Category Archives: Health & Medicine

Vivienne Tam ’15, Swedish Neuroscience Institute

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I applied to this Princeternship at Swedish Neuroscience Institute expecting to see how research and medical practice intersected. It ended up being a face-to-face encounter with life and death – a story of the struggle for hope and a battle for survival all in a short three days of a neurosurgeon.

Tam 2Monday

It started off with a tumor board where doctors in scrubs congregate at 7:30 a.m. around Starbucks cups and fMRI projections. A brain image would go up and after giving a short description of the patient, the group of surgeons and radiologists would proceed to comment and dialogue about potential treatment. It was hard to believe that every single blotchy black and white blob on the screen belonged to an actual person – with a story, a family – a life. Sometimes, it was very easy to forget that in the jargon of ‘necrotic tissue’ and ‘intertemporal medial lobe’. Dr. Charles Cobbs ‘85 started to speak of a woman in a comatose state; and in that moment, it was no longer tissue, the case had a face and a name. She had 3 kids, was divorced, addicted to narcotics and still young – only 34 years old. The gentleness and compassion with which he spoke moved me. This is where medicine touched real lives. They were going to have to pull the plug on her pretty soon, it seemed was the verdict. A procedure to implant a shunt was scheduled later that afternoon as a last-ditch measure to keep her alive.

Without taking off the doctor-cap, we immediately switched gears to talking about research at his lab meeting. By applying his experience with brain cancer patients to his time beside the lab bench, Dr. Cobbs is able to generate the most cutting-edge research as it pertains to brain cancer. He discovered, for example, that cytomegalovirus is behind glioblastoma, the most deadly form of malignant brain tumors and this has led him to design vaccines to cure brain cancer which currently has no cure. This was groundbreaking.

As the newly recruited director of the Ivy Institute, Dr. Cobbs’ job also takes on an administrative role. An advisor counselled him on how to make Swedish the most competitive in the space, so that those with brain tumors will see it as a place that has ‘got it right’. We also talked about how to cut down on extraneous costs.

Back in the office, Dr. Cobbs receives a call from the comatose woman’s mother requesting they cancel the surgery and remove life-support.

I step outside the hospital doors. One more person has just crossed the line from life to death. I can’t imagine every day being like this. Seeing lives pass through your fingers, but like gripping sand you can’t do anything to stop it. I ponder about eternity as I board the bus back home.

Tuesday

After a rather somber end to the first day, I was ready to meet the hopeful cases – the patients who had gone through surgery and were coming to see Dr. Cobbs for a post-op follow up visit, and also those who were contemplating a potential surgery. He had eight patients lined up back to back without a lunch break and with persevering dedication, he powered through all of them – going into a room, meeting patients, going back to his office and dictating notes, then back to another room again.

If I could use one word to describe Dr. Cobbs as he met his patients, it would be humble. As a very accomplished neurosurgeon, he probably knows all there is to know about the brain. Yet, with each patient, he broke the concepts down to a very basic level and patiently walked them through enigmatic grey-and-white brain scans.

A couple of scenes stick out in my mind: Dr. Cobbs holding an elderly man as he got out of a wheelchair, his arms reassuring the man as he stood wobbling; Dr. Cobbs gingerly pulling back a woman’s hair to clean up the scar tissue beside her ear and apologizing when he hit some raw tissue; him very gently breaking the news to a visibly distressed elderly lady of the need for surgery as soon as possible to remove a malignant tumor. Even though he has only been at Swedish for a couple of months, he is much respected by his patients and it was such an honor seeing such a display of genuine caring. This world needs more doctors like that.

I was also amazed at the hopefulness Dr. Cobbs carried in the face of such a menacing disease. I can’t even imagine the frustration of months of hard work only to have the patient pass away. How do you stay sufficiently emotionally detached so that each inevitable loss is not devastating, yet continue fighting this amorphous monster to the last breath? Perhaps it is the way Dr. Cobbs doesn’t take himself too seriously that gives him the grace to carry on this kind of environment.

“Thanks for answering all of my questions doctor,” a patient pipes up after an intense interrogation.

“Oh, it was tough,” Dr. Cobbs responds with a twinkle in his eye.

Wednesday

The first day I saw death, the second, life and now I was to stand at the brink of life and death. It was surgery day.

After sending my parents a quick email to please pray for me so I don’t faint, I donned my scrubs and entered the already-buzzing operating room at 7 in the morning. Today’s was a “cranie,” in other words the removal of a cancerous tumor in the brain.

It was my first surgery so I had to look awayTam 1 as the anesthesiologist stuck an IV into the patient’s neck. I never was a big fan of needles. Unfortunately, I didn’t look away fast enough to miss the other surgeon nonchalantly screwing a U-shaped fixture with long sharp needles on either end into the man’s head.

Dr. Cobbs took me and another observing student into the back room to show us where the tumor was located using an fMRI. This man’s tumor was huge and he would probably have to remove about a quarter of the brain to get it all out.

