devices properly even though she was under a lot of pressure from the patients to finish up as soon as possible.

I also met with a number of technical representatives from the companies who manufacture the devices such as the spinal cord stimulators. Their job involves being present for such operations so that when the time comes, they can step in and operate a measuring device that determines if the devices are working optimally. They were very helpful in explaining to me how the devices operate as well as exciting future devices and applications that are in the pipeline.

Later that day I sat in on an operation to remove a brain tumor performed by one of Dr. Petersen's colleagues who specializes in such surgeries. The surgery involved a very fine and precise operation and careful delineation of the brain structures in the vicinity of the tumor and the residents present were kind enough to point out to me on the screen the different brain regions and tissues and their distinguishing features. Once the tumor had been removed, Dr. Ghandi, one of the residents and I took a sample down to the pathology department to identify what kind of tumor it was. Again, this involved making very fine distinctions that take a long time to master.

During the operation a very distinguished neurosurgeon, Dr. Yasargil, appeared to observe the operation. Dr. Yasargil is known widely as the father of neurosurgery and the founder of microneurosurgery. It was quite humbling to be in the presence of such a revered and brilliant man.

That evening, Dr. Petersen very kindly took me out for dinner as I would be leaving the next day. It was really wonderful to hear her take on things like balancing career/work with family and social life, how neurosurgery and neurosurgery training differs around the world, and many other things.

DAY 4
On my last day in Little Rock, Dr. Petersen had clinic. She met with a number of new and returning patients and I was fortunate enough to be allowed to sit in on the consultations. I got to see the kind of doctor-patient interaction which is so important in the work of a surgeon. The diversity of patients was very great, from many levels of socioeconomic and educational levels and Dr. Petersen was required to handle a diverse range of situations and questions that did not always relate to her particular role as the patient's neurosurgeon.

After a busy day of seeing patients, I had to rush to the airport to catch my returning flight.  My brief experience in Little Rock with Dr. Petersen and her colleagues had left me greatly inspired and with much to think about.

On both days, we were picked up promptly at 8:30 AM by a friend of ours and arrived at Dr. Richard Levandowski's ('70) office by 8:45 AM. At this point, the nurse in the office handed us white coats and we then proceeded to shadow Dr. Levandowski up until noontime. After spending forty minutes at lunch, we headed back to the office and continued to shadow the doctor up until 5:00 PM. Along the way we had the opportunity to talk to third and fourth year medical students doing rotations in the office. These students answered our questions about the medical school experience and residency.

During the Princeternship, we saw Dr. Levandowski evaluate a variety of patients (Parkinson's Disease, pneumonia, shoulder pains, foot pains, etc.) and the medical students take down their medical history. We even participated in giving patients a full-body alignment (i.e., a full-body massage), wrote prescriptions, and occasionally, Dr. Levandowski would quiz us. We saw a wide range of patients, from deans of Princeton University to local high-school athletes, with sports injuries or other illnesses.

Both of us had shadowed physicians before, but Dr. Levandowski's warmth and passion for making people feel better was in contrast to what we previously saw. It made us realize that there was a wide variety of ways to treat patients and that Dr. Levandowski's method made his patients feel comfortable putting their full trust in him.

The thought of going to medical school is an intimidating one, one which we have to spend time to think about and explore through various activities, shadowing experiences, and talks with others. This Princeternship allowed us to witness a professional who truly enjoyed every minute of his job. Dr. Levandowski's love of medicine and his patients' love for him were evident in every appointment. This inspired us to fully commit to medical school and tackle all of the challenges ahead with this type of specialization as a possible goal.

We would enthusiastically recommend this Princeternship because of the environment Dr. Levandowski creates with his energy. He engaged us in various ways, whether it be asking us questions or sharing anecdotes, or giving us stethoscopes to give us a way to contribute to patient care in a small way. Dr. Levandowski and his staff made us feel welcome at every step, and it was a great experience. Although writing simple prescriptions and taking heart rates was fun, the true value of this internship was spending time with Dr. Levandowski and his caring staff.

