Yoojin Lee ’16, University of Arkansas Medical School

Eunice-Yoojin-LeeDay 1 
Though it was only my first day at UAMS, my schedule was jam-packed. I met Dr. Erika Petersen ’96 in the lobby at 6:45 am, and as soon as I changed into scrubs, we met the patients she was scheduled to operate on. She talked to each of the patients and their family members as they were being prepared for the operation, providing reassurance and reminding them of the operative procedures that would take place.

The first operation I observed was a laminectomy, used to treat spinal stenosis. Stenosis involves a thickening of ligaments and bone tissue that surround the spinal nerve sac, which often causes pain, stiffness and weakness. In our case, the patient was suffering from pain in his legs, and was unable to stand straight for even the six minutes needed to brew a cup of tea. A laminectomy removes the ligaments and bone tissues to widen the area around spinal nerves and give them more “breathing room,” relieving pressure. The operation took about two hours, and when we went to visit him later in the afternoon, he reported that his leg already felt a lot better. I myself gained a lot of respect for doctors by the end of this first operation; it was hard just to remain standing up for two hours—imagine how hard it would be to stand for two hours straight while operating on a patient under high-stress conditions! The stakes were even higher for Dr. Petersen because the patient was her colleague’s father. 

The second operation was the first of a two-part operation for deep-brain stimulation, Dr. Petersen’s specialty. During this procedure, electrodes are surgically implanted into the brain and are later wired to a generator, which is implanted into the patient’s chest. Stimulation of these electrodes via the generator is said to relieve tremors and treat symptoms of Parkinson’s disease; according to Dr. Petersen, some doctors have also used it to treat anorexia and depression. That day, DBS was used to treat a patient with dystonia, which causes tremors, twisting and abnormal postures. Although Dr. Petersen didn’t expect to see any immediate effects of DBS on his condition, the patient said his muscles felt less tight. Dr. Petersen and her staff will have to run more tests and observe him throughout the next couple of months, but things do look quite promising!

The last operation didn’t take place in the operating room, but in the patient’s ward. The patient had suffered major brain trauma from a motorcycle accident, and the resident doctor was planting an intracranial pressure sensor so that he would be able to monitor pressure changes in the patient’s brain. The operation was relatively quick, and implanting the ICP itself took only ten minutes. According to the doctor, it is impossible to tell how bad the effects of trauma will be on the patient, but hopefully long-term care and therapy will bring as much of him back as possible. 

Day 2
Day 2 started even earlier at six in the morning, which began with Dr. Petersen’s lecture to the anesthesiology department about Spinal Cord Stimulation—which, surprisingly enough, I understood! As its name may suggest, SCS stimulates nerves in the spinal cord, which blocks them from sending pain signals to the brain. Although DBS is Dr. Petersen’s specialty, she performs SCS operations more frequently.

After checking in on Dr. Petersen’s patients, Dr. Petersen and I entered the OR with a busy schedule ahead of us.Y Lee 1 I was able to observe five “day” operations, which means that patients both come in and leave on the same day without having to stay overnight in the hospital. The first two operations were Stage 2 DBS operations, in which Dr. Petersen and a resident physician implanted the generator used to stimulate DBS electrodes that had already been inserted in a previous operation. To connect the electrodes to the generator, the wires were literally tunneled through the head, neck and upper chest area using brute force, which was interesting to watch. The third operation involved a decompression of the ulnar nerve, which is the nerve that runs through the “funny bone” in the elbow. The area around the nerve was very tight, and by removing the tissue around the nerve, Dr. Petersen gave it more “breathing room.”  Next, Dr. Petersen implanted a generator for Vagus Nerve Stimulation, which stimulates the vagus nerve originating from the medulla of the brain. The procedure was very similar to that of DBS. Finally, Dr. Petersen changed a SCS generator that had run out of battery. The last patient kept waking and yelping out in pain from time to time, but all five surgeries ended successfully, and we delivered good news to all of Dr. Petersen’s patients and family members.

At the end of the day, Dr. Petersen treated me to dinner again; this time, we had Mexican food! The bean and cheese dip was delicious; make sure to get it if you happen to visit Senor Tequila in Little Rock any time soon.

Day 3
My final day at UAMS started the earliest, at 5:50 am. I met the neurosurgery residents at the Intensive Care Unit (where patients in the most critical conditions are) and listened in on their meeting, where they went over the current conditions of the patients they were taking care of. After the meeting, I joined Dr. Day (the chair of the UAMS neurosurgery department) and his residents in an aneurysm removal surgery. An aneurysm is a bulge in a blood vessel—not only did this patient have three aneurisms, but these bulges extended from carotid arteries (arteries that supply the head and neck with oxygenated blood) located deep in the brain. A doctor from Japan who was visiting Dr. Day was very helpful and walked me through all of the steps Dr. Day and the residents took to remove the aneurysms. The surgery was intense, which is probably why the entire procedure took six hours from start to finish. Residents had to rotate from one to another, and even Dr. Day had to take a small break!

I then joined Dr. Petersen in her clinic sessions, during which she consulted patients with a variety of conditions, from brain tumors to chronic back pain to face pain. The way in which Dr. Petersen seemed genuinely devoted to her patients’ wellbeing was very admirable, and I hope to become the same kind of caring, committed doctor in the future. She was also very accessible, which is a must for any good doctor. Dr. Petersen’s patients are certainly lucky to have her.

