Marina Nogueira ’15, The Children’s Hospital of Philadelphia

Tuesday, January 10, 2012

This morning I rode the train to Philadelphia with two other students to meet Dr. Howard Snyder ‘65 at the Children’s Hospital of Philadelphia. Dr. Snyder is a renowned urologist who helped establish the division at CHOP. When we arrived, Dr. Snyder and his assistant, Sharon Brown, were very welcoming and showed us around the Division of Urology. Evelyn Siu ’15 and I decided to shadow Dr. Snyder today in clinic. By 9:30 am, we were quickly absorbed into Dr. Snyder’s routine. His first patient was a baby girl who had recently been taken to the emergency room for a very high fever. She was suspected to have had a urinary tract infection (UTI). Dr. Snyder explained UTIs very carefully to the girl’s mother and I was impressed by Dr. Snyder’s focus on education. With all his patients, he made sure to explain to the parents what was occurring. It was clear that the parents found Dr. Snyder’s explanations very helpful, and reassuring in some cases. Other patients that came to Dr. Snyder today ranged in the ages from eight months to thirteen years old. Some of them had recent UTIs while others came in for kidney and reflux concerns. I learned the differences between the symptoms of a bladder infection versus a kidney infection and how to look at renal scans. I am really impressed by how much I learned today. Shadowing Dr. Snyder was very exciting and I cannot wait to come back tomorrow.

Wednesday, January 11, 2012

Dr. Snyder and his Princeterns

Instead of shadowing Dr. Snyder today in clinic, we were given the opportunity to shadow one of Dr. Snyder’s colleagues, Dr. Sarah Lambert, in the operating room (OR). We were introduced to the urology residents and were then shown to the locker rooms where we dressed in scrubs. In the OR, I saw the anesthesiologist team prepare the patient for surgery. Once the patient was anesthetized and doing well, Dr. Lambert and the resident surgeons were allowed to proceed with the operation. The three surgeries today included a hernia repair and an orchiopexy (an orchiopexy is an operation to move an undescended testicle into the scrotum). The duration of each operation ranged from 90 minutes to two hours and we were allowed to stand near the operating table to get a closer view of the operation. Throughout each operation, the residents and Dr. Lambert explained to me the process of the operation and what they were doing. I understood the general idea of each operation, but as for the specific steps, I was a little lost trying to distinguish the vas deferens, for example! The hernia repair was very interesting to watch as well because it proved to be a challenge and more difficult than expected. I was impressed to see the teamwork involved. The surgeons and nurses discussed the operation and what ought to be done, almost like working through a puzzle.

After Dr. Lambert finished operating for the day, Dr. Snyder took us to a meeting for the entire urology division. The residents presented difficult or challenging cases and asked for input. The cases provoked much discussion among all the surgeons as they presented various suggestions and ideas. I really enjoyed the opportunity to see on a first-hand basis the collaboration necessary in medicine. It was a long and tiring day, but I rode the train back to campus feeling very enthusiastic and satisfied with my day.

Thursday, January 12, 2012

In the morning, I first shadowed Dr. Snyder in clinic. Many of the cases were very similar to Tuesday. Dr. Snyder once again exhibited his expertise and dedication to teaching the parents of his patients. After seeing a few patients, I shadowed another surgeon in the OR. This time I saw two operations, a cystoscopy and another orchiopexy. The procedure for the orchiopexy was almost the same as what I had seen yesterday. The cystoscopy on the other hand was very different. The original intent of the procedure was to apply deflux inside the bladder at the opening of the ureters to prevent reflux. The surgeon inserted a camera through the urethra of the patient and into the bladder. The image was displayed on multiple screens throughout the room and I was able to clearly see the tissue lining the urethra and the bladder. The residents looked for the openings to the ureters, which proved to be very difficult due to the anatomy of the patient’s bladder. As a result, they were unable to proceed with the procedure and had to finish the cystoscopy as they discussed further possible treatments. After the cystoscopy, we talked for some time with the residents about pursuing a career in medicine and surgery. I found that talking to the residents was very valuable because they recently had finished medical school and were familiar with the process in general. Soon it was time to say good-bye to everyone at the urology division of CHOP. We all felt a little sad about leaving, as we had just gotten to know everyone and we were having a fantastic time. I thoroughly enjoyed my experience at CHOP and I am so thankful to Dr. Snyder and everyone in Urology for giving me the opportunity to really see what a career in surgery entails.