Being careful to stay 3 feet away from all the blue sterile stuff lest I get kicked out of the OR, I made my way to the front of the bed where the surgery was proceeding like clockwork. The skin was cut through, holes were drilled in the bone, dura peeled back and finally brain revealed. I gasped quietly in awe at the first sight of the brain.

However, the recognizable folds of the brain were quickly dismembered under the skillful scalpel of Dr. Cobbs. Soon, he was burrowing deep into the brain, sucking out pieces of brain to the tune of Adele in the background.

All of a sudden, Dr. Cobbs’ voice turned terse, “He is showing a lot of swelling, also hyperventilating. I need an ultrasound.” It is an emergency situation. The lights turn down and I pray under my breath for a man I do not even know. “Shut the music,” he orders. No one moves as they stare intently at the screens displaying the man’s vitals. I walk over and press ‘mute’.

The silence hangs heavy in the room as Dr. Cobbs works fast to save his life. I watch with abated breath, in disbelief that I was observing what he was later to describe as one of the scariest experiences he has had in a long time doing surgeries. This literally was the brink of life and death. A couple of tense moments later, Dr. Cobbs had removed the problematic tissue and the patient was back in the ‘safe zone.’ I remain amazed at how calm he was. Later on, he confided that the challenging cases were actually his favorite part of his job because it gets him to think on the spot. No wonder he’s a neurosurgeon.

The second surgery – a spine decompression – was simpler, though it involved the correction of major errors made by the previous surgery, one of which included leaving the patient’s major spinal nerve protruding from her spinal cord. After the surgeries, we went to visit the patients recovering in the ICU. It was so encouraging to see them responding well, and I was actually quite surprised to see the man being able to obey commands without a large part of his brain.

I am now on the plane returning to Princeton and to finals awaiting me. Usually, I would be approaching this season with much fear, but after what I have been through these past few days, finals seem so insignificant. We complain about receiving a bad grade on an exam, when people receive news of having an incurable glioblastoma leaving them about 1-2 years to live. Honestly, I feel so blessed just to be alive – and with brain cancer that could affect anyone with no known reason, that is definitely not something to be taken for granted.

To anyone who is thinking about doing a Princeternship – go. You only have one life; live it to the fullest. Who knows, you might even get to see a human brain (I definitely wasn’t expecting to!).

To Dr. Cobbs – what can I say.  You inspire me. I can’t believe I had the amazing privilege of following you around – it was surreal. You’ve shown me what it means to do a job with genuine passion, pursued excellence and real love. Thank you.

Ruina Zhang ’17, Staten Island University Hospital

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Ruina-ZhangI was extremely excited when I walked into the bright lobby of Staten Island University Hospital. The lounge chairs, the giant teddy bears in the display window of the cozy gift shop, and the helpful staff at the information center instantly made this a pleasant place. However, I was still a little scared since I had no idea what to expect: I have never shadowed a doctor before.

Lucky for me, Dr. Bajaj, the Princeternship host, is one of the most friendly and easygoing doctors I have ever met. He is the head of the ultrasound department at SIUH, and he actively engaged us in interesting conversations while he read his ultrasound and CT images.

On the first day of the Princeternship, I met Dr. Bajaj and Arence, the other Princetern, at 9 AM in Dr. Bajaj’s office. It took me a while to find his office, since it’s inside the ultrasound section, which is inside the Radiology Department. His office’s space is mostly taken up by four large computer screens positioned vertically next to each other. He explained to Arence and me what the colors on the scans mean as well as how Doppler’s effect works in these scans. I found it fascinating that what I’ve learned in physics in the past semester is actually applied here. Dr. Bajaj delved right into his work list, looking at multiple ultrasound images of livers, kidneys and gallbladders. He worked very efficiently, with the help of a voice dictation system (which worked most of the time. It was a laughing moment when Dr. Baja found that it wrote down “pelvic leg” instead of “pelvically.”) Dr. Bajaj explained to us that since sound does not travel well in solid, stones appear bright with dark shadows behind them. At first, I could not recognize anything but black and white blobs distributed randomly on the screen. But with the help of Dr. Bajaj, I learned to recognize a bright spot as a gallbladder stone after several images. Dr. Bajaj also explained to us that macrovesicular steatosis (fatty liver) would be one of the leading causes of health concerns by 2020. I was surprised to hear that because most of the health issues brought constantly to our attention were breast cancer and cardiovascular diseases. Fortunately, one can lose the fat on his or her liver by having a healthier diet and exercising more.

After looking at some abdominal images, Dr. Bajaj moved on to ultrasounds of fetuses. He found out that the technicians have mis-measured the fetal heart rate. A little later, he saw a fetal ultrasound image and paused for a moment. He looked carefully at the head of this fetus, and concluded that the dark region either indicates severe hydrocephalus or anencephalus in a serious manner. Dr. Bajaj recognized this extremely unfortunate event, and subsequently raised a controversial ethical question of whether to suggest termination of pregnancy or to encourage the birth of this baby in order to harvest its organs after it’s born. He said that it is a hotly debated topic in the medical community, and encouraged us to think about what we would do.