Y Lee 2Overall, the past three days at UAMS gave me a more than worthwhile experience. Not only did I get to observe many intense, interesting surgeries (some of which I had never even heard of before, like DBS!), but I also was able to get a good feel for what it means to be a doctor. Medicine (especially surgery) involves long hours, patients, little sleep and a lot of fatigue, but it really is worthwhile, especially when both you and your patients know that you’ve completely turned their lives around 180 degrees for the better. That one smile or token of appreciation—that feeling of knowing you’ve made a huge difference in someone else’s life—is priceless, and it keeps you going.

Edward Xiao ’16, Staten Island University Hospital

Ed-XiaoMy three-day Princeternship with Dr. Sanjiv Bajaj ’02 at Staten Island University Hospital was an incredible learning experience.  To a freshman fascinated by science and medicine, Dr. Bajaj’s guidance and tutelage solidified my interest in pursuing a medical career.  Each day, it was evident that Dr. Bajaj enjoyed his career studying and practicing medicine.  I had always been concerned that the life of a doctor would be monotonous, seeing similar injuries or illnesses on a day-to-day basis.  However, Dr. Bajaj showed me how much critical thinking is involved with each individual patient’s case and how radically different every day could be.

On the first day of the Princeternship, I met Dr. Bajaj at Staten Island University Hospital at 9 am.  Shortly after, I met Dr. Adam Bernheim, a fifth year resident doctor who worked with Dr. Bajaj.  We started the day by examining ultrasound and CT scan images of various patients’ cases.  Dr. Bajaj first gave me a quick and comprehensive explanation and description of key colors and figures to look out for on scans.  It was interesting to see how experienced Dr. Bajaj and Dr. Bernheim were at analyzing the details of the scans.  Although simple in theory, I realized how complex this task could be in practice, considering how complex the human body is.  One of the patients we saw had swelling and discomfort in the upper leg.  As Dr. Bajaj deftly navigated the probe along this patient’s leg, I slowly began to make out the outlines of veins and tissues.  Meanwhile, Dr. Bajaj had already come to a conclusion.  He pointed out on the display how certain tiny superficial veins displayed significant clotting – enough to cause swelling of the leg, although not a serious condition.  I was fascinated by how precise he could be in what I originally thought was simply a fuzzy gray image.

I experienced more of Dr. Bajaj’s critical thinking prowess as we examined the ultrasound images of a pregnant woman.  Strangely, the baby’s heart rate was reported at 234 beats per minute, much higher than normal.  Unfortunately, since the patient was not currently in the hospital, we could not take another ultrasound test to confirm this report.  Dr. Bajaj however, realized that he could examine a graph of the heart movement and beating, and manually recalculate the heart rate by measuring the points where the heart was fully contracted.  Using precise computer measurements on a graph over 4 seconds, Dr. Bajaj recalculated the real heart rate to be 165.  He concluded that there must have been some tiny movement that interfered with the machine’s algorithm.  It was amazing to see how Dr. Bajaj’s critical thinking and understanding of the technology behind scans enabled him to work around the problem.

For the second day of the Princeternship, I met Dr. Bajaj at the Verrazano Radiology Associates building next to the hospital.  We first performed a fluoroscopy test on a patient planning to undergo surgery to remove a tumor.  Dr. Bajaj explained that this test would give details on the precise location and nearby effects of the tumor cells.  For this test, the patient drank barium and we examined on x-ray how it flowed down through the esophagus, stomach, and intestines as the patient stood up and laid down. 

Later in the morning, I got to watch as Dr. Bajaj performed a biopsy on a patient’s neck.  Dr. Bajaj explained that by using a small needle with the help of an ultrasound display, he would take small cell samples of lesions, which the pathologist would check for tumors and cancers.  As Dr. Bajaj performed the biopsy, Dr. Bernheim pointed out what Dr. Bajaj was doing, the theory behind the biopsy, etc.  He explained how it would be dangerous to stab the needle into a lesion, and how it would be better to scrape away at peripheral parts along the major axis (more rubbing surface area).  As Dr. Bajaj took samples of multiple lesions, the pathologist would first stain each sample with a dye that kept the cells from lysing or breaking while fixing them to the microscope slide.  The other dyes would stain the cytoplasm, nucleus, etc.  Near the end of the biopsy, Dr. Bernheim and the pathologist suddenly fell completely silent.  I found out later that the last node Dr. Bajaj took a sample of measured only 2 MILLIMETERS in diameter, even smaller than the width of the needle.  To complicate matters more, the node was located centimeters from the jugular vein.  For a whole minute, Dr. Bajaj didn’t even breathe as his stable hands managed to pull a sample without any harm.  Dr. Bernheim and the pathologist later commented how there are very few doctors who would attempt a biopsy on that node, let alone complete as successfully as Dr. Bajaj did.

On the third day, Dr. Bajaj and Dr. Bernheim spent a significant amount of time examining one specific set of ultrasound images.  They explained that an ultrasound probe can pick up masses and cysts but cannot see behind multiple layers of tissue.  This particular patient had an ultrasound of his pancreas, which is very hard to examine using ultrasound.  Due to the difficulty of examining the pancreas, Dr. Bajaj explained how pancreatic cancer has an incredibly low 5-year survival rate (around 4%) because usually the tumor has progressed significantly before it is noticed by any tests.

