David Thomas ’13, University of Arkansas for Medical Sciences

I arrived in Little Rock, Arkansas on Sunday the 19th of March, a little unsure of myself in a part of the country that I haven’t explored very much. I felt welcome from the first night on, though, after a warm dinner with fellow intern Chris Diehl and our Princeternship host, Dr. Erika Petersen ‘96(’96). We learned about the operations that Dr. Petersen had scheduled throughout the week and got a taste of her favorite pizza place in Arkansas. Once we had the week outlined, we started talking about some of our common experiences at Princeton and what we could look forward to in medical school.

We started the first day early for me at 6:45 am, but I soon became aware that this was a bit late for by hospital standards. Chris and I put on scrubs and met with Dr. Petersen’s patients for the day. Pretty soon I was observing my first surgery, and Dr. Petersen was careful to explain what she did and gave us a firsthand view of the procedure. I was thoroughly impressed with the expert knowledge of the body that Dr. Petersen displayed in replacing an electronic device that had been implanted in a patient. After finishing with the first patient she immediately got to work on a more complicated case which made full use of the cutting edge technology of deep brain stimulation. The patient whose surgery we observed had a noticeable alleviation of symptoms for a disease that I did not know could be treated so effectively, and I was really impressed to see it. We finished off the day by observing a spinal surgery that made use of another advanced technology to stay minimally invasive while making a dramatic intervention in the structure of the spine.

On the next day at the hospital, we got a broader survey of what surgeons at UAMS do. We started a bit later than the day before and split up between different surgical teams. Between me, Chris, and Arthur, another student observing surgeries for the week, we saw urological surgery, cardiothoracic surgery, and more neurosurgery. This packed day wrapped up with Dr. Petersen performing a spine surgery on an awake patient while explaining each step to Chris and me. We said goodbye to Dr. Petersen but hung around the surgery wing to observe an open heart surgery. Watching the heart beat inside a patient while the surgeons went to work was a really inspiring experience, especially having studied the heart so much without ever seeing one in action. Later on Dr. Petersen took Chris and me to dinner at a really impressive sushi restaurant, and we had a good chance to debrief a lot of our experiences and get a little more personal insight on the life story of a doctor.

On the Wednesday morning of our Princeternship Chris and I managed to wake up early enough to follow the residents for morning rounds. I’ve heard a lot about the intense lives of residents, so I was eager to see what things were like first hand. After finding our guide, a particularly helpful resident named Dr. Gandhi, we started visiting patients and listening to their symptoms and statuses. The residents on rounds displayed an impressive ability to take in and put together a stream of information about patients that needed diagnosis or treatment. Refreshingly, they all also seemed to enjoy their daily routine a lot, despite the intensity of life as a neurosurgery resident.

David, Dr. Petersen, and Chris

Following this, Chris and I observed the removal of a brain tumor by Dr. Day, the chair of neurosurgery at UAMS. We watched him perform the procedure while following the steps in a book describing the procedure that a resident had provided. Toward the end of the surgery we were surprised to learn that the author of this textbook was none other than Dr. Day himself! This was a really artful surgery, with a lot to appreciate how much the patient’s life would improve directly as a result. We ended the day with a visit to Dr. Petersen’s clinic, which really put more of a human face on the practices we had observed. Dr. Petersen seemed to really do her best to explain the technical side of complex procedures to patients, who in turn really appreciated the transparency and compassion she showed.

The last day of my Princeternship was in some ways the most exciting. I was lucky enough to see Dr. Petersen herself remove a very serious tumor from a patient in a very involved procedure which I was able to observe start to finish. Also, Dr. Petersen sent a sample of the tumor down to the hospital’s pathology unit, and I got a chance to see this other part of the hospital as well. The pathologist there classified it and explained what to look for and the severity of different types of brain tumor. Luckily for me, Dr. Petersen finished this very thorough tumor removal in time to grab a final bite to eat with me before I made my way to the airport to fly home.

We ate with Arthur and Dr. Gandhi and had a conversation that was enlightening for me about the role of research in medicine. Dr. Gandhi, an MD/PhD who worked on metabolism of neural cells during his PhD, had a lot of insight to share with me since I’m interested in pursuing an MD/PhD and I’m involved in metabolism research. Dr. Petersen also shared a few thought provoking stories about the history and future of neurosurgery research. I left that night with nothing but positive experiences from my Princeternship, for which I really have to thank Dr. Petersen for carefully setting up such an inspiring experience for undergrads. I would highly recommend this Princeternship to future students as an opportunity to get a first hand view of the practice of medicine and the positive things it can bring about.

Christopher Diehl ’13, University of Arkansas for Medical Sciences

Shortly after I arrived in Little Rock on Sunday evening, I met Dr. Petersen ’96 and the other Princetern outside the student housing dorms near the University of Arkansas for Medical Sciences (UAMS).  She drove us to a nearby restaurant where we discussed the schedule for the next few days over pizza.  During our conversation, we also talked about the path that Dr. Petersen took to become a doctor, and I was surprised to learn that she was a history major and that she spent a few years in consulting before going to medical school for neurosurgery.  After dinner, she drove us back to the dorms, where we prepared for an early start to the next morning.