Dr. Bajaj sent us to a residents’ noon conference, where the residents learned to read images. I thought the diagnosis process is very interesting, and it reminds me somewhat of Sherlock’s thought process. Everything follows logic. Dr. Bajaj told us that normally, he does some ultrasounds and other small procedures himself. Unfortunately, he was hit by a car several weeks ago and consequently is unable to do those tasks with a broken leg. Dr. Bajaj took us to another Radiology Reading Room in the afternoon. Arence and I had a chance to talk to two other attendings and a third-year resident there.

On the second day of my three-day Princeternship, I arrived at SIUH at around 2 PM because Dr. Bajaj had a late shift that day. We looked at more CT and ultrasound images. Dr. Bajaj told us that ultrasound actually has a higher resolution than CT, which most people don’t realize. I never would have expected that because the CT images seem a lot clearer to me, but I guess it is due to the way the images are taken, not their actual resolution.

The last day was very exciting. In the morning, I found Dr. Bajaj at the Verrazano office. This office gives a very different feel than the one in the main hospital area. This outpatient imaging center is very cozy, with a spacious lounge area outside. The wall colors follow a dark orange theme, which renders this place friendly and welcoming. Dr. Bajaj worked on more CT and ultrasound images in the morning. Later, he sent us to the neuroradiology reading room in the main hospital building so that we could get a sense of what other branches of radiology look like (I mentioned on the second day that I really loved my neuroscience class. I was surprised that Dr. Bajaj actually remembered this and thoughtfully worked out something for me so I could learn more from this experience. Thank you Dr. Bajaj!) I found the brain images absolutely fascinating. I have a basic idea of the brain anatomy after dissecting two sheep brains in my neuroscience class, and this general knowledge really helped me appreciate neuroradiology. Dr. Arnuk, a friend of Dr. Bajaj, kindly shared his stories of switching from internal medicine to neuroradiology with us.

In the afternoon, Dr. Bajaj introduced us to Dr. Sperling, who works in the ER. Dr. Bajaj wanted to give Arence and me an opportunity to experience other branches of medicine because radiology only represents a tiny portion of it. Indeed, the two hours I spent with Dr. Sperling in the emergency department was drastically different from my time shadowing Dr. Bajaj. Dr. Sperling checked up on three of his patients while we shadowed him. He greeted his patients and their families warmly, chatted with them, and explained what was going on patiently. I loved the doctor-patient interaction, which was rather rare in radiology.

I am extremely grateful to Dr. Bajaj and his co-workers, Staten Island University Hospital, and Princeton Career Services. I’ve learned a lot during these three days. In addition to helping me decide what I want to study at Princeton, I also observed how the theoretical knowledge that I learned in class is applied in real life. I am sure that this will become a motivation for studying harder in the future.

Sharon You ’17, North Shore LIJ Health Systems

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Sharon-YouI spent my Princeternship at the North Shore-LIJ Health System in Long Island, New York. For three days, I shadowed Dr. Mitchell Adler ’73, Chief Medical Informatics Officer (CMIO) of the Medical Group. He is in charge of the AEHR, the ambulatory electronic health record system, which the health system has been implementing in accordance with a national initiative encouraging the use of electronic health records

When I arrived at Dr. Adler’s Manhasset office on my first day, he explained some important concepts that would be relevant during the next three days, like the EHR and the health system’s network security, as well as the idea of PHI – private health information – and the increasing importance, given today’s technological advancements, of preserving patient confidentiality. He also had a lot of interesting things to say about the healthcare sector and its significance in today’s economy.

The first day involvedSharon You quite a few meetings, including a teleconference about extending the electronic records system to the Staten Island network. Dr. Adler also met with the developers of a particular interface to see how it could be made to work with the software that the records system currently uses. I started to appreciate the level of behind-the-scenes detail and work involved in maintaining, improving, and expanding a health system, and what a complicated process was entailed by the implementation of the EHR itself. Improvements of every magnitude are continuously sought as I realized, for example, one of Dr. Adler’s tasks during the time I was there was to incorporate a new form into the records system.

The next day proved to me once more the versatility of Dr. Adler’s job. We attended a meeting about organizing the filming of an instructional video for doctors, and then I sat in on a meeting with the health information management supervisor. Afterwards, we went to a different office in the health system and met with all the other CMIOs and their head for a regular discussion of current projects and developments. One topic raised that I found interesting was the availability of information to the parents of adolescent patients for procedures not requiring parental consent. My favorite part of the day was the following ethics meeting at the Long Island Jewish Medical Center, where the ethics committee discussed two confidential end-of-life cases and issues like hospice, transfer, and mental capacity.

The last day, I came in late because Dr. Adler had been meeting with the Joint Commission, a national not-for-profit that inspects hospitals and evaluates various elements of the care provided, like waiting times, amount of radiation in CT scans, &c. When I arrived, he filled me in on the meeting, and we talked a little about the expansion of ambulatory care relative to inpatient care. Afterwards, I got to see the EHR in use and watch residents present their cases to Dr. Adler and several others, which was one of the highlights of my experience.