Oddly, this prompted an ethical discussion about organ donation – should individuals be allowed to donate whole or even pieces of organs?  Organ donation is often accompanied by rejection from the patient’s immune system, Dr. Bajaj explained.  Thus, aside from the danger of the surgery, there is a significant chance that the donation will fail, putting both lives in larger jeopardy.  Should someone in poverty then, be allowed to donate a kidney in return for money to send his children to college?  Can we justify putting someone in significant medical risk to improve lives of others in a similar medical risk?  I have never been very interested in ethical debates, but I was surprisingly active in this discussion.  I realized how unique every day in the life of a doctor really was, and not monotonous as I had once thought.  Doctors did have ordinary conversations after all!

I am incredibly grateful to Dr. Bajaj, Xiao 1Dr. Bernheim, Staten Island University Hospital, Princeton Career Services, and everyone else who helped me throughout the Princeternship experience.  By shadowing Dr. Bajaj and Dr. Bernheim for the program duration, I was able to see a less biased view of a doctor’s daily routine.  Furthermore, I began to notice how everything I was learning in school came together in the medical profession.  I hope to continue along this premed track at Princeton and perhaps one day even work alongside Dr. Bajaj as his colleague.

James Wang ’16, Staten Island University Hospital

As Ed, the other Princetern, and I rolled into Staten Island University Hospital around 8:30 in the morning, I had little idea what to expect from the Princeternship ahead of me. Even though thousands of pre-meds and high schoolers have shadowed doctors in the past, I was not one of them. The outside of the hospital had a fairly modern appearance: glass panes covered the front of the building on one of its irregularly arranged faces as the rest were a seemingly random assortment of white/brown brick and even more smaller glass segments. As Ed and I searched the halls for the ultrasound department, of which Dr. Sanjiv Bajaj ’02 was the head, we wandered for almost 15 minutes because there didn’t seem to be a clearly demarcated section. Lucky for us, that day was not my first encounter with Dr. Bajaj, who actually interviewed me in St. Louis for Princeton as he was completing his fellowship at Washington School of Medicine. Because of that, I recognized him just enough to finally say hi and start our Princeternship.  Easy enough.

After we went hallway-through-hallway in order to reach our final destination, we finally reached his office. The office itself was dim, lit only by the faint glow of Dr. Bajaj’s computer workstation, which had four very-large computer monitors radially positioned. The bulk of his daily work came from this workstation. As we sat down with Dr. Bajaj and his resident doctor Adam, he immediately jumped into his work and pulled up his first CT and Ultrasound images of the day. The first images were of a liver with significant fat residue. Dr. Bajaj explained to us that Fatty Liver was going to be one of if not the largest public health epidemic within the next 10 years. This was surprising to me because I had not heard of this public health issue as opposed to issues like smoking and childhood obesity, but he explained that fatty liver (formally macrovesicular steatosis, but no one really calls it that) was creeping up because it’s a byproduct of our modern diet that develops much later on in life, as opposed to obesity itself which is apparent almost immediately.

After dictating his diagnosis of these images and a few more similar kidney/liver issues through an extremely rapid but sometimes troublesome voice dictation system, something much more serious arose. After examining two ultrasound images of a woman’s uterus with only a few weeks in between, Dr. Bajaj simply stated “this is very bad.” Although in his explanation to Ed and me he never formally used the “m” word, we knew exactly what was happening as we saw that this woman had lost her baby. It was in this specific case that I first realized the human urgency of what Dr. Bajaj was doing, something that can be easily missed by the untrained eye after looking at grey-scale images of livers and kidneys. After hearing more on his diagnoses of things like vein clots, kidney cysts (mostly benign) and possibly HIV-induced bilaterally enlarged kidneys, I became more and more amazed at his ability to almost immediately tell what was happening with any given patient.

However, his job simply wasn’t to look at these images all day. Although many of his photos were taken by the technologists he was managing, he also performed his own ultrasounds one or two times an hour. It was in this that I saw his dual role in keeping the patient informed as well as applying his own clinical experience to the situation at hand. In addition to that, when I asked him what role radiologists had in treatment, he said that imaging techniques like CTs and ultrasounds could be used in real time to better survey physically hard-to-reach treatment areas like the spleen for operations such as biopsies. Finally, he stated that he chose radiology as his specialty because the portion he appreciated the most in the medical process was not necessarily the treatment itself or its follow-ups, but in the onslaught of constant puzzles presented to him on an hourly basis, where it was his specific job to give a keen and precise diagnosis to the puzzle at hand, and then move on to the next person’s illness. I greatly admired his confident medical ability and his essential role in diagnosis. For future students, I would strongly recommend the Princeternship program not just for the opportunity to see what a certain doctor does on a day to day basis, but also for the advice mentors like Dr. Bajaj so readily give to us as we consider the life paths they also considered as they reached this current point in their lives. 

 

Tugce Tunalilar ’15, Stanford University

Tugce-TunalilarI arrived the first day at 12.30 at the Child and Psychiatry Clinic to meet Dr. Kiki Chang ’88, who is the director of the Bipolar Disorder Program at the clinic. This was the internship that I have been waiting two years for, and it was great to be finally here. I would call the first day the “introduction and meeting day.”  The first meeting was the laboratory meeting that happens every Wednesday; there are quite a few people working with Dr. Chang and they all gave updates about the projects they are running. I was introduced to the staff and given some basic information about some of the ongoing projects such as the Family Focus Therapy (FFT), Brain Imaging and A-life, an evaluation program for the families in FFT. That meeting was followed by a research meeting with Dr. Jennifer Frankovich, a rheumatologist from Lucile Packard Children’s Hospital, and Cheryl Koopman, a research professor.  The research is about an autoimmune disease called PAN/PANDA that manifests itself by behavioral changes, especially similar to obsessive compulsive disorder (OCD).  It is something that I had no idea about before coming to Stanford, but the group with Dr. Chang, Dr. Frankovic and Prof. Koopman seems to really focus on that study.

