Spending two days shadowing Dr. Michael Armstrong ’85 at his Richmond ENT office was a truly eye-opening experience. As someone who held an idealized and dramatized vision fueled by episodes of “House” of the day-to-day practice of a physician, this Princeternship afforded me the opportunity to actually witness not only doctor-patient interactions and surgeries but the actual business side of owning a practice and the daily operations that go with it. Dr. Armstrong also answered all of the questions I had pertaining to his journey to becoming a doctor, and what he enjoys the most and least about his job, among other things.

Day 1

The first day started a little after 8am when Dr. Armstrong met with his first patient. Much like many of the patients he met with that day, the patient had a problem with their sinuses. Here I witnessed the first of many nose examinations wherein a camera at the end of a tube was placed within the nose as Dr. Armstrong examined the sinuses and turbinates (one of the new words I learned during my shadowing experience). Most of these were checkups and the patients were fine, but some patients had signs of potential sinusitis and may have needed balloon sinuplasty. This is a procedure usually used to treat sinusitis, where a small balloon is inflated within the sinuses, which may be inflamed or narrow, opening them.  Because no surgery is required it is much less invasive than traditional procedures. What was most rewarding about this experience was seeing the doctor-patient interactions. Dr. Armstrong was extremely patient and caring and actually described the anatomy of the medical issues in terms that the patient understood and gladly answered any questions. The rooms even had mirrors so that the patient could view the monitor showing the interior of their noses. Even when a patient experienced discomfort Dr. Armstrong or Amy, one of the nurses, reassuringly comforted her.

In my downtime, I spent most of my time with a future med student who worked as a scribe for the office and a nurse in training, Sud and Kara respectively. They were just as invaluable to my experience as shadowing Dr. Armstrong. Sud helped me to realize just how real it is, in terms of what it actually takes to get into medical school and gave me advice on how to study for the MCAT. Kara gave me insight into the transition from school to the workforce. That afternoon I was able to ask Dr. Armstrong a few questions about his profession and his journey to said profession. The doctor’s interest in the complexity of gynecological oncology lead him to the ENT specialty because while he enjoyed the challenge of the complex anatomy and engaging in certain emotional aspects that went into that specialty, he realized that the demand for male gynecologists was decreasing and the ENT specialty was also complex and involved facial plastics. Dr. Armstrong said that Princeton prepared him for medical school because of the thesis process which entails engaging in detailed original research and reaching out to people.

Day 2

On the next day I was able to witness two surgeries, a CO₂ laser treatment, and other appointments with patients. For my first surgical experience I was expecting this super serious environment, but surprisingly everyone involved was relaxed and happy and even talked during the surgery. It was a tonsillectomy and I was able to see right over Dr. Armstrong’s shoulder while he performed the surgery; it was quick and afterwards the patient awakened with no difficulty and could even talk. The next surgery was a corrective rhinoplasty. This took a bit longer but I really got to see Dr. Armstrong as a sculptor of an actual human body. It was incredible to see him expertly reconstruct someone’s nose while mentally envisioning what the outcome would be. Throughout the surgeries the nurses and anesthesiologist were extremely gracious and eased any anxiety I had about the experience through their kindness and willingness to explain the procedure and their roles within them. After the surgeries, I accompanied Dr. Armstrong to his next procedure, the CO₂ laser treatment used to cosmetically treat deep lines or wrinkles in the face with penetrating lasers. After watching the lasers being systematically applied to the patient’s numbed face for approximately five minutes I got to observe more patient appointments with Amy. Amy had the same reassuring confidence as Dr. Armstrong and had the ability to make the patients feel comfortable through her excellent communication skills. Interestingly, throughout these two days I saw the entire process of preparation for and recovery from rhinoplasty in three different patients. The first patient had already had the procedure and came in for a check-up, the next patient was the morning surgery that I witnessed, and the last came in to get his sutures removed. For my last shadowing experience I followed Dr. Giordano, an associate of Dr. Armstrong. After an eye-opening discussion about the usefulness of organic chemistry for a doctor, I witnessed my first ear tube procedure. I was able to see the ear drained and the tube being inserted in the eardrum. Finally, before saying goodbye Dr. Armstrong showed me a CT scan of the sinuses and the mucus within the sinuses.

Overall this was an amazing experience where I got to see doctor-patient interactions that showcased the importance of communication and thoroughness. I saw another side of the practice as Dr. Armstrong participated in TV interviews, dealt with paperwork, and made executive decisions in terms of the office and patients. His beautiful analogies to art put his practice in terms that were familiar, with me being an Art History major. Dr. Armstrong stated that surgery, specifically rhinoplasty, was his favorite part of the job, which was evident in the way he skillfully performed his procedures. In fact, seeing those surgeries was my favorite part of the experience. Thank you to Dr. Armstrong, Dr. G, Amy, Gina, Sud, Kara, and the entire staff at Richmond ENT for being so hospitable and making this experience amazing!