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!