The second day was a long one. I started the day off at 10 by watching a patient and parent interview with Jennifer Pearlstein, a research assistant with Dr. Chang, for depression evaluation. It was followed by a phone screen to asses if a family with both bipolar parents were actually eligible for any of the programs in the clinic.  I learned that they have to meet certain criteria like a certain age and symptoms to participate in a program in the clinic. Later on in the afternoon, I observed some of Dr. Chang’s patients who either had bipolar disorder or depression. Dr. Chang asked kids’ parents for their observations of their kids over a period of time, and did some adjustments to the medications. Some of them were on straight bipolar disorder medications whereas some of them were put on antibiotics to test for the possibility of PAN/PANDA.  I noticed that these psychiatric diseases decrease the kids’ functionality very much, and affects them in every aspect of life, from school to social relationships. I gathered so much information about the psychiatric medications and their side effects, as well as more about the nature of bipolar disorder.

The third day was the longest and the most interesting one for me. I started off at the PANS/ PANDAS clinic with Dr. Frankovich and Dr. Chang. They had three patients who either had PAN/PANDA symptoms or some other behavioral changes that were predicted to be related to an infection. It was an interesting experience to see the parents there whose worries were apparent on their faces because I suddenly found myself sympathizing, or at least trying, with them. I know that I can never understand the actual intensity of their feelings, but it was intensive enough for me. After the PANS/PANDAS clinic, I went back to the psychiatry clinic with Dr. Chang to see a Lamictal, a mood stabilizer for bipolar disorder, research patient who has been observed over a certain amount of time. As much as I could gather from a short conversation, the patient was doing much better on Lamictal and his mood has been improving greatly. Unfortunately, that was also my thank you and goodbye call to Dr. Chang, who was very kind to let me shadow him and do other activities in the clinic for three days. However, I was not done! I headed down to the neuroimaging section to talk to Spencer, another research assistant, about MRI imaging and of course about the brain anatomy.  The MRI images that I saw fascinated me, and I could not keep myself from asking more questions about the brain and the effects of bipolar disorder on the brain.  Although not completely understood, there seems to be a correlation between the amygdalar hyperactivation and bipolar disorder and depression. After that, I went to meet Amy Garrett who is a senior research scientist from neuroimaging, and we talked about different studies being conducted on bipolar patients and their amygdalar reactions to therapy.  The studies are really interesting and can pave a way to predict which psychiatric medications can be used based on brain images from patients, which I found to be really exciting news. The last thing on my agenda for the day was to see an actual scan. There are research studies going on for children at risk for bipolar disorder and the MRI scan is a ritual to assess the brain properties and activity. I was with Jennifer and Spencer and I watched Spencer while he was conducting the scan of a young patient. It was fascinating to watch the brain at different states – baseline, resting etc. – and see its different structures. The scan took half an hour, and after that, at around 6.00 p.m., I was unfortunately at the end of my amazing Princeternship experience.

Looking back at it now, I think this internship Tunalilar 1has helped me a lot with realizing my interests. I am a molecular biology major; I knew that I did not want to go to medical school, but I was not sure if I would like to do research in molecular biology either. In general, I had mixed feelings and thoughts about molecular biology in the first place. However, after this internship I realized I actually want to study it.  It helped me realize that I like wet bench work more than clinical work but that I am also leaning more towards neuroscience rather than pure molecular biology. I was also happy to see my interest in research has been revitalized. As a sophomore who is close to choosing her major, I now feel more confident about what I want to do for the rest of my time at Princeton and after. I know that I have a lot to learn, but I think I now have enough motivation to move on with what I want from life, at least as a career.

Sarah Liang ’15, Sovatsky Counseling and Yogic Research

Sarah-LiangIn the span of just six short hours, I was able to not only meet Dr. Stuart Sovatsky ’71 in his office in Richmond, Calif. over spring break, but I was also able to learn about the very unique practice that is yogic counseling. Essentially, he focuses on unifying marriage and relationship counseling with the traditional meditative practices of Yoga. This particular melding struck my fancy because I have personally studied these two topics separately, but have never encountered them together before. He even played his shruti, a wooden box emitting a droning sound that evokes a sense of calmness and peace within oneself. I felt its effects fully and powerfully; it was truly an eye-opening and relaxing experience.

For the first half of my time there, Stuart and I simply sat face-to-face, as he would with his clients, and chatted about both the spiritual Yoga that he has researched and published on, as well as the psychology side of his practice (that I was far more familiar with). I got to hear about some incredible experiences he had across the world, such as Slovenia, lecturing with the vast amounts of research he has conducted on Yoga practices. I also got to hear some monumental events throughout his lifetime, such as the impacts he has left on people’s relationships and lives.