Overall, I thought this Princeternship was a great opportunity. Even though the medical and administrative jargon was a little hard to follow at times, these three days gave me insight into what I hope to be doing in the future and exposed me to new aspects of health care that I had never considered. I am very grateful to Dr. Adler for taking the time and effort to arrange this opportunity, and I would recommend this to anyone considering a future in health care.

Samantha Wu ’16, MedStar Union Memorial Hospital

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Samantha-WuOne of the reasons why I decided to participate in a Princeternship was to observe surgery for the first time. There is a difference between reading about the intensity and intricacy of surgeries online to witnessing them firsthand from the lengthy start to finish. As such, I was really excited that I would be shadowing Dr. Gage Parr ’91, a cardiac anesthesiologist at MedStar Union Memorial Hospital in Baltimore, MD. On day 1, I met Dr. Parr at 7:15 am and proceeded to change into scrubs. Then Dr. Parr went to a patient waiting room to sift through the medical records of the patients to be operated on that day, while filling out Anesthesia Evaluations and part of the Post-Anesthesia Records. The first patient of the day suffered from renal failure and would be undergoing an arteriovenous (AV) fistula. An AV fistula widens the vein by connecting it to an artery, causing the blood to flow faster and better dialysis access. Dr. Parr then went to talk to him, gathering more medical history, providing comfort, information, with a splash of humor here and there. In the end, she knew what anesthetics to provide him with the most comfort during the procedure given his specific medical condition and current health issues.

Afterwards, Dr. Parr went to the operating room (OR) to prepare for the AV fistula surgery. The first thing I noticed was how high-tech the room seemed. In the right corner was an estimated $1million beast of a X-ray machine. Dr. Parr prepared her “cocktail” and set up the anesthesia machine and when the patient arrived, she sedated him, inserted a breathing tube, and connected him to a ventilator that would help him breathe. During the surgery, Dr. Parr informed me of every drug she was administering and what was happening during distinct stages of the procedure while explaining the biochemistry behind it all, all while regularly monitoring the patient’s heart rate, blood pressure, breathing, and blood oxygen level. After about 3 hours the surgery was over and the patient was transferred to his recovery room. Dr. Parr continued to monitor the patient’s vital functions and manage his pain immediately post-operation to ensure the best comfort possible.