Day 1

We started the day by meeting Dr. Petersen in the 2nd floor lobby at 6:45 am.  From there, we changed into scrubs and observed Dr. Petersen as she met with the patients on whom she would be operating that day, which was my first real introduction to how doctors and patients interact.  One of Dr. Petersen’s areas of expertise is deep brain stimulation, which involves implanting electrodes in certain areas of the brain to counteract things like tremors and seizures.  The first operation was relatively quick, and it involved changing the battery (located near the pectorals) that produces the electrical signals to block seizures in the patient.

The 2nd operation was probably one of the most interesting operations I saw on the entire trip, and it involved considerable prep work.  They were installing electrodes in the brain of a patient with Parkinson’s disease who had significant tremors in his left arm.  Because the target area of the brain was so small, they had to be very precise when implanting the electrode, so Dr. Petersen and her colleagues analyzed MRI results to determine the necessary measurements.  One of the things that stood out to me about this operation was that the patient was actually awake the entire time, even as holes were being drilled into his head.  Without a doubt, though, the best part about this experiment was that once the electrodes were installed and turned on for testing, the man’s tremors stopped immediately (he even said that he “felt finer than a frog’s hair”).  It really was amazing to see the transformation, as all the stiffness in his arm disappeared too, and his motions were smooth.

Before leaving, we also observed some of Dr. Petersen’s colleagues performing a spinal surgery which required inserting rods and screws in the vertebrae.  This procedure involved the use of some very high-tech equipment that used something like a GPS to allow the surgeons to see where the screws were being placed in the vertebral column on a TV screen.  It was really cool to see the integration of cutting edge technology into medical procedures to make the surgery less invasive.

Day 2

We were able to wake up a little later on the second day, but as soon as we arrived and changed into our scrubs, we were immediately whisked away to watch surgeries.  The first surgery I saw was prep work for a deep vein harvest, in which a vein in the patient’s thigh was isolated from all the other side veins.  In the actual harvest and subsequent surgeries, this vein would be used to repair/reconstruct the patient’s aorta.

After that surgery, we met back up with Dr. Petersen, who was performing spinal surgery on a patient who was also awake.  Dr. Petersen and her colleague were installing a device against the spinal cord to help reduce some the patient’s chronic pain through the use of electrical signals.  Throughout the procedure, Dr. Petersen was communicating with the patient both to make the patient feel comfortable with what was going on in her back and to assess whether there were any problems.

Fellow Princetern David, Dr. Petersen, and Chris

After Dr. Petersen’s surgery was complete, we moved to another OR to observe a heart valve replacement.  This was a very intensive procedure, so every space around the patient was filled, which prevented us from seeing much, but one of the anesthesiologists offered us the chance to observe some of the surgery from their position.  Although we didn’t see the whole procedure, which was supposed to take a fairly long time to complete, I still appreciated the opportunity to see an open heart surgery.  It’s not every day that you actually get to see a beating heart inside someone’s chest.

Later that night, Dr. Petersen took us out to dinner again, where we talked some more about the types of procedures she does.  We also got a chance to find out about her medical school experiences and what it’s like trying to balance work and school responsibilities with a social life.

Day 3

We had our earliest start yet at 5:45 the third morning when we went on rounds with the neurosurgery residents.  Because they only had a limited amount of time to meet with each patient, I saw that they were very efficient when it came to checking up on the conditions of their patients.  Furthermore, they were very helpful in explaining what was wrong with the patients and answering any questions that we had.

Most of the rest of the day was devoted to watching a brain tumor removal.  Before the surgery, I was surprised at how long it took to position the patient, but one of the surgeons explained that they needed to make sure that the patient wouldn’t lose circulation or pinch any nerves if held in the position for a long time.  It turns out that their prep work was certainly necessary, as this was the longest operation that we saw by far.  Procedures like this reminded me of the incredible patience that a surgeon must need.  I also realized that wearing comfortable shoes in the OR is a must, since standing around for long periods of time definitely causes some foot pain.  Because the surgery required was so precise, the surgeons had to use a sort of microscope to view their work, which was great because it also showed a picture of what they were seeing on a TV screen.  Other residents in the room were very helpful in explaining what parts of the brain we were seeing, and what the surgeon was doing.  There was a bit of trouble removing the tumor all at once, but after a long time of removing it bit by bit, it was finally gone.

Shortly after the surgery ended, we took the opportunity to shadow Dr. Petersen in her clinic at the end of the day.  Watching Dr. Petersen meet new patients and check up with post-op patients was again a very enlightening experience and taught me more about patient care, which is one of the most crucial aspects of being a good doctor. 

This Princeternship was an amazing experience, and I’m sure that many of the memories I have of it will stay with me as long as I live.  It was incredibly rewarding and gave me more insight into what the life of a surgeon is like, and for that, I would like to thank Dr. Petersen and all of her colleagues at UAMS.