In the second half, I had the opportunity to meet a couple that had been seeing him for several years already. They told me about the painstaking experiences over time that it took for them to achieve the bliss and love that they felt between each other today, and then were kind enough to answer the questions I had thereafter. I was also able to meet one of the interns that works under him, and observed the different career paths I could possibly take in order to achieve my personal ends in working in the field of psychology. Overall, the hands-on experience from today was not something that I had fully anticipated but nonetheless appreciated to the fullest.

From this Princeternship, I not only Liang 1learned new skills, but developed preexisting ones from areas that I’d previously studied, and was able to explore miscellaneous career path interests in the process. I am so grateful to Dr. Sovatsky for taking time out of his busy schedule to meet with me for this rare opportunity. This Princeternship has left a very positive impact on the rest of my time at Princeton, and hopefully beyond my collegiate career as well. I’d certainly recommend it to anyone considering clinical psychology as a possible field in which to study in the future.

Gabriela Villamor ’16, Dominion Fertility

Gabriela-VillamorSpending spring break with my host Dr. John Gordon ’85 at Dominion Fertility was an incredibly eye-opening experience into a specialty field of medicine. My goal for this Princeternship was to solidify my interest in the medical field and to gain experience in a field that I was incredibly fascinated with but never really understood beyond textbooks and the Internet. Shadowing Dr. Gordon for three days allowed me to accomplish this goal.

On the first day, I experienced so much in such a short amount of time.  Dr. Gordon kindly picked me up at 6:40 am from the nearby hotel where I was staying.  We first headed over to INOVA Fairfax Hospital where he gave a lecture to the hospital’s resident students. Afterwards, we attended the OB/GYN unit’s business meeting at the hospital that focused on the importance of patient care.  After the conclusion of the meeting, Dr. Gordon and I made our way to the Dominion Fertility office in Arlington. There, I was introduced to the welcoming and friendly staff and saw what Dr. Gordon’s job as a reproductive endocrinologist and co-director of the clinic entailed. He performed vaginal ultrasounds on many patients at different stages of their treatment. Some patients, for example, were being checked for their follicle growth progression as well as their uterus lining thickening, and some were being checked for the growth of their baby. I even got to hear a baby’s heartbeat! Besides the ultrasounds, Dr. Gordon performed various procedures, including an intrauterine insemination (IUI), a form of infertility treatment in which sperm is directly placed into the uterus via a catheter, and an in-vitro fertilization (IVF) transfer in which an embryo (a fertilized egg cell) is placed into the uterus of the patient. Dr. Gordon also held many consults with new and returning patients. I was fascinated by the patients’ stories and the options available to them based on their specific circumstances. Dr. Gordon displayed the ideal way in which to interact with patients. I admired his supportive, yet honest, advice about the different types of fertility treatment that he believed would be most effective for the individual patients given their various physical, financial, psychological, and ethical circumstances.

Additionally, not only was I able to see theVillamor 1 clinical side of the office, I was given the opportunity to observe the laboratory aspect of the infertility treatments. Dr. Gordon gave me an initial tour of the office, where I saw live sperm cells under a microscope. I later spent time with the lab coordinator, who also gave me a tour of the laboratory which stored frozen embryos, egg cells, sperm samples, etc.  I was also allowed to view blastocysts under a microscope and was advised of the different procedures that the laboratory staff perform.

On the second day, we started at the Arlington office and Dr. Gordon performed more ultrasounds, checking on the follicle growth of many patients. We later left for the Dominion Fertility’s office at Fair Oaks Hospital where Dr. Gordon held several consults and performed ultrasounds. It was exciting to learn that just after one day I was able to recognize the images of the ultrasound, including the uterus and ovaries.  After spending some time at the hospital branch, we returned to the Arlington office and attended an office meeting with the four doctors of the clinic, including Dr. Gordon, two of the head nurses, and the lab coordinator. They discussed the different infertility treatments and the progress of their patients. They also discussed ways to improve their patient care and run the clinic. It was interesting to see this business aspect of the clinic, as it is important even in a medical setting. 

On the final day, I was able to view more ultrasounds and hear consults at both the Arlington and Fair Oaks offices. I also spent more time in the laboratory where I was able to watch an intracytoplasmic sperm injection (ICSI), a procedure in which a single sperm cell is injected into an egg cell. This was one of the most amazing things to see.  It was a great way to conclude this Princeternship program.
 
During the time we commuted each day, Dr. Gordon and I had great talks in the car about our Princeton lives, his journey to becoming a reproductive endocrinologist, and our families in general.  Moreover, he challenged me with many topics, including the understanding of statistics and ratings of medical clinics and how it affects patients.  Dr. Gordon had sent me books Villamor 2that he wrote regarding his specialty, which we also discussed.  He also presented me with tough hypothetical and ethical situations and asked me questions based on such situations.  Dr. Gordon has proven to be great teacher and mentor.  Each day was a new and rewarding experience. At the end of it all I could not help but think, “Wow, this is something I would really love to do.”  This experience helped me understand how challenging a medical issue such as infertility can be from the physical and biological aspect to the psychological impact on patients.  It left me with an overwhelming motivation to help others with infertility or any other kind of medical issue.  I definitely encourage anyone who has any interest in the medical field to take this opportunity. I deeply appreciate Dr. Gordon’s commitment and the experience that I gained from this informative and inspiring Princeternship.