Upon my arrival at Richmond's Ear, Nose and Throat specialists (known as Richmond ENT), I met Dr. Mike Armstrong ('85) and his partner Dr. Travis Shaw. I was then allowed to sit in on a collaboration meeting between the two doctors. This meeting, one of their weekly collaboration meetings, was focused on how to best transfer the group's medical evaluations from paper to technology. In examining a patient, the nurse now is required to fill out forms on the computer, rather than linguistically describe the patient's symptoms. The two doctors were working out the most successful system in which this evaluation would ensue.

Following this meeting, and for the remainder of the day, I shadowed Dr. Armstrong as he visited with each of his scheduled patients for the day. Throughout the day I saw an extremely wide range of medical issues. The first patient of the day was a middle-aged woman suffering from hoarseness. I was able to watch the examination Dr. Armstrong was able to perform on her, and then as he diagnosed her with what he thought was the problem: sleep apnea with a resulting acid reflux. We visited many other patients with similar symptoms, and I was able to watch Dr. Armstrong perform many video endoscopic examinations. I was able to see sinus polyps, tumors, septum deformities and other abnormalities.

Throughout the day we also saw many patients with enlarged tonsils and adenoids (two children in particular). Dr. Armstrong allowed me to see and observe the examination of throat nose and ears of these patients as well. There were a few patients with tumors, or cysts within their sinus cavities. I was able to observe a pre-op examination for a middle-aged man with a large tumor taking up the left cavity of his nose. I met and observed the check up appointments with patients that had already endured surgery months or years past: one man with throat surgery (now living with a voice box and microphone to talk through his throat), and a older woman who had recovered from nose skin reconstruction surgery (a result of skin cancer).

Later that day I was able to meet another woman visiting Dr. Armstrong for nose skin reconstructive surgery due to skin cancer. This was her pre-op appointment, immediately following her actual skin cancer removal surgery. She came to the office with a large open wound on her nose from the skin cancer removal. She discussed the options for her reconstruction with Dr. Armstrong for her surgery the following day.

The last thing I was able to see, and actually partake in on Thursday was the viewing, and videotaping of a balloon sinuplasty surgery. Although not invasive enough to take place in an operating room, the balloon sinuplasty is an internal procedure that opens a sinus passage. Not only was I able to watch this externally, but also able to see the process through an internal video tape projection on a tv.

The majority of my day on Friday mirrored that of Thursday, shadowing Dr. Armstrong around the office visiting with patients with varying symptoms. In addition to some of the things I witnessed on Thursday, I was able to watch some small cosmetic procedures on Friday. In addition to steroid injections, I was able to witness botox injections.

The most interesting part of my princeternship was the nasal reconstructive surgery I was able to watch on Friday morning. This operation was to help repair the open wound on the nose of the skin cancer patient who had visited the office on Thursday. I was able to go through the entire process of getting dressing in scrubs and getting ready for the operation. I was exposed to the entire surgery, including watching the intake of anesthesia (meeting the anesthesiologist, who explained his job and the chemistry behind some of his work). During the surgery I watched as Dr. Armstrong first measured and planned the way he would reconstruct the nose, and then as he made the necessary cuts on the nose and forehead. While watching this surgery I was able to see a very large portion of the forehead part of the skull as Dr. Armstrong pulled back the skin. The surgery mostly entailed the relocation of part of the forehead skin onto the wound on the nose (keeping part of the skin connected at all times). I learned that by not detaching the skin from the body, the disparity between new and old skin will be less due to constant blood flow through the reattached skin. Through this surgery, my fascination with the medical field grew immensely. I also became confident that I can handle the gore of surgery, and not get nervous or scared while seeing all the blood.

Overall my experience with Dr. Armstrong was one that cannot be put into words. Not only was I exposed to a surplus of an enormously diverse group of medical issues, but I was able to see the true lifestyle of an ENT surgeon. Both in and out of the operating room, Dr. Armstrong helped to teach and show me the different parts of his profession. From this experience, I have decided to go pre-med, and get on track with those classes next semester. Of course I have a very long time until I need to decide a specific medical field, after completing this princeternship the ENT and plastic surgery fields have sparked my interest.