The next operation I observed was the beginning of a coronary artery bypass grafting (CABG).CABG is a type of surgery used to treat people who have coronary heart disease- plaque build-up in the coronary arteries, which limits oxygen-rich blood flow to heart muscle. During CABG, a healthy artery or vein from the body is grafted to the blocked coronary artery, bypassing the blocked region of the coronary artery. When I entered the OR, the patient was completely covered with sterile blue sheets but the chest was still sterile and transparent. A camera was inserted into the leg. According to Oliver, the surgeons were harvesting the greater saphenous vein in the right leg and the left internal mammary artery which will serve as the greater conduits. After seeing the first incision to the chest and the opening of the ribs with a saw (!) to expose the heart, another anesthesiologist came to take over Dr. Parr.

~~~ Dr. Parr’s Words of Wisdom #1: “3 Rules of Surgery. Eat when you can, sleep when you can, and don’t touch the pancreas.”

After a quick lunch, Dr. Parr’s next surgery would be another AV fistula. We went through the drill again: paperwork, meet the patient, have the patient sign consent forms, and then OR. During the second AV fistula, I took this opportunity to ask Dr. Parr more questions on what being an anesthesiologist is like and why she was specifically attracted to cardiac anesthesiology. She said that the advantages to being an anesthesiologist are that call is well defined and self limited and there is no rounding. She also said that an anesthesiologist is more focused on the one-on-one interaction with the patient, which I easily noticed during my first day of shadowing. From what I learned, it seems that surgeons do the dirty and then leave the OR when the surgery is done. An anesthesiologist, on the other hand, is with the patient every step before, during, and after a surgery. As to why she was attracted to cardiac anesthesiology, she liked that there was a lot of action and collaboration. When you’re dropping the heart and blood pressure to non-homeostatic conditions, it requires people who can stay calm and focused under these stressful situations.

When the surgery was over, the drill continued: Dr. Parr brought the patient back to consciousness, moved her to her recovery room, comforted her at her bed while asking questions and taking notes. Dr. Parr spent the final part of her day filling out pre-operation paperwork to prepare for next day’s surgeries. She then met and chatted with the two patients, going over what to expect the next day before, during, and after surgery and obtaining signatures for the consent forms.

I felt I had learned so much from my first day of my Princeternship about the various medical professions and a great mountain of biochemical knowledge required in anesthesiology. If you are in the OR, you need great listening skills. People will usually be talking at the same time and when one person says one thing, you have to immediately recognize if it is being addressed to you, picking it out from the rest of the crowd and then act on it. Dr. Parr is a hilarious person and I was also shocked to see the rest of the staff crack so many jokes. It definitely diminished my initial misconception that doctors were high-strung, overly-serious people.

The second day of my Princeternship began at 8 am and thank you to Debby for helping me get ready! Preparations for the first surgery actually began at 7 am but by the time I arrived, they were nearly done and the operation was about to begin. The patient I had met yesterday in the afternoon would be undergoing aortic valve surgery to treat aortic stenosis, a condition when an aortic valve does not fully open because of calcium deposits on the valve leaflets, rendering them thick and stiff. The heart has to work even harder to push enough blood through a narrowed valve. Since she had heart surgery before and was too high at risk for typical open aortic valve surgery, a minimally invasive procedure would be conducted instead where a tube is inserted through an artery in the groin, leg, or a small incision between the ribs. The artificial valve is compressed and fed through the tube until it reaches the aortic valve. A balloon expands the artificial valve, pushing against the old aortic valve, and the tube is removed.

Given that this was a more complex operation, there were over 10 people in the OR. There were two cardiologists, a surgical assistant, an anesthesiologist, three nurses, a perfusionist, and a number of surgeons. On top of my scrubs, I also had to put on lead because today I would actually see the great claw-machine-shaped X-ray machine in use. The surgeons first cut the femoral vein, snaked a wire up to the heart, and inserted a pacemaker wire that would be controlled by Dr. Parr. While doing this, the surgeons were assisted by the X-ray machine as an image of a wire going up to the heart appeared on the room’s TV screen. The machine also spins, capturing a 3D view of the patient’s chest. As the surgery continued, I was able to see them operating on the chest, real-time, through a video feed on the TV screen. Although I looked calm on the outside, in my head I was screaming, “I can actually see the heart beating!!!” It was definitely one of the coolest experiences I have ever had in my life. Although Dr. Parr was very busy, she still walked me through the procedure answering my questions regarding what was happening. Whenever she would use a different drug, she told me the name, what it does, and the biochemistry behind the mechanism of action.

When the time came to insert the tube through the aortic valve and expand the valve by inflating a balloon, I realized how much teamwork this particular field demanded. When Dr. Wang said, “Let’s all help out,” almost every surgeon stepped up and played a crucial role in this critical step. However, the valve was so calcified that they had to inflate the balloon again. They then inserted a catheter, injected dye into the coronary arteries to check that the aortic valve was working properly and that there were no leaks. Thank you to Kodsi for explaining this part of the operation to me!

After lunch, Dr. Parr wanted me to observe more of the CABG even though we would have to separate briefly since it was not her operation. I am very grateful that Dr. Parr went to great ends to ensure I had an enriching experience at my Princeternship and observed all the new and great sights I ought to see during my stay.

In the OR, I got to chat with Dr. Mantel, another anesthesiologist and Kurt, the perfusionist. I want to thank Kurt for devoting so much time to explaining to me how such a complicated machine functioned. The perfusionist operated the cardiopulmonary bypass machine (heart-lung machine). During CABG, the heart is temporarily stopped and the blood is drained from the body and cycled through the bypass machine, which takes over the function of the heart and pumps blood to the body.

~~~ Dr. Parr’s Words of Wisdom: (Regarding the blue drape separating the surgeons from the anesthesiologist) This is the blood-brain barrier. (Points to surgeons) That’s the blood. (Points to herself and her work station) These are the brains.

I had an unforgettably amazing and eye-opening experience during my Princeternship and it was another reminder of why I was really attracted by medicine. There is just a unique power of cutting into the person, patching them back up, and reviving them. The patient resumes life just as it was before as if nothing had happened (ignoring the post-surgical pain). The Princeternship was also a great opportunity to observe patient care in a hospital setting. Although I am unsure as to what field I would like to specialize in as a doctor, I am considering anesthesiology for its deep connections with chemistry, versatility and applications in all forms of medical procedures, and the opportunities for patient interaction. This Princeternship allowed me to gain a better idea of the duties of different medical professions, clear insight into the hospital environment, and I am gradually gaining a better idea of what area I want to specialize in. The entire staff was helpful, hospitable, and explained to me what was going on during surgeries despite how busy they were. Working at a hospital is a high-stress job, but the surgeons were all laid-back people who love to make jokes, including the air-guitar playing Gary, the chief cardiovascular surgeon, Fiocco, who enjoys listening to the radio during his surgeries, and my “best friend” Lisa who never fails to tease me. I want to extend my deepest thanks to Dr. Parr for sharing her world with me and giving me one of the most rewarding experiences I have had in my life.

Morgan Taylor ’15, Loyola University

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Morgan-TaylorFor my Princeternship experience, I shadowed alumni Alison Papadakis, Ph.D. ‘97, an associate professor of psychology at Loyola University in Maryland. For three days, I attended classes, spoke with professors about their research, and learned more about the university’s Psy.D. program.