Rachel Parks ’15, Capital Digestive Care

Rachel-ParksFor my Princeternship, I spent two days shadowing Dr. Julia Korenman ’78 at Digestive Disease Consultants in Rockville, Maryland. I was interested in shadowing a gastroenterologists because I am interested both in digestive diseases and in the importance of cancer screening, which are the two biggest reasons that someone would see a digestive specialist. I spent my first day observing patient appointments in the office, and then on the second day we went to a nearby endoscopy center to do procedures.

On Monday, Dr. Korenman had a meeting, so I arrived at her office a few minutes before she did. She rushed in, showed me around, and then settled down in her office to make some calls. She explained that first thing in the morning was usually the time she took to talk to patients: making personal calls to patients and writing explanatory notes on their test results. In those few minutes, she called both a Korean-speaking patient and a Spanish-speaking patient. I’ll get to this later, but I was really impressed with the way Dr. Korenman dealt with language barriers.

Dr. Korenman said that what she liked about being in a specialty like gastroenterology is that you get to perform procedures regularly, but you still have patients who you see frequently – and that was true. Most of her patients were either patients with something chronic, like Krohn’s disease, and therefore came frequently, or were just getting a one-time procedure, like biopsies or a colonoscopy. But even for this second group, they still had several interactions in a row – for example, a consultation, a pre-op visit, and one or two follow-up visits. Dr. Korenman worked really hard to write herself good notes, so that she could remember details from a visit later. On this particular day, there were a lot of computer issues, but I could see that the electronic chart system was also a big help – Dr. Korenman could see x-rays and other tests with a few click, and it was easy to forward or receive information from patients’ primary care doctors.

Even though GE seems like a specialized field, there was a lot of interaction with other areas. For instance, if patients were on a long list of medicines from their primary care doctor, it influenced the medications that they could take for GE problems. There was one patient who claimed that the procedure he had just had on his esophagus had cured his migraines! There was another woman who seemed to be bouncing back and forth between an ENT doctor and Dr. Korenman – the tight feeling in her throat wasn’t easily explained by either discipline.

Those patients were very interesting, but my favorite patient was a Salvadoran woman who came into the office for a follow-up. Dr. Korenman said that she had studied Spanish in college, and that it was extremely rusty, but I was really impressed by her ability – not necessarily by her vocabulary, which was very good, but more by the fact that she approached her patient from equal footing and worked hard to be understood. She didn’t talk down to the patient, and she patiently tried new ways of explaining when her point didn’t get across. I have worked with Latino patients before, and Dr. Korenman proved what I already believed, which is that the confianza, or trust, that patients feel toward their doctor is much more valuable than perfect conjugation of every verb.

On the second day, we were in a different building, performing procedures. This was a lot more like surgery than I expected – Parks 1Dr. Korenman was wearing scrubs, and all of the patients on this day had chosen to be fully sedated. There was a whole team doing the procedure – Dr. Korenman, an anesthesiologist and a technician. I was so impressed with how well Dr. Korenman worked with her team. She managed to be a strong, focused leader while still being friendly and considerate. The day before, when she took time out of her schedule to resolve an office conflict, I thought she was being nice, but then I realized that having a good relationship with your staff directly affects both your own and the patients’ well-being.

It was a long day of procedures – some were easy and straightforward, and others were more difficult. As I observed, I was excited when I started recognizing things like the appendix, or the difference between the way the stomach and the esophagus looked. She removed a few polyps, but many of the procedures were due to specific complaints, so she took a lot of biopsies to look for things like Celiac disease or gastritis. Afterward, she would talk to the patients (who were still a bit groggy) and explain how the procedure went. I barely remember anything from when I got my wisdom teeth out, so I was not surprised that she directed most of her comments toward the family members who had come to pick the patient up.

I enjoyed this Princeternship for one of the same reasons Dr. Korenman said she enjoys her job – I got to see so many different patients, all in just two days. I was expecting a specialist’s job to be fairly impersonal, but I saw that her relationships were extremely important – with patients, their primary care doctors, her staff, and the other doctors in the practice. I’m still not sure what kind of doctor I want to be, but this Princeternship broadened my horizons and let me see so much in just two days.

Hope Xu ’15, University of Arkansas Medical School

Hope-XuA typical day at the University of Arkansas for Medical Sciences hospital went a little like this: The first operation of the day was scheduled for 7:00 am, so we’re up at 5:30 and ready to meet up with Dr. Erika Petersen ’96 in the Pre-Op waiting room by 6:30. Dr. Petersen takes us to the locker room, where we change into scrubs and masks before entering the Operation Room (OR).

Our first patient was an elderly lady in need of a generator replacement. Certain patients suffering from severe nerve-related pain can undergo surgery to have small rechargeable generators implanted in their bodies. These generators are wired to a series of electrodes connected to the central nervous system, and by creating an electric field, they can interfere and effectively block pain signals to the brain. Our patient originally had her generator implanted in her lower back, but its position had been causing her increasing discomfort as her skin began to sag. Working together with Dr. Gandhi, Dr. Petersen removed the old generator, added extensions that were strung beneath the dermis to the abdomen, hooked the wires to the new generator, and inserted it into an incision just below the rib cage. At all times, an anesthesiologist closely monitored the patient’s vitals and administered the necessary drugs for paralysis or stimulation. We were allowed to observe as Dr. Petersen explained the procedures for proper positioning, sterilization, radiology, and stitching of the different epidermal layers.

