Day 1: Jan­u­ary 9, 2012

Today marks the start of my 3-day Princetern­ship at the Stan­ford Uni­ver­sity Med­ical School, and what a beau­ti­ful day (Cal­i­for­nia sun is glo­ri­ous! I almost for­got what it felt like to sweat…)! This morn­ing Tay­lor, the other Princetern, and I met Dr. Kiki Chang ’88, a child psy­chi­a­trist and clin­i­cal researcher. Dr. Chang is the Direc­tor of the Pedi­atric Bipo­lar Dis­or­ders Pro­gram and Asso­ciate Pro­fes­sor at the Stan­ford School of Med­i­cine. He also played ulti­mate fris­bee at Prince­ton— shout out to Clock­work! After intro­duc­tions, Tay­lor and I met with Rosie Shoe­maker and Sher­rie Li, the clin­i­cal research coor­di­na­tors. Sev­eral clin­i­cal research projects are ongo­ing under Dr. Chang’s direc­tion, and we were able to watch Meghan Howe, clin­i­cal research man­ager, con­duct an inter­view with a nor­mal teenager who was a con­trol patient in a 5-year lon­gi­tu­di­nal study fol­low­ing con­trol and chil­dren with bipo­lar dis­or­der.  As part of the inter­view, the patient was asked a series of per­sonal ques­tions. I was sur­prised to see that the research assis­tants had such strong rela­tion­ships with the patients to the extent that the chil­dren were even com­fort­able shar­ing pri­vate details about their lives. After­wards, we observed the patient com­plete face recog­ni­tion and face mor­ph­ing tasks that tested for things such as the abil­ity to iden­tify emo­tions and the­ory of mind.

In the after­noon, we attended a mood dis­or­ders meet­ing with Dr. Chang and other researchers and physi­cians work­ing in related fields. There is cer­tainly a spirit of col­lab­o­ra­tion amongst researchers. Part of the meet­ing focused on genet­ics and the search for a genetic link to sev­eral of these mood dis­or­ders. We left the meet­ing early to meet Dr. Rex Huang, the child and ado­les­cent psy­chi­a­try Chief Fel­low. Dr. Chang and Dr. Huang dis­cussed updates about sev­eral patients (what was going on in their lives, if any changes in med­i­cine dosage were nec­es­sary). Although many patients were diag­nosed with the same mood dis­or­ders, every patient was dif­fer­ent— each patient faces dif­fer­ent envi­ron­ments and fam­i­lies that influ­ence their moods. I had never real­ized that there was such diver­sity in the onset of bipo­lar dis­or­der or depres­sion and other mood disorders.

To end our first day as Princeterns, Tay­lor and I accom­pa­nied Dr. Chang to the Lucile Packard Foun­da­tion, an orga­ni­za­tion that helps fundraise for child health pro­grams. We walked into an impres­sive board­room with an enor­mous table sur­rounded by the peo­ple who would poten­tially help secure donors Dr. Chang gave a pre­sen­ta­tion out­lin­ing his clin­i­cal research and the impor­tance of grants or phil­an­thropy to really keep the research going. While con­di­tions such as autism have gained a larger pres­ence in the pub­lic eye (and a sub­se­quent increase in dona­tions), the per­sist­ing stigma sur­round­ing bipo­lar dis­or­der has made it dif­fi­cult to secure dona­tions from pri­vate donors.

Day 2: Jan­u­ary 10, 2012

Fel­low Princetern Tay­lor, Eva­line, and Dr. Chang

Today was my favorite day of the Princetern­ship as it is Dr. Chang’s “clin­i­cal day,” where he sees patients for pri­vate con­sul­ta­tions. Tay­lor and I began the day with a debrief­ing ses­sion in Dr. Chang’s office, dur­ing which we dis­cussed our goals and expe­ri­ences at Prince­ton so far as well as his life path and how he ended up where he is now. After Prince­ton, Dr. Chang went straight to med­ical school, but still paused and took time to pur­sue his inter­est in music and to really think about whether med­ical school was what he wanted to do. To hear this from some­one who is so accom­plished in his field and career was def­i­nitely a sur­prise. Peo­ple always say that “you have time to fig­ure out what you want to do” or that “you should explore your pas­sions and inter­ests.” But when push comes to shove, I always feel pres­sure (from par­ents, peers, and maybe just “soci­ety” in gen­eral) to really buckle down and com­mit myself to a con­crete path towards a rep­utable pro­fes­sion. As a stu­dent look­ing up at these accom­plished and happy indi­vid­u­als who are busi­ness own­ers or pro­fes­sion­als or doing amaz­ing things in the world, I seemed to always pic­ture them as hav­ing known what they wanted to do from the get-go; they were the spe­cial ones who didn’t have to strug­gle with fig­ur­ing things out, and that’s how they ended up at the top of their fields. To hear such can­did and sin­cere sto­ries from Dr. Chang about his own ques­tion­ing was unex­pected, but more impor­tantly both com­fort­ing and inspir­ing. When every­one around you seems to be very go-go-go (as is the case at Prince­ton), it’s scary to admit to your­self that you may not even know where to go, and it’s even scarier to dig your heels in the ground and stop— to take time to fig­ure out what you want to do. This talk with Dr. Chang was more reas­sur­ance that even if I walk away from this Princetern­ship not know­ing what career I want to pur­sue or what type of med­i­cine to prac­tice or whether or not to go into psy­chi­a­try, it’s all okay— as long as I do some­thing that I love and enjoy, I will (most likely) be great and accom­plished in that field (fin­gers crossed and knock on wood). Dr. Chang also dis­cussed with us the real­ity of his career and the bal­ance of research, clin­i­cal prac­tice, and acad­e­mia. Being involved in acad­e­mia requires a lot of trav­el­ing to con­fer­ences (often to Hawaii!), teach­ing, and (unpaid) men­tor­ing. Being involved in research requires deal­ing with the process of writ­ing and apply­ing for grants when you could be spend­ing that time doing much more pro­duc­tive things. How­ever, that’s sim­ply the nature of sci­en­tific research.

