Ha Eun Kong ’13, Memorial Sloan-Kettering Cancer Center

I woke up early to go to the Memorial Sloan Kettering Center in New York City. It is a world-famous cancer center, and Dr. Noy is a highly recognized specialist in cancers of the lymphoid immune system, especially lymphoma. I was warmly greeted by her secretary. The first day was a pretty long one simply because there was a long registration process that I had to go through in order to be able to interact with patients. Her secretary was so hospitable and made me feel comfortable in the office during the registration process. When I was finally allowed to enter the clinic around 3pm, I had unfortunately missed many of the patients, but I still got to see the last  three patients and sit with Dr. Noy as she reviewed patient charts with a fellow. It was a very cool experience because I got to see what goes on behind the curtain as the doctors prepare to meet the patients, how they present the information to the patients, and then how they discuss patient responses afterwards. I learned that how you present the same information (framing) has a strong influence on the patient’s understanding of the information and their subsequent decisions based on that information. I also learned that in most cases, if you lay the options out in a logical, simple manner, patients are more confident about making a decision on what treatment to take. So even though it ended up being a very short day in clinic, it was still a valuable experience.

The second day I attended a lecture by Dr. Groopman and his wife Dr. Hartzband in the Rockefeller Research Laboratory adjacent to the Memorial-Sloan Kettering main building. It was on medical decision-making, which was a very interesting topic for non-specialists and pre-meds like myself. Dr. Groopman was applying game theory to the medical setting, which made me interested in perhaps taking game theory before I graduate Princeton. I was able to understand everything in the lecture without any medical training, which I think made it even more interesting to me. Following the lecture, I followed Dr. Noy to do rounds with her. I then followed another Attending, and ended up doing rounds until noon. This was a very useful time for me, seeing the in-patients and also having time to talk to the interns and residents that were rounding with me. In addition to several MD’s, one of them was an MD/PhD, another an MB/PhD (she got her medical degree from China, hence the MB), and I also met a clinical pharmacologist. It was great to interact with doctors who have followed different tracks to get there, and I was able to get their contact information in case I had questions later. I remember the MD/PhD intern telling me that she had taken the non-traditional route in doing MD first then transferring into an MD/PhD program, and inspiring me by saying something along the lines of: “ You don’t need to be so hung up on trying to plan out the next 10-20 years of your life. If you have a clear dream and goal, then even if it isn’t the traditional route, you will be able to achieve it if you put in the effort.” The rest of the day I spent with Dr. Lamanna in clinic. Her specialty is in leukemia, particularly in chronic lymphoycytic leukemia (CLL). It was interesting that patients with CLL tend to be older, and therefore they age with the disease and do not usually die of the disease, but with the disease. I loved that she has a very charismatic style of interacting with the patients; she was very outgoing and energetic when speaking with them.

The final day, I did rounds again, then attended a multi-disciplinary conference between various specialists in which they discussed two patient cases. Then, I spent the rest of the day in clinic with Dr. Noy. I witnessed a lumbar puncture, two bone marrow procedures, and longer patient-doctor discussions than on Monday. I felt that Dr. Noy has a very calm and witty way of interacting with the patients, and that she made the choices very clear for the guardians and patients in deciding which treatment path to take. It was very good to know that you can have real interactions with patients; not just 10-minute short encounters, but 30-40 minute sessions to really get to know the patient better. Also, there was a foreign couple who came in, and so a translator was on the phone translating between Dr. Noy and the patient. It was a very unique experience truly realizing what a global world we live in.

I am so grateful to Dr. Noy for this opportunity. She not only found time to allow me to shadow her, but also went out of her way to try to fill up my schedule so that I could meet different doctors and experience the various elements that make up a doctor’s day-to-day life. She was very friendly and down-to-earth with me. I was happily surprised that in addition to being so accomplished in her career, she is also a singer and an artist. I was worried that I might have to give up my hobbies of singing and drawing if I become a doctor, but it was great to see a real example of someone who has managed to do all.