The three of us observed a neighboring operation with one of Dr. Pait’s patients, a woman who had recently suffered a spinal fracture and needed to have two of her collapsed vertebrae removed and replaced with a titanium cage. In order to strengthen the spine during recovery, Dr. Pait inserted metal screws into the vertebrae above and below the fracture by exposing the spinal cord from the back (posterior approach) and hammering holes into each pedicle. Using CT technology, the surgeons were able to render a spatial animation of their tools in relation to the patient’s X-rays, making it much easier to carefully guide each screw deep into the bone without pinching nerves or the spinal canal. Once all the necessary screws were inserted, metal rods were strung through each screw to create an even stronger wire frame before the patient was stitched back together and sent back to recovery.

After a quick lunch at a nearby cafe (“Surgeons eat when they can, sleep when they can, and never pass up a bathroom break”), Xu 1Dr. Petersen left us in the care of Dr. Gandhi for our third and final operation of the day. We learned that a patient’s lifestyle can have a profound impact on not only general health, but also on the success of surgery. Being incredibly overweight, the patient was very difficult to position, and cutting through the fat tissue to reach the spinal cord proved to be a long and tedious process. Similar to the second operation, this patient suffered a spinal fracture and needed to have the collapsed vertebrate removed. Several X-rays were taken to confirm the position of the patient’s spinal cord throughout the operation. Near the end of the operation, Dr. Petersen led us back to the locker rooms, where we were given fresh scrubs and a meeting place for the next morning before being dismissed for the day.

In addition, we were able to witness other functional surgeries involving vagal nerve Xu 2stimulators, aneurysm decompressions, and brain tumor removal. Everyone we met at UAMS was incredibly intelligent and supportive of our budding interest in medicine and neurosurgery. I’d like to give my thanks to the entire Neurosurgery staff and the neurosurgery residents for showing us around and giving us a rare chance to really live out their lifestyles, and I’d like to thank the Princeternship Program for giving me this incredible opportunity!

Connie Wang ’14, University of Arkansas Medical School

Connie-WangDay 1: Monday, January 28
Though the sun had barely risen in the sky, the surgical floor of UAMS (University of Arkansas for Medical Sciences) Medical Center was already abuzz with activity at 6:45 a.m. when Hope – the other Princetern – and I met with Dr. Erika Petersen ’96, our alum host. After brief introductions, Dr. Petersen entered the pre-op area to explain the surgical procedure to her patient. We then changed into scrubs and went in to the OR.

Dr. Petersen’s first case for the day involved the replacement of a battery pack for a spinal cord stimulator – a device that electrically stimulates the spinal cord to relieve pain from damaged spinal nerves.  Dr. Petersen invited us to watch the procedure up close from a step by the operating table – on the anesthesiologist’s side of the sterile drapes –and explained each step of the procedure as it was performed, pointing out anatomical details such as the different layers of tissue underneath the skin or the fibrous capsule that the patient’s body has formed around the battery. While Dr. Gandhi, a neurosurgery resident, removed the old battery, Dr. Petersen made the incision to insert the new battery, which was considerably smaller compared to the older model.  With Dr. Gandhi and Dr. Petersen working together, the procedure was completed quickly. After taking X-rays to confirm that the electrodes on the spinal cord have not moved during the procedure, Dr. Gandhi and Dr. Petersen closed the incisions, aligning the edges of each layer of tissue so that the wound can properly heal.

Typically, on Mondays, Dr. Petersen performs a procedure called deep brain stimulation (DBS), in which she installs a pacemaker device that provides electrical stimulation to the brain to relieve the tremors caused by conditions such as Parkinson’s disease.  One of the special things about DBS is that, unlike for most other surgeries, the patient is awake for part of the procedure. On this particular Monday, however, Dr. Petersen’s DBS case was cancelled; thus we spent the rest of the day observing two spine surgery cases – one for spinal fusion and one for spinal decompression –  performed by one of Dr. Petersen’s colleagues. Dr. Petersen and Dr. Gandhi explained the procedures to us using a model of a human spine and the X-rays displayed on the monitors. Both patients had suffered spine fractures. The fractured bone had narrowed part of the spinal canal, compressing the spinal cord and causing pain and numbness as a result.

At one point during the second surgery, Dr. Gandhi invited us to come close to the patient and look into the deep wound on the patient’s side. There, underneath the ribs, was the patient’s lung – dark red and glistening with moisture – rhythmically expanding and contracting with each breath, metered by the ventilator.  There is a certain awe and trepidation in being so close to the insides of a living human body.

Day 2: Tuesday, January 30
On Tuesday, we arrived at the hospital even earlier to experience morning rounds with the neurosurgery residents. After presenting updates on the condition of each of their patients, the residents quickly walked down to the hospital cafeteria to snatch a bite to eat before the conference at 7:00 a.m. At the conference for this particular day, the neurosurgeons were discussing candidates for treatment with the gamma knife, a type of radiation therapy that can deliver a dose of radiation to a very specific location within the brain. After the conference, we followed Dr. Petersen to the OR. Both of her cases for this day involved the replacing components of implants with newer technologies. In her first case, Dr. Petersen replaced older wire electrodes on a patient’s spinal cord stimulator with a new paddle electrode that cannot shift out of place as easily. Her second case was a generator replacement for a vagal nerve stimulation (VNS) unit, an implant that can treat epilepsy that does not respond to pharmaceutical approaches, or in some cases, OCD and depression.

