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.