Day 1

Dr. Papadakis and I met in her office at 8:30 am on Monday, January 27th. After some brief introductions, we walked across the quad to her 9 am class—Research Methods in Clinical Psychology. This course is designed to help second year graduate students prepare their dissertation proposals. For the first hour, Dr. Papadakis discussed organization and time management techniques. She then dismissed Chelsea (a fellow Princetern) and me so we could travel to the Loyola Clinical Center (LLC). There, we received a tour of the facility from Dr. La Keita Carter, the LLC Psychology Division Director. The LLC specializes in four main areas: psychology, speech-language pathology, audiology, and pastoral counseling. Graduate students in the Psy.D. program have the opportunity to train there under supervision and receive detailed feedback on their clinical techniques. We ended the tour in Dr. Carter’s office and asked her more about the training opportunities the Psy.D. program offered. After some free time, we met four first-year graduate students (i.e. Psy.D. candidates) for lunch. They shared their experiences as grad students, detailing everything from the application process to their day-to-day schedules. My impression was that the first year or two in the program was very similar to the undergrad experience—lots of time in class and a minimal amount of time in the field. I like how the program doesn’t force your clinical experience; it offers it to you in manageable chunks and allows you to gradually acclimate yourself to meeting with clients and creating an action plan for treatment. Chelsea and I ended the day by attending an undergraduate course called “The Psychology of Women.” We talked about gender vs. sex and the outside influences that determine our personal view of men and women.

Day 2

After briefly checking in with Dr. PapadakisPrinceternship picture in the morning, Chelsea and I attended “Introduction to Counseling,” an undergraduate course designed to introduce students to the roles and practices of a clinician. We discussed how counseling is a collaborative work process between the counselor and client. The counselor should be in the middle of a spectrum that spans from directing the client’s life on one extreme and leaving the client to work out their problems alone on the other. Next, I met with Dr. Matt Kirkhart, an associate professor of psychology. He talked about his career path and how over the past few years his interests have shifted from doing research and clinical work to teaching. He felt that it was a natural progression and is very content with his current position. After that, Chelsea and I had lunch with one third-year and two fourth-year graduate students. They, of course, were able to offer a very different perspective of the program. In these years, the students apply to externships at clinics and hospitals not affiliated with Loyola University. They still check in with their advisers and may take a class or two, but most of their work is independent. The fourth-years are currently applying to internships for next year—jobs that will place them in the field full-time. Once you successfully complete your internship and dissertation, you are rewarded with your Psy.D. degree and can continue on to practice or go into teaching, depending on your interests. After lunch, I attended two graduate courses—“Principles and Practices of Psychotherapy” and “Introduction to Health Psychology”.

Day 3

On the last day, I had two more individual meetings with professors Dr. Marianna Carlucci and Dr. Frank Golom. The former is a forensic psychologist interested in the intersection of psychology and law and the latter is an IO (Industrial/ Organizational) psychologist. It was very interesting to hear about their experiences. As a prospective cognitive psychologist primarily interested in research, it was refreshing to hear about the other options that exist outside of academia. To end the day, Dr. Papadakis treated me and Chelsea to lunch. She discussed her experiences as a Ph.D. student and gave us more information about how that program differs from a Psy.D. program. She also reminisced about her time at Princeton and gave us advice about how to proceed with our education/career goals in the coming years.

Overall, this was a very rewarding experience. Talking with Dr. Papadakis and other professors really gave me some clarity about the graduate school process and the different ways I can use my degree once I obtain it. It was also useful to learn more about the Psy.D. program. Although, I am not currently considering going into the clinical field, it was nice to learn about alternative options to the Ph.D. I now feel that I have a more complete understanding of the different areas of psychology.  This knowledge is invaluable to me, especially considering my plan to attend graduate school within the next few years. I am incredibly grateful for this experience and encourage anyone considering any type of psychology to attend this Princeternship if it is offered again. Don’t limit yourself to only the things you think you are interested in—explore everything and you won’t regret it!

Nathan Suek ’17, Memorial Sloan-Kettering Cancer Center

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Nathan-SuekI left for my Princeternship in New York early in a morning shrouded in dense, white fog. As I chugged along in the dinky train, I couldn’t help but wonder what kinds of interesting things I would be able to see today. What kinds of patients? What kinds of diagnoses?

My Princeternship was at the Memorial Sloan-Kettering Cancer Center with Dr. Ariela Noy ‘86. My excitement grew as I continued to mull over the possibilities for the day. After an hour-long train ride, I arrived at Penn Station and experienced, for the first time, the fast-paced style of NYC. As soon as I stepped off the train, everyone was off. Unfamiliar with the local terrain, I trudged my way through bustling crowds of people, bumping into strangers as I focused on the notebook paper with a hastily drawn diagram I called my map.

It was my first experience commuting to work. After walking to the wrong subway station and a few stops downtown instead of uptown, I finally arrived at Memorial Sloan-Kettering Cancer Center. Perfect timing. Lauren, Dr. Noy’s extremely warm and friendly assistant, greeted me. That morning, Lauren informed me, I needed to complete a few mandatory medical tests required of all employees before beginning. Adventuring from building to building to complete these tests, I couldn’t help but stop and try the local eateries and food carts as my stomach growled when lunchtime neared.

