Clara Kerwin ’16, Massachusetts General Hospital

Clara-KerwinDay 1 (1/8/13)
I left my hotel at 8 o’clock and walked across the street to the vast expanse of buildings that makes up Massachusetts General Hospital.  I made my way to the main lobby, and from there navigated through a maze of doors and hallways to the Yawkey Center for Outpatient Care, in which the Orthopaedic Trauma Division is located.  At 8:30 my host, Suzanne Morrison ’89, escorted me to her office.  Suzanne is the program director for Partners Orthopaedic Trauma Service, which is a combined program that includes Mass Gen, Brigham and Women’s Hospital, and Harvard Medical School. 

Suzanne immediately struck me as someone who was both genial and assertive.  I enjoyed hearing about her path to medical administration.  She graduated in 1989 from Princeton with a degree in sociology.  After spending time working at a travel agency, she became interested in public health and obtained her Master of Public Health degree at Boston University.  She began working at Mass Gen as a patient advocate and then switched to her current position in 2000.  We talked for a while about the hospital and her career and reminisced about Princeton.  We discovered that she had lived in the same entryway in Rocky College! 

Next, Suzanne gave me the “two cent tour” of Mass Gen.  It is truly a vast complex and consists of so much more than what would normally come to mind when one thinks hospital.  Suzanne led me through the key buildings and centers of the hospital, frequently pausing to greet a colleague or friend and introduce me.  We passed the effective hubKerwin2 (the coffee shop of course), and ventured into Bulfinch, the sole building that comprised Mass Gen when it was founded in 1811.  I was surprised at the amount of history contained in the hospital.  It was in the iconic Ether Dome (the original operating room within Bulfinch) that surgical anesthesia was first employed in a public demonstration.  Another memorable aspect of the tour was going to Phillips House, the exclusive patient care unit on the top three floors of the Ellison building.  It is here that Mass Gen’s numerous VIPs stay.  While I sadly was not entitled to any first-class treatment, it was wonderful to see the panoramic views of Boston.  Suzanne pointed out some of the interesting buildings and neighborhoods of the city.  I appreciated the beauty of the icy Charles River, the gold-domed capital building, and Mass Gen’s helicopter pad! 

We then made our way back to Suzanne’s office where she had a meeting with the orthopaedic division’s director of research.  Various studies are being conducted simultaneously on a wide variety of topics:  the effectiveness of surgical treatment of elbow fractures; the improvements that result when a geriatrician contributes to the treatment of elderly patients;  how a lack of vitamin D can serve as a predictor of treatment failure.  It was interesting hearing about the procedures involved in initiating a new study including the writing and review processes. 

After eating lunch with Suzanne in the hospital’s cafeteria, I met with the unit nurse leader and spent the afternoon in the clinic.  The amount of patients was apparently startlingly low that day, but I still enjoyed finding out how the clinic operates.  Some patients are easy follow-ups.  Others have to be admitted to the operating room.  Many different kinds of staff are active in the clinic including doctors, residents, nurses, nurse assistants, etc.  The day confirmed that the hustle and bustle of hospital life greatly appeals to me.  I love being around such a wide variety of people and asking questions about the specifics of their jobs. 

Day 2 (1/9/13)  
Early morning today!  I was at the hospital at 6:15 am to go on morning rounds with the nurse practitioner, Kathy Burns.  We began by gathering with the residents and fellows to go over the X-rays of the approximately twenty-five patients who spent the night in the hospital for orthopaedic problems.  There is truly a diverse spectrum of cases that orthopaedics encompasses including tibia fractures, hip replacements, and joint dislocations.  After each of the residents presented any developments with their patients, I accompanied Kathy and one of the physicians to check on some of the patients themselves.  We then met up with the residents from the other teams to make sure everyone was on the same page for all the cases.  It was great to hear about some of the newly-admitted patients who I had encountered yesterday in clinic.

After a quick coffee break, I went with Kathy to several interdisciplinary meetings in which Kathy updated non-orthopaedic staff (including nurses, physical therapists, and administrators) on the progress of the various patients.  It was very clear to me that Kathy’s job entails many different types of activities and there is always something that needs to get done. 

We then checked in at the nurses’ stations on the two different orthopaedic floors.  Kathy showed me the results of various blood tests, which are performed to ensure that the patients are stabilized.  I also learned about the processes involved in repairing fractures.  It was impressive to see the X-rays that displayed the intricate network screws and plates that had been surgically placed into the pelvis or the tibia. 

Kerwin1Kathy then took me on a tour of some of the critical care center including the intensive care unit, the emergency room, and the recovery room.  It was interesting to hear about the daily proceedings in other parts of the hospital.  Kathy, who used to work in the general surgery department, knew many insights regarding the treatment of patients with unforeseen ailments.  She also pointed out and explained what CT scanners and MRI machines are used for.  Kathy then headed off to do some paperwork.  Because Suzanne was at Brigham and Women’s Hospital today, I had the afternoon off.  Time to study for finals!