Day 1: Monday, March 14, 2011
Today was my first day. When I arrived at 8:30 am, Dr. Parham Ganchi ('87) wasn't yet in his office, so I met Karen, who is in charge of financial negotiations. She gave me a quick tour of the practice - she showed me all the patient rooms, discussion rooms, and even the operating room. She also explained how the patient information is documented and the schedule is organized in the computer. I was then introduced to the medical assistants Michelle and Carly. Then, Dr. Ganchi arrived. We met and he outlined the course of the day. Today was "Patient Day." That means that we were going to see a lot of patients coming for pre-op or post-op consultations. We would also see a few minor procedures, such as Botox injections. I also met Allison, who is in charge of skin treatments such as microderm abraision. I got to walk into the patient rooms with Dr. Ganchi and sit in on his consultations. For the pre-op patients, I got to see how Dr. Ganchi introduces himself, and how he explains all of the different procedures that can be done to get the results the patient wants. I learned about the pros and cons of different types of implants, and I also learned about many different types of procedures and their effects. From the post-op patients, I was able to see the results of Dr. Ganchi's work, and learn about the recovery process. I also got to learn about the process of making medical notes. There were many patients, and they all had a lot of questions, so the day was long. I left at about 7:30 pm.

Day 2: Tuesday, March 15, 2011
Today was my second day. I arrived at about 8:20 so that I would have time to change into scrubs. Michelle, one of the medical assistants, gave me scrubs, shoe covers, a hair net, and a mask. She told me I would be seeing three surgeries today. It was very exciting! Then I went into the operating room and watched the medical assistants set up. I learned about preparing for surgery in a sterile way. Then I met Dr. Lee, the anesthesiologist who works with Dr. Ganchi. He taught me a bit about the chemical preparations he was using. He also taught me that different people react differently to different medications - some fall into a deeper sleep than others. However, it is always important to carefully monitor the patient's breathing. When everything was set up, I met Dr. Ganchi. He told me a bit about the procedures I was going to see that day - a breast augmentation, a vertical breast lift, and a labiaplasty. Then the first patient came in, and Dr. Lee administered the anesthesia. While Dr. Ganchi was working, he explained each step of the process to me. It made a lot of sense, because I was already familiar with some of the material (he had explained much of it the day before to the patients on "Patient Day.") I was pleasantly surprised to discover that I did not get queasy at all! I was able to learn a lot, and though some of the procedures were very long, they were instructional and interesting to watch. I left at about 8 PM.

Overall, this Princeternship was an excellent experience. It was much more interactive than any shadowing I had done before - I was able to go everywhere that Dr. Ganchi did. I got to see his interactions with his staff and with his patients. I gained much knowledge about the plastic surgery field. The days were long and action-packed. The Princeternship was organized very thoughtfully into two days - an informative "Patient Day" followed by a demonstrative "Surgery Day." Everyone I met was welcoming, helpful, and kind. I certainly enjoyed my experience, and I would highly recommend the program!

Following a very early flight out of Newark and a connection in Charlotte, I finally arrived at UNC Chapel Hill's campus, where I met my host inside a nearby coffee shop. Dr. Rebecca Wells ('88) is an Assistant Professor in Health Policy and Administration at the University of North Carolina Chapel Hill's Gilling School of Global Public Health. I shadowed her for the remainder of the day, before my late-night flight back to Newark.

First, I accompanied my host in a departmental meeting, where she met with about 4 colleagues. They were discussing their many research projects, one of which was not doing very well, and some of which were yielding positive results. They brainstormed on how to improve the faltering project. Suggestions touched upon funding, changes in data collection methods, changes in data analysis, etc. Second, I had a bit of free time with which to talk to my host. I briefly visited her office. She showed me some surveys relating to one of her research projects, and answered numerous questions on health policy. Third, I sat in a seminar taught by my host to a group of students enrolled in a doctoral program entitled "Strategic Management in Health Leadership". This was their first lecture of the semester, but I got to sit in and look through her lecture on casual loop diagrams. Apart from my host, I met a few of her colleagues, who are also researchers at the School of Public Health. They were all very receptive and kind, and the work environment seemed collaborative. However, while they work together in developing ideas for their research efforts, they also seem to work in a very individualistic fashion when it comes to completing their part of the project.