At noon, I was all cleared to go. That day was an incredibly busy day for Dr. Noy’s office. The early afternoon through late evening was filled with back to back visits with patients. I think one of the most interesting things about Dr. Noy’s work was how she combined her two backgrounds as a physician scientist together. As we continued to see patients, she sometimes commented on how the diagnosis of certain patients particularly fit her research interests. And while she let me look at several of the patient’s medical documents, I did not completely understand everything. It was interesting for me to try to piece together parts of the diagnoses as words like platelet and white blood cell count floated across the screen.

We had one patient in particular that seemed to fit Dr. Noy’s research profile perfectly. The patient had a history of both HIV and cancer. I went in to see the patient with Dr. Noy, not knowing what to expect because apparently, the cancer had gone into remission but seemed to have recently come back. Thankfully, upon Dr. Noy’s examination, everything was fine. It was great news considering that it was the patient’s marriage anniversary that day!

All in all, this Princeternship was an incredible experience being able to see how Dr. Noy blends her research with her work as a physician. For a long time, I have debated between pursuing a career in medicine versus research, but now I am sure that I won’t have to pick one over the other. It is equally interesting and rewarding to be able to do both. I am so grateful to have been able to shadow the incredible Dr. Noy. This Princeternship has definitely given me a clearer direction in the pursuit of my future career.

Sarah Santucci ’17, Ganchi Plastic Surgery

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Sarah-SantucciMy first day with Dr. Parham Ganchi ’87 (see bio) began with a surgery that lasted several hours. It was a SMAS facelift in which the skin of the lower face and neck is lifted from the layer of fat underneath, and the muscular system of the face is manipulated to create a natural-looking and not excessively “tight” result. Dr. Ganchi’s surgery room is remarkable—pristine and equipped with the latest technology. I’m eternally impressed by the design of medical equipment. For example, Dr. Ganchi’s surgical loupes had a light whose cord clipped to the back of his collar to stay out of his way. But there was a tool even more remarkable and something I’d never seen before. Dr. Ganchi had insulated forceps to which he could touch the cautery tool in order to precisely stem tiny facial vessels. This helps to prevent bruising and other bleeding-related complications in his patients. For more information on Dr. Ganchi’s facelift procedures, see http://www.ganchi.com/plastic-surgery/face/face-lift/

Dr. Ganchi’s wife also works with him on days he sees patients. OrchidsTara, one of Dr. Ganchi’s nurses, informed me that Leyla Ganchi had done much of the impeccable decorating, which, to my great joy, included some beautiful orchid varieties. She ordered lunch for his nurses and for me. For Dr. Ganchi, she peeled a clementine. She said, “Dr. Ganchi, take two minutes and eat this orange.” But he was already off again. Later, a nurse asked what he was doing with the peeled citrus just sitting out, Dr. Ganchi responded wisely, “I’m aging it.” Funny, because he does the exact opposite to his patients.

A picture of Dr. Ganchi is a picture of a busy but devoted man. He chooses to give each patient special attention. Busy officeMost doctors nowadays rush through their jobs—you may sit in a waiting room for two hours to see your doctor for only two minutes. He is not that way. He works with his patients, giving them his valuable time in order to guide them toward the best plan of action. I heard one of his staff saying, “Sure. We’ll see you afterhours.” A nurse told me, “He stays here sometimes until two in the morning. That man gets no sleep.” And he has four children fifteen years old and younger, enough of a job in itself for most mortals.

Sometimes, with all the silly speculation about which movie stars have gotten breast implants or a rhinoplasty, it’s hard to see cosmetic plastic surgery at the personal level. Like it or not, appearance is very important in our society—important to how others see us and therefore how we see ourselves.

One of the last patients I saw was a kind woman who had had a body lift and a breast reduction and was in for a post-operative checkup. She told Dr. Ganchi how appreciative she was of the surgery he had done for her. Right before Dr. Ganchi and I left for her to get dressed again, she looked me in the eye and said, “I want you to know, sometimes it’s not just cosmetic. I couldn’t go shopping with my friends… I couldn’t be with anyone… Sometimes it’s not just cosmetic.” He had changed her life.

Thanks to him, and thanks to State-of-the-art operating roomPrinceton and the Princeternship program, I spent what would have otherwise been a boring Intersession instead having the experience of a lifetime. If I became a surgeon as skilled and as caring as Dr. Ganchi, I would consider my life a success. He has changed the lives of countless people, and now I think he can add my name to that list.

Deborah Sandoval ’16, Prescription Advisory Systems and Technology, Inc.

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Deborah-SandovalDay 1

I arrived sharply at 10 am to PAST, Inc. headquarters, a collection of offices hiding above Panera on Nassau Street, along with two other Princeterns: Kevin Pardinas ‘16 and Katherine Lee ‘17. Our host, Joe Studholme ‘84, gathered us into the conference room to introduce himself and his newly founded company. Mr. Studholme, Chairman of Colonial Club’s Grad Board and CEO of PAST, Inc., informed us about his experiences with startups, sharing his story about leaving Princeton his senior year to join a company that would eventually go “belly up” and showing us his “tombstone” – a plaque representing a 14-million dollar deal for his former company. Having been successful with his previous startup, Mr. Studholme explained that he now had a better chance of attracting investors and, of course, a better idea of how to make this company grow.

