Even on the phone, Ms. Suzanne Morrison ‘89, the Program Director for the Partners Orthopaedic Trauma Service, seemed amiable. In our first conversation some weeks before the Princeternship, Suzanne introduced herself, asked what my goals were, and assured me she would do her best to see them through. I told her I hadn’t pinned my mind on anything and would be happy to see as much as I could. As I sat in her office the first morning going over my schedule, I couldn’t help but smile. It was thoughtful and carefully crafted; in my three days, I would be spanning the clinical research division, the ER, and the OR. But before we started, Suzanne offered to take me and Yende (the other Princetern) on a tour of the hospital goliath. Massachusetts General Hospital (MGH) spans nearly 30 buildings and is the oldest and largest hospital in New England. Yet, when it was founded in the early 1800s, it was singularly concentrated in the Bulfinch Building, my favorite place on the tour. Designed by later U.S. Capitol architect Charles Bulfinch, the building is to MGH as Nassau Hall is to Princeton. The walls were lined with photos of past medical staff, nurses, and residents decked out in full attire. Medical fashion has changed quite a lot since then! Within the Bulfinch Building we also visited the Ether Dome, the surgical amphitheater where the first surgery using anesthesia was administered in 1846.
After the tour, I was introduced to Bobby, a recent Princeton graduate working as a research coordinator at the orthopedic trauma clinic, and his colleague Jordan. Today Bobby was seeing several patients involved in the PROMIS and RSA studies. The goal of PROMIS is to effectively and efficiently capture patient reported outcome measures from patients – in this case answering questions about their health on a tablet while waiting for the doctor. Their answers would provide doctors with important information even before they entered the room. .Bobby was in the late stages of trimming down the questionnaire to the questions most highly correlated with patient treatment and outcomes.
The RSA study aims to establish a new standard for monitoring lower leg fractures through the use of X-ray florescent beads. The beads are placed above and below the fracture line during surgery. Afterwards, X-rays are taken as force is applied at the base of the patient’s foot. Initially, the bone is soft and pliable so the average distance between the beads above and the beads below the fracture line is small because the beads are pushed closer together. Over time as the fracture heals, the bone becomes more rigid and the distance between the beads above and the beads below increases when the same force is applied. It was exciting to watch Bobby work with two patients participating in the RSA study who came in today for routine monitoring. Both patients did very well and as expected, their average distances were larger than their last measurements. A beautiful thing.
Tuesday began at 6:30 am with X-ray and Care Rounds. During this round table discussion, residents of the night shift relayed information about the night’s patients to the attending physicians. It serves as a review of the night, a debrief of the day, and a medium for residents, attendings, and nurses to share their perspectives on patient treatment. As I was later told, that night was very busy with an unusually high number of admitted patients. The resident gave a quick synopsis of each patient—age, mechanism of injury, physical assessment, vital trends, projected treatment—as MRIs and X-rays flashed across the screen. Although there was much medical jargon I did not understand, the residents’ ability to summarize and remember the specifics for each patient was undoubtedly impressive.
After Grand Rounds, I spent the rest of the day with Shaun, a second-year resident in the orthopedic trauma program. First, we visited the rooms of the patients who were admitted to the service. Shaun monitored their progress and made sure no unexpected changes occurred overnight. All the while, he kept an eye on his pager for consults from the ER. A consult is requested when a patient’s condition requires a specialized assessment. The cases for that day were diverse, ranging from reducible, non-operative fractures to a bilateral humerus fracture. Along the way, I got a good sense of the daily routine of a resident and the pace and workings of the ER. Each consult and assessment was followed by an extensive write-up on the hospital’s electronic paperwork filing system. Each patient has a portfolio of extensive notes written by their medical staff detailing their medical history and status. The amount of paperwork is daunting, but I imagine knowing that your input helps treat the patient you just met and talked to motivates the process.
The third day opened with another morning of Rounds. Having heard the terminology for two days now, I felt the words “anterior,” “posterior,” “proximal,” “distal,” “lateral,” and “medial” setting up camp in my brain. These direction words were confusing at first but quickly proved immensely useful; it allowed an injured area to be pinpointed with a few words. After the discussion, I spent the morning with Todd, a nurse practitioner. Like the previous day, Todd and I went on rounds to visit the patients. Todd was funny and encouraging, urging patients with limited motility due to orthopedic injuries get up and moving again. Todd also talked with patients about medications and their treatment schedules. During the afternoon, we went to the OR to watch the surgical stabilization of a right ankle fracture. The bone sections on either side of the fracture were realigned and held in place to heal with a metal plate and screws. The medical team was very accommodating and even projected the surgery onto a monitor so we could watch the operation close up.
I am very thankful because this Princeternship gave me what I needed most: exposure. Although I was only able to spend a short time with everyone, I learned a lot about the different moving parts of a hospital and careers in medicine and research. I would like to thank Bobby, Jordan, Shaun, and Todd for taking time to make me feel welcome and share a part of what they do. Above all, I am extremely lucky to have had Suzanne as a host. Now when I say “I want to go to med school”, I feel a certain weight and confidence behind my words that I didn’t know before. I owe very much to all of you for that.