In the afternoon, we observed in the clinic of one of Dr. Petersen’s colleagues who specializes in brain surgery. Dr. Ghandi was also in the clinic on this day and took brief pauses in between seeing patients to explain the features that are seen on the MRI and CT scans and the diseases or abnormalities that are observed.  Using a model of the human skull, Dr. Ghandi traced out the grooves and fissures and pits, pointing out the names of these anatomical landmarks and explaining where a surgeon might enter through the skull to reach the disease or injury deep within the brain.

At 5:00 p.m., we joined the residents and Dr. Petersen at the journal club, where they discussed and critiqued recently published articles in the field. Following journal club, we stayed briefly with the resident on call, whose long night shift began with a drive to the children’s hospital – during a rainstorm and a tornado warning – to perform a surgical procedure on an infant.

Day 3: Wednesday, January 31
Wednesdays are Dr. Petersen’s clinic days. On these days, Dr. Petersen evaluates and discusses possible surgical treatments with her patients or follows up on patients after their operations. While Dr. Petersen met with patients in her clinic, we observed in the OR where one of Dr. Petersen’s colleagues was performing brain surgery. The first case of the day was the clipping of an aneurysm, and the second case was the removal of a brain lesion located perilously near the region of the patient’s brain responsible for speech.

After making an incision in the scalp, the surgeons held the muscles with retractors and removed a plate of bone from the skull.  Cutting through the dura, the thin but tough layer of tissue that surrounds and protects the brain, the surgeons revealed the surface of the brain, with its complex network of branching blood vessels that pulsated slightly with each beat of the patient’s heart. From here, the surgeon switched to operating under the surgical microscope to perform the intricate maneuvers required for the operations. In the darkened room, we watched the procedure on the video monitors as the surgeon’s hands delicately dissected through the brain tissue and blood vessels. Only after looking at the actual wound did we realize how minuscule were the blood vessels that appeared so large on the screen – and how rock-steady the surgeon’s hands must have been.

After the functional neurosurgery conference that afternoon, in which the surgeons evaluated candidates for DBS (deep brain stimulation), Dr. Petersen took us out for dinner. In addition to sharing some of the stories during her time as a Princeton undergraduate, Dr. Petersen also shared some of the experiences on her journey to becoming a neurosurgeon and told some of the challenges of balancing personal and professional lives as a neurosurgeon – challenges that do not go away post-residency. Although this Princeternship was only a short three days in length, I have learned a lot from the amazing and diverse experiences of these few days.  As my first time observing in the OR, watching Dr. Petersen and her colleagues’ surgical procedures was an incredibly eye-opening experience. Through conferences and clinic and the other activities in Dr. Petersen’s and her colleagues’ busy schedules, I have experienced a taste of both the diversity of activities in the daily work of a neurosurgeon as well as the rewards and rigorous demands of this profession. I will remember these experiences – and hopefully also the nuggets of clinical knowledge that Dr. Petersen and Dr. Gandhi shared with us – as I continue to pursue a career in medicine, and I would like to thank Dr. Petersen, her colleagues, and the Princeternship program for providing us with such a truly incredible opportunity!

Sandra Goldlust ’15, The Children’s Hospital of Philadelphia

Sandra-GoldlustDay 1:
Today was the first day of my Princeternship at the Children’s Hospital of Pennsylvania (CHOP) shadowing Dr. Howard Snyder III, MD, an attending urologist and professor of Urology in Surgery at the University of Pennsylvania School of Medicine. Once the other Princetern and I had arrived, Sharon Brown, who works for the Division of Urology, showed us around the clinic and introduced us to Dr. Howard Snyder ’65. Dr. Snyder taught us about the surgical techniques used in hypospadias repairs and soon after we had the chance to watch the procedure close-up in the operating room. I had never before had the chance to observe surgery and it brought to life so much that I had read in books.

Later that day, Dr. Snyder took us to the Mütter Museum, where he is on the board of trustees of The College of Physicians of Philadelphia. The museum is filled with some of the most fascinating medical abnormalities such as the skeleton of one of the world’s tallest people and the body of the soap woman.  I definitely hope to return to the museum in the future and I am looking forward to starting again early tomorrow!

Day 2:
Today we shadowed Dr. Snyder in the clinic, where we saw a variety of pediatric urologic conditions, such as UTIs and kidney infections. Dr. Snyder developed a unique treatment plan for each of his patients, carefully explaining the medical details to his young patients and their parents. Dr. Snyder recommended biofeedback techniques to several of his patients, in order to offer useful solutions without immediately turning to medication.  Between patients, we learned all about Dr. Snyder’s involvement in health policy and his experiences as both a general surgeon and pediatric urologist.

Day 3:
Today was the last day of the Princeternship and we observed a pyeloplasty performed laparoscopically. Once the camera was inserted, one of the residents explained each step of the procedure, which we could follow on a large screen. It was fascinating to me that such a major repair could be performed through such a small incision, minimizing the patient’s recovery time. Although the surgery was several hours long, the time seemed to fly by.

After the surgery, we sat in on aphoto 2 conference in which the residents presented their most challenging cases. After each presentation, they discussed the risks and benefits of different possible approaches in order to determine the best treatment plan.  It was a great experience for us to learn not only about standard treatments in the field, but also some of the more cutting-edge approaches. Overall, the experience was definitely unique in the way it combined exposure to the clinic, the operating room, and health policy, all within the context of a teaching hospital. These three days have gone by so quickly, but I am grateful to have had this opportunity.