Lawrence Chang ’14, Memorial Sloan-Kettering Cancer Center

Monday, January 9, 2012

I arrived at the Memorial Sloan-Kettering Cancer Centerat 9 am for my Princeternship shadowing Dr. Ariela Noy, a hematologist and medical oncologist specializing in lymphomas. Before I was able to meet Dr. Noy, I got a glimpse of the administrative side of hospitals as two of Dr. Noy’s incredibly helpful and very friendly assistants nearly pulled hairs wrestling with administrative hurdles—and there were a lot, as one might expect from such a large hospital—so that I could complete the required HIPAA training regarding patient privacy. Once this was done and I was cleared to enter the clinic, things became much more straightforward. I was warmly greeted by Dr. Noy at her clinic and proceeded to shadow her for the entire afternoon until 6 pm as she saw patient after patient, virtually nonstop (she mentioned that she only had enough time at lunch for half a PB&J sandwich).

Seeing firsthand an experienced oncologist’s approach to clinical work was quite an enlightening experience. Before meeting with each patient, she efficiently and thoroughly pored over each patient’s medical history and test results; that the X-rays were accessible online was one technological convenience she clearly appreciated and made a point of to show to me. I was impressed with the comprehensive nature of her inquiries into her patients’ health; I would have expected specialists to narrow their focus only to their field of specialty, but Dr. Noy was careful to find out, with the aid of a long checklist, a variety of medical problems that her patients were having in addition to lymphoma. Indeed, many of the patients had multiple cancers and other diseases, for which she offered as much advice as she could and tried to refer them to other specialists. She also pointed out the importance of documentation in a medical setting, as evidenced by the copious notes she took at every meeting.

Dr. Noy definitely set an example for me in her interaction with patients. She was very direct in telling her patients what they needed to hear, but she also took the time to listen patiently to some talk about completely unrelated matters—several of them were suffering from depression—and  conversed freely with others on topics ranging from parenting to yoga. She also offered philosophical insights as pep talks to some of her depressed patients; perhaps my favorite was one in which she reflected that the human body should not be treated as a piece of china, never to be touched, but something to be fully lived in, even if it meant getting dents here and there. When I asked her about how she handles the emotional difficulties of caring for patients, her response was that she did not make them sick to begin with, and that she was there only to make them better, which made the job ultimately rewarding. Such was the philosophy with which I hoped to go into medicine, and I was reassured to hear that it still held for her even after many stressful years of experience in the field.

Tuesday, January 10, 2012

Lawrence and MSK Staff

After quite a struggle getting out of bed at 6:40 am, I managed to make my way to the hospital for an 8:00 am conference featuring a presentation by Dr. Morton Coleman, director of the Center for Lymphoma & Myeloma at the neighboring New York Presbyterian Hospital, on different anti-angiogenic therapies for myelomas and lymphomas. It was interesting to see the different approaches to treating cancer that have been tried and encouraging that some of them have produced promising results, but Dr. Coleman did raise a pertinent, concerning issue of pharmaceutical companies often overly prioritizing new, potentially profitable treatments over already existing ones that are just as effective.

Right after the conference ended at around 9:00 am, I joined a lymphoma in-patient care team headed by Dr. Jonathan Schatz. The environment here struck me as markedly different than that of Dr. Noy’s clinic yesterday, right from the very beginning when I was instructed to wear a mask tightly around my face before entering the room of the first patient, who had AIDS and lymphoma and might have had contracted tuberculosis. Indeed, using hand sanitizer and wearing a mask (and even an isolating gown and gloves, in the case of one patient who might have contracted a “superbug”) was required before entering any of the rooms with obviously very ill, bedridden, and sometimes immunocompromised patients. What impressed me most was the team dynamic, as Dr. Schatz would be briefed by his team members in a “House-esque” fashion before each visit and they would bounce ideas off each other in discussing treatment approaches; they were all very friendly and enthusiastic about explaining the medicine to me so that I was not left completely clueless. As they only had six patients, it only took them an hour to finish there round, and I definitely found myself wishing I could have spent more time with them.

