Having already shadowed a neurosurgeon and a radiologist through Princeton’s amazing alumni network and the Princeternship program, I came into this third Princeternship with Dr. Debra Palazzi ’92, an attending for the Infectious Diseases department at Texas Children’s Hospital, excited to observe a side of medicine I hadn’t seen before. For most of the three days I was there, I followed Dr. Palazzi, Dr. Silvia Chiang (fellow) and Dr. Judson Moore (resident) on their rounds, which took us everywhere from the Neonatal Intensive Care Unit to the ward of a 19-year-old who was only a couple months younger than me. We were never in one place for long—it was a lot of walking (and a great workout), so be prepared!
We saw children with a variety of conditions, and many of them were at the hospital for a viral or bacterial infection, sometimes following a surgical procedure used to treat a preexisting disorder. For instance, a girl with static encephalopathy (brain damage) and severe scoliosis (abnormal spine curvature) had acquired an infection of her spinal rods. We also came across neonates who suffered complications that arose from premature birth. One premature baby had suffered respiratory failure since birth, along with thrombocytopenia (decrease of platelets) and methicillin-sensitive Staphylococcus aureus bacteremia, a serious bacterial infection with high mortality rates. Other children had relatively minor conditions, such as a girl with eczema herpeticum (when someone with eczema has a breakout of the herpes virus), although the rash on her skin definitely didn’t look “mild.” Because most kids had multiple disorders, shadowing Dr. Palazzi and her team really taught me the importance of communication and collaboration across various medical disciplines to provide each patient with the best care.
Another thing I gathered was that, despite all the science involved in diagnosing and treating sickness, there often isn’t a completely “right” answer in medicine. A prime example was a baby girl we saw in the Pediatric Intensive Care Unit, who came in with spiking fevers, severe edema, green diarrhea, an abnormal white blood cell count and thrombocytopenia. We first thought her symptoms might be the result of a bacterial infection, but her cultures were shown to be negative. Other possibilities included a viral infection (but even then, her response to the virus was abnormal), Kawasaki syndrome (an autoimmune inflammatory disease), and even leukemia (because her platelet count was so low). After a careful examination of her symptoms and lab results, Dr. Palazzi concluded the baby most likely had hemophagocytosis lymphohistiocytosis (HLH), a rare hyperinflammatory disease in which macrophages and lymphocytes are over-activated. The baby seemed to be getting worse in the two days I was there to see her, but I hope things are starting to look up, even if only slowly.
One other case I found particularly memorable was a girl that had received an appendectomy after her appendix ruptured (on Christmas Day, too!). The rupture led to infections that resulted in several intra-abdominal abscesses, which were treated with antibiotics and multiple drains that perforated her abdominal cavity. She was allowed to leave on my last day there, and when we dropped by to say goodbye, she and her parents were extremely grateful for Dr. Palazzi and her team. The way they showed their thanks almost made me tear up, and reminded me why I had wanted to become a doctor in the first place—doctors really can make a difference!
Finally, aside from following the team on their rounds, I also accompanied them to conferences and lab sessions. I attended two conferences on the first day, one on a baby boy with leukocytoclastic vasculitis (an inflammation of small blood vessels that results in purpura), and another on dysmorphology. On the second day, I attended a CityWide Infectious Diseases conference about a man with neuroleptic malignant syndrome (a neurological disorder caused by an abnormal response to antipsychotic drugs) and a baby with acute cerebellitis (inflammation of the cerebellum), where doctors working at different hospitals in the Texas Medical Center come together each week to discuss cases. The lab session on the third day, where I observed how blood and urine cultures were used to identify bacterial and viral infections, was especially exciting because it gave me an opportunity to observe a real-life application of what I had learned in the molecular biology courses I took at Princeton.
So by now it’s probably quite obvious how rewarding I found this three-day shadowing opportunity at Texas Children’s Hospital. I learned a lot about a field I hadn’t even realized existed prior to applying for this Princeternship, and I came away from the experience with a confirmation of my desires to become a pediatrician. Dr. Palazzi’s patients are really lucky to have her, and you’ll be lucky if you get to shadow her.