Evaline Cheng ’14, Stanford University School of Medicine

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!