I also got to meet my host's students and read about their various academic and career backgrounds. They had worked in a variety of different health initiatives all over the world. They were doctors, directors of community health centers, social workers, directors of global health programs, etc. I was also able to interact with some of them in the classroom setting. Looking back, this might have been the most crucial aspect of my Princeternship, since it allowed me to see the variety of fields and places that these students had been able to cover with their interest in health care.

With that said, I think the Princeternship reinforced my desire to study Public Health, since my host's students showed that an education in the field will likely make me a better physician. Specifically, it has made me realize that I might want to study health systems, which would allow me to look at many different levels and types of health care delivery initiatives all over the world. Hence, this experience was paramount in showing that I want to study Health Policy in a more global framework.

I also learned of obstacles my host had to face in her work, including the financial crisis and the state government.  The closer one comes to seeing the reality of the American health care system, the more appreciative they must become of the people who struggle to work with it.

I would recommend this Princeternship for students who already have a basic understanding of the American health care system, and health policy. Students who have no previous exposure to the field might also benefit, but not to the same extent. This is not to discourage students from being interested. Rebecca Wells was an extremely kind host and a very receptive teacher. I am sure anyone would learn a great deal from her. This was quite a rewarding experience, and I am very grateful.

Monday, Jan 24th
We arrived at the Emory University - Midtown Hospital at around 7:30 am, unsure of what to expect. At first, it was a bit confusing because we were unsure where to go, but the person at the information desk directed us towards the OR area, and we called the OR reception to let them know that we were supposed to shadow Professor of Neurosurgery & Orthopedic surgery, Dr. Gerald Rodts ('83). They gave us temporary badges (very important!) and scrubs, and we met Dr. Rodts around 8 am. He was extremely kind in welcoming us and explaining the surgeries that he was about to perform. The first surgery that we witnessed was of a patient whose C1 and C2 bones in her spinal cord had come loose, so Dr. Rodts and another surgeon were working to fuse the bones together. The procedure lasted a little over an hour, and afterwards, Dr. Rodts almost immediately went into another surgery. The second patient had a slipped disk in her lower back, so Dr. Rodts performed a lombarectomy to remove part of the L4 bone that was pinching the patient's spinal cord. I learned from Dr. Rodts that most neurosurgeons do spinal work, not brain surgery. What most surprised me today was the equipment that surgeons used. To put in metal screws, rods, and supports, the surgeons actually used screwdrivers, hammers, and even a chisel!

Tuesday, Jan 25th
On Tuesday, Dr. Rodts had regular clinic work, so he sent us to his colleague Dr. Dhall in the Grady Memorial Hospital. There, we watched two of Dr. Dhall's residents perform a cranioplasty, which entailed fitting a hole in the patient's skull (bone had to be removed earlier due to an infection) with a polymer replacement. Afterwards, we listened to the residents talk about some of their other patients, and we got to attend another surgery in the afternoon. They had spotted an abnormal mass in the spinal cord region of a patient near the T12 bone, and they performed surgery to determine whether the mass was a tumor or some kind of cyst. After cutting into the patient, they determined the mass to be a huge tumor, which they resected and determined to be an intradural adenoma after lab analysis. Later in the day, we also met a first year resident who talked to us about the long on-call shifts that can last up to 30 hours straight...

Wednesday, Jan 26th
We were back at Grady Hospital on Wednesday morning, and we arrive just in time to see the end of an emergency case where a patient had a bullet wound to the head. The surgeons left the bullet in since it was too risky to remove, but they sewed up the wound cleanly. We later found out that we did not have the appropriate badges, so we were redirected instead to the Emory University Hospital, where we met Dr. Dadashev, the chief resident. There, we watched Dr. Gross perform a corpus callosectomy to mitigate seizures experienced by an epileptic patient.

Overall, I think the experience was very interesting and definitely eye-opening in some ways. I'm not sure I want to be a neurosurgeon myself, but I definitely feel that they have a very cool and incredibly helpful job.