In the after­noon, we shad­owed Dr. Chang in his clinic mode and observed sev­eral patients dur­ing their vis­its. There were chil­dren (with accom­pa­ny­ing par­ents) who were diag­nosed with bipo­lar dis­or­der, depres­sion, ADHD, anx­i­ety, or schiz­o­phre­nia. At first, I didn’t know what to expect; I had never wit­nessed a child who has a mood dis­or­der, and I wasn’t sure how I would react if the sit­u­a­tion became intense. For­tu­nately, I ended up not hav­ing too much to worry about. Dur­ing each visit, Dr. Chang and the patient first dis­cussed updates on his or her emo­tional state, fam­ily sit­u­a­tion, and life in the past weeks in gen­eral. These updates allowed Dr. Chang to decide if the patient was mak­ing progress and if med­ica­tion dosage changes were required. It seemed like Dr. Chang and his patients had really close rela­tion­ships, and that aspect of psy­chi­a­try is appeal­ing to me. I was also drawn into each patient’s story; each patient has his or her own quirks and per­son­al­ity, and each exhib­ited the mood dis­or­der in dif­fer­ent ways.

Day 3: Jan­u­ary 11, 2012

This morn­ing, Tay­lor and I spent time learn­ing about the neu­ro­science aspect of Dr. Chang’s research. First, Dr. Amy Gar­rett, a research sci­en­tist and the neu­roimag­ing man­ager, gave us an overview of neu­roimag­ing with fMRI. We learned about the physics and sci­ence behind how fMRI works, the com­mon types of tasks used, and the dif­fi­culty with recruit­ing patients and man­ag­ing vari­abil­ity between patients and their brains. Next, Spencer Boucher, a neu­roimag­ing research assis­tant, showed us the struc­tural aspects of neu­roimag­ing. Although the tech­nol­ogy has made remark­able progress, Spencer uses a pro­gram called FreeSurfer to make touch-ups on the struc­tural brain images includ­ing nor­mal­iz­ing the images with a “stan­dard” brain. Finally, Ryan Kel­ley, another neu­roimag­ing research assis­tant, walked us through the sta­tis­ti­cal analy­sis of the data in one of the ongo­ing projects. One inter­est­ing thing that he men­tioned was that there is a change in how we approach sci­ence from when we’re an under­grad­u­ate to when we’re actu­ally con­duct­ing research. In real­ity, sci­ence isn’t as absolute as it appears in text­books; there are actu­ally a lot of assump­tions and lim­i­ta­tions in research.

Later in the after­noon, we attended a lab meet­ing with Dr. Chang, his research assis­tants, and col­leagues, where they dis­cussed updates with ongo­ing research projects. Although every­one is busy with spe­cific tasks or parts of projects, they still get together to dis­cuss the research holis­ti­cally, which is pretty great. After the lab meet­ing, we joined Dr. Chang in his office to observe a patient who is par­tic­i­pat­ing in a clin­i­cal trial. Although sim­i­lar to the pri­vate con­sul­ta­tions from yes­ter­day, this patient was being paid to par­tic­i­pate in clin­i­cal research involv­ing med­ica­tion that could help with man­ag­ing bipo­lar disorder.

At the end of this Princetern­ship, I am extremely thank­ful for such a won­der­ful oppor­tu­nity and an amaz­ing expe­ri­ence. Every­one was gra­cious and will­ing to show us aspects of their research projects and clin­i­cal work. I enjoyed this insider’s peek into the daily work life of Dr. Chang. With my only impres­sions of the daily work life of a doc­tor com­ing from watch­ing “House,” I was sur­prised to see that Dr. Chang was involved in so much more than see­ing patients— it was amaz­ing to see how diverse a career in med­i­cine can be. All in all, this was a won­der­ful Princeternship!