For the rest of my day, I attended conferences and lectures, which introduced me to the academic in academic medicine. I met up with Dr. Noy at 10:30 am and took a taxi ride with her downtown to a clinic, where she gave an hour-long talk on HIV-related cancers. This was a particularly intriguing subject for me, as I had not been previously aware of the connection between HIV and cancer development. In the afternoon, I also attended a research presentation by a doctor from the National Institute of Health on the process by which transmembrane proteins are inserted into the membrane. Not surprisingly, this lecture was heavily molecular biology and I was mostly just left with the impression that biologists must have quickly gotten tired of coming up with creative names for all the myriad proteins in the cell, hence protein names like Get1, Get2, and Get3. Finally, at the end of the day, I listened to a presentation by Dr. David Meltzer, an M.D./Ph.D. holder from the University of Chicago who has made a name for himself analyzing the economics behind medical care, on the effects of increasing specialization in medicine on quality of care and medical costs. Following some economic analysis, he found that specialization has generally improved medical practice from the perspective of physicians, but not for patients who are frequently admitted to hospitals, for whom dealing with multiple doctors can prove inconvenient and compromise quality of care. Dr. Meltzer finally proposed a new model involved stratifying patients based on their likely frequency of hospital visits that would avoid such problems. I definitely enjoyed this presentation, as it was provided me with a new socioeconomic perspective on medicine I would not have otherwise considered as a science-oriented person.

Wednesday, January 11, 2012

I began my day at 8:00 am with a return to the in-patient care ward, now with a lymphoma team led by Dr. Steven Horwitz. This team was assigned to the patients who were the most ill, and before visiting each patient, the doctors would spend at least fifteen minutes discussing all the factors that needed to be considered to decide on a course of treatment. Not surprisingly, the rounds for this team took significantly longer than those for the team from the day before. Again, the doctors were very friendly and took the time to explain concepts to me, such as the process by which the severity of the patients’ cancer was determined and the purposes of different tests such as PET and CAT scans.

At 10:30 am, I left the team to attend a symposium with Dr. Noy on chronic lymphocytic leukemia (CLL), the most common form of leukemia. At this symposium, doctors from various medical institutions presented research findings on the diseases. Perhaps the presentation I found most interesting was one that covered the effectiveness of multiple therapies of the disease through protein inhibition.

At 12:30 pm, I returned with Dr. Noy to her clinic, and just as in the first day, I sat in on patient visits. Each patient obviously presented with different health problems, and with each one I learned a little more about medical treatment. Perhaps the tensest moment was when Dr. Noy received the blood test results of a patient she had already finished seeing earlier and was shocked to find the level of one particular disease marker in that patient to be ten times normal; she urgently contacted hospital staff to arrange for the patient to be transferred for immediate care. In the time between visits, Dr. Noy was kind enough to search for and give me medical articles pertaining to a particular medical interest of mine, gene therapy, as well as clarify scientific concepts from the symposium earlier in the day. I might also add that I got to meet a high school senior—and Princeton applicant—also shadowing Dr. Noy and had an enjoyable time talking to her about college and, of course, selling her on Princeton (as did Dr. Noy).
At 6:00 pm, just like that, My Princeternship was over before I knew it, and I was left wishing that I could have stayed longer to absorb all the information there is to know about medicine. As it stands, I learned more about cancer in a clinical and academic setting than I possibly could have hoped for from just three days. I definitely emerged with a greater desire to become an oncologist in the future for the opportunity to make a difference in the lives of patients. I am very thankful to Dr. Noy for taking the time out of her incredibly busy schedule to provide such an educational experience for me. Without a doubt, the lessons I learned during this time will stay with me throughout my future years in the field of medicine.