Though the morning was long, I had a very valuable experience.  It was amazing how many activities were crammed into the short hours I spent with Kathy.  Seeing some of the other facets of the hospital made me consider how many possibilities exist within the medical field.  At this point, I do not think that I would enjoy working in orthopaedics in the long-run.  However, I really like the people who work in this field.  The hospital personnel all sincerely want to see patients get better.  Even though there are sometimes conflicts with family members or complications brought on by a patient’s carelessness, everybody loves seeing positive results.  Its inspiring knowing that the work done by the medical staff at Mass Gen directly affects the long-term health of patients.

Day 3 (1/10/13)
This morning, I met Suzanne in the main lobby at 7:50 to go to Grand Rounds.  The term “rounds” refers not only to walking around to see patients, but can also describe any conference in which clinical cases or problems are discussed.  Grand Rounds consisted of a fairly formal lecture given by an expert geriatrician that was intended to educate hospital staff on the merits of an interdisciplinary approach to dealing with fractures in elderly patients.  The lecturer was from a hospital in Rochester, and he was espousing the success of their Geriatric Fracture Center.  In addition to helping their patients, hospitals want to be efficient and keep costs as low as possible.  The presenter explained how having an elderly patient be examined by a geriatrician as well as an orthopaedist allows for both higher quality care and a reduced length of stay.  These improvements simultaneously increase patient satisfaction and reduce costs.  Mass Gen’s Orthopaedic Trauma Service has recently initiated a similar interdisciplinary program and has already seen positive results. 

Sitting in on Grand Rounds was very interesting and educational.  I learned a great deal about the special care elderly patients need even for minor fractures.  Unlike younger patients, those over 60 years of age have weakening bones, fragile skin, slower recovery times, and may suffer from dementia when in an unfamiliar environment for extended periods of time.  For all of these reasons, it is greatly beneficial to reduce the amount of time an elderly patient is in the hospital.  Hearing about this program made me realize how pertinent research and development are to modern day medical facilities.  There are advances being made every day, and new ideas are constantly being tested and put into play.  I find it exciting and appealing to know that medicine is still a very dynamic field and there is always room for improvement.

Back in Suzanne’s office, she told me more about the work she had done as a patient advocate.  No case is black and white. At times she had to deal with patients who were mentally unstable, and also with those who had legitimate complaints. Nevertheless, patient advocacy, as well as general faith in the hospital experience, contributes to the healing process, which in turn makes medicine such a rewarding field.

I then went with Suzanne to a conference with the geriatrician from Grand Rounds along with other heads of the orthopaedic departments at Mass Gen and Brigham.  I listened attentively as they discussed the emerging program and the details of how the program will continue to be developed.  There are many factors that must be considered and many different departments that must be brought up to speed on the advances.  The meeting was largely focused on strategizing on how hospitalists will be recruited for geriatric care and how the economics of the program should play out.

At lunch I asked Suzanne more about her time at Princeton.  In many ways, her experiences seem very similar to what I have encountered so far at Princeton.  She really enjoyed her time at Princeton and is actively involved in various alumni programs.  Suzanne also reaffirmed the importance of networking and the role that chance plays in terms of career decisions. 

After a quick meeting, Suzanne and I got into scrubs to pay a visit to the operating room.  I was pretty excited to see a surgery in person (as opposed to on TV) and felt very professional in the surgical garb.  One of the residents explained the case: a boy who had badly fractured his left fibula at the ankle when he slipped on ice that morning.  While examining the X-rays of the ankle, the resident explained the standard procedure of correcting the placement of the bones and inserting screws to bind them in place.  I stood by as the patient, still conscious, was brought in.  Once the leg was numbed, the patient would be put into a light sleep. 

Unfortunately, at that point I felt lightheaded and went out of the room with Suzanne to get some air.  It was there that I fainted (for the second time in my life)!  It was the ideal location to do so, as a bed was close by, and I spent about fifteen minutes resting and munching on graham crackers!  Surgery had been a branch of medicine that I was (and still am) eager to explore.  While I sadly had to forgo that surgery, I am hopeful that I will have another opportunity in the future.  Apparently, it is fairly common to faint the first time one sees a surgery, and plenty of people acclimate and go on to work in the OR daily.  So there’s still hope for the future!

After that minor diversion, Suzanne and I went back to her office.  We took some quick photos and then changed out of our scrubs.  Then it was time to go.  Though my time at Mass Gen was brief, there were plenty of people to say goodbye to and thank.  After promising Suzanne I would keep in touch, I headed out.  

I would definitely recommend this Princeternship to other students.  I gained valuable insights into the intricacies of hospital life and the vast network of fields and subfields that any department encompasses.  So many different kinds of staff are involved in every step of patient care and program development.  I know I am much more informed about the realities of medicine, but at the same time, there is so much more to learn and investigate.  Although this hospital experience was too short to confirm my intentions to become a physician, it definitively reaffirmed my interest in learning about realms of medicine like public health, patient advocacy and integrated patient management.  I now know that if I do choose a path in medicine I will have a much better idea of what it could entail.  I am very appreciative of Suzanne, Kathy, and all the other Mass Gen personnel for making time for me in their busy lives and giving me the opportunity of a lifetime to explore medicine at its best.