Mr. Studholme then quickly briefed us on the background of his product. A surprisingly large number of people die each year from prescription drug abuse and being prescribed a deadly combination of drugs – common, costly, and deadly problems in United States healthcare. Today, doctors are pressed to see as many patients as possible in a limited amount of time and cannot afford to do a thorough analysis of a patient’s medical background information. Mr. Studholme’s product addresses this problem and allows meaningful information to be viewed efficiently– helping prevent lawsuits, abuse, and most importantly, injuries or deaths. He gave us a tour of his product so that we became familiar enough to begin our first assignment.

We were asked to find ways to represent the data provided by a Fitbit®, a wearable fitness-monitoring device, so that it was meaningful. Our first assignment quickly immersed us in the developing stages of the company – our findings were to be implemented in the product and pitched to the client as soon as possible. As a group, the Princeterns researched, discussed, debated, and finally, presented our findings to Mr. Studholme and his team. We were given some feedback and would continue to shape this project the next day.

Day 2

Essentially, we were back toPardinas 1 the drawing board, so we headed straight to work with the feedback from yesterday in mind. I felt very productive and fulfilled knowing that our efforts would be manifested in the product. Since we all had technical backgrounds in computer science, Mr. Studholme thought we would benefit from seeing the technical perspective of the startup. We met with the software programmers who gave us a thorough overview of how the product is structured and run. The programmers emphasized on separating modules and implementation to make for easier changes – a very important theme I learned in my computer science classes. It was fascinating to see the applications of computer science in a “real-world” setting. Since there was currently no patient data, the programmers explained that they had to create mock data in order to show clients what the product does and will do. With that in mind, we created mock data for the patients seen in the product demo, so that it would be easier to implement when we were finished with our project. We wrapped up our work and prepared to present in a web meeting/conference call at 10:30 am the next day.

Day 3

We presented our project to Mr. Studholme (who was on a train at the time heading to an important meeting) and his staff once more and received additional feedback on how to improve and take into consideration some pitfalls in our calculations and displays. However, we were on the right track and much closer to getting it right. The other Princeterns and I began to discuss and consider the pros and cons of all our options, slowly eliminating each one until we decided on the most efficient and less-time consuming feature for the client. We then presented our final project to Chief Legal Advisor Ahmet Bayazitoglu ‘00 and Business Development Director Douglas Blair ‘71 who agreed that our version of displaying data was most efficient.

We asked the staff questions about how they became involved with PAST, Inc. as well as their roles and expectations for the company. They provided invaluable insight on careers and networking after Princeton and with that we closed a fascinating and exciting experience with Prescription Advisory Systems and Technology, Inc.

I sincerely thank our host, Mr. Joe Studholme, for opening his company to three interested Princeton students and for providing a quality experience that will influence our future perspectives and careers. I would also like to thank Ahmet Bayazitoglu, Douglas Blair, Vin Shelton ‘80, Jeanette Thomson ‘85 and the rest of the staff for offering their knowledge, sincere advice, and help in making this possible.

Lisha Ruan ‘17, Capital Digestive Care

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Lisha-RuanDay 1

I arrived at Digestive Disease Consultants in Rockville, Maryland at 7:30 am. After signing a confidentiality agreement, I met Dr. Julia Korenman ‘78, a gastroenterologist. Dr. Korenman showed me around the office and introduced me to the staff and other doctors, who were very friendly. She asked me about my interests and my previous experience with medicine. I told her that I was trying to decide between medicine and computer science. I hadn’t had any exposure to medicine besides my physical exams, so I was extremely excited to have the opportunity to shadow her.

Dr. Korenman had a busy schedule of appointments. Before each one, she asked the patient if I could observe the appointment. I’m grateful that every patient said yes. It was very interesting to listen to patients describe their symptoms, such as stomachache or constipation, and observe how Dr. Korenman identified potential causes and ordered tests or prescribed a treatment. From my experience with routine physicals, I hadn’t appreciated how important it is for a doctor to comfort patients who are anxious about serious illnesses. I was truly inspired by the honest and reassuring guidance that Dr. Korenman gave her patients. I was surprised to find that a big part of a doctor’s job is convincing patients to take her medical advice. When a patient didn’t want to take the recommended drugs or have a screening colonoscopy, I admired how Dr. Korenman presented alternatives while stating that they are less effective.

Between appointments, Dr. Korenman made calls to patients and entered patients’ paper medical records into the new electronic medical record system. Because I’m also interested in computer science, Dr. Korenman highlighted the connections between computer science and her work as a doctor. She pointed out aspects of the system that were inconvenient from a doctor’s perspective and told me that there’s a lot of room to improve health care technology. I learned that it’s very important for a software developer to directly consult the users of the product to find out what they need.

I really appreciate that Dr. KorenmanLisha_Dr_Korenman explained in detail what she was doing at every step and answered all my questions. She told me that the class she took at Princeton that helps her most now is