The day before my Princeternship was rather hectic. After I finished my neuroscience exam, I quickly packed for my evening flight to San Francisco, where I would be staying in a downtown international hostel. I decided to stay in San Francisco instead of Stanford because I really love major cities and it’s close location to Palo Alto made transportation a breeze! At least, that’s what I expected when I printed out a Google map, left early, but still managed to miss my early train to Milbrae (a Caltrain station – think of Caltrain as a slightly better version of NJ Transit). After a thirty-minute subway ride, I took another thirty-minute Caltrain ride to Palo Alto, the home of Stanford School of Medicine. Since commuting to work is very common, this was a real experience! I ended up arriving right on time and was greeted by a receptionist who told me Dr. Chang was on his way. I spent this waiting time walking around the psychiatry building, absorbing my surroundings: the child and adolescent clinic seemed really warm and inviting, especially with its artwork, children’s games and fish tank.
The clinic’s characteristics contrasted with the serious academic and clinical work of the medical doctors, psychologists and researchers affiliated with the Lucile Packard Children’s Hospital. Dr. Kiki Chang ’88 soon arrived and I followed him to his research group meeting. In a short meeting, Dr. Chang addressed an array of research-related issues for a small group of visiting scholars, research assistants, and lab coordinators. The Comp Lit major I am, I did not understand everything, but learned a little about their research in pediatric bipolar disorder. They use brain scanning as a means of early detection and preventive medicine, especially for children who come from families with a history of the disorder.
After the meeting, I went up to the research wing, where a few assistants showed me several brain images. It was all really interesting! After that, I sat in on one of Dr. Chang’s pediatric consultations while he was supervising a child and adolescent psychiatry fellow. During this meeting, I learned more about the complex nature of PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptoccocal Infections) and PANS (Pediatric Acute-Onset Neuropsychiatric Syndrome). As the mouthful of names sound, these disorders are really complex because they involve a range of symptoms including autoimmune problems, tics, motor difficulties, OCD, depression, anxiety – just to name a few!
Day 2: Thursday, January 24, 2012
Because Dr. Chang was still [technically] on leave, this day was a lot shorter.
In addition to completing some paperwork, he had to undergo a computerized training for the pharmaceutical company that was funding his research. Interestingly, there was a company overseer there to ensure that he was complying with their guidelines. Since the training was all about ethics, I was glad to see how my knowledge of philosophy could be applied to real-world ethical dilemmas! Afterwards, I talked to a few of his research assistants about the clinical projects they were doing. One of them was running a cognitive behavioral therapy group for children and adolescents with bipolar disorder. Another was training a therapy dog named Raleigh.
Day 3: Friday, January 25, 2012
On my last Princeternship day I spent the morning in Dr. Chang’s office for his clinical consultations. Beforehand, I had a great conversation with Dr. Kim, a visiting scholar from South Korea. She told me about the challenges she faced practicing child & adolescent psychiatry in overbooked Korean clinics. As I am interested in comparative international health, our conversation was very enlightening.
At Dr. Chang’s clinic, Dr. Kim and I observed consultations with two families, both with children exhibiting PANS symptoms. At first, I was a little surprised at how murky their illness was. With simpler ailments, doctor’s can make a diagnosis and patients can be assured that the treatment will most likely work. With pediatric psychiatric disorders, there is definitely no cure-all! Diagnosing and treating a pediatric population requires great skill, patience, perseverance and a really great sense of humor. Dr. Chang is definitely the wittiest doctor I ever met and I saw how his humor definitely puts everyone at ease. In such a demanding field, knowing how to communicate with different people is an essential skill. During one of the consultations, a rheumatologist joined Dr. Chang to help address the patient’s autoimmune issues. It was then that I realized how the unique, interdisciplinary approach I take as a comparative literature major could be useful in medicine. Child psychiatry is a specialty that draws on knowledge from other fields, including psychology, neuroscience and pediatrics.
Despite all the difficulties and controversy of child psychiatry, the great hope is that symptoms are alleviated, so that the children can enjoy being children. Some of these kids had to be out of school for weeks at a time, which, as a Princeton student, I could never fathom! All in all, I am extremely grateful to have had the opportunity to shadow the talented Dr. Chang. This Princeternship was extremely rewarding because it gave me some insight into a medical specialty I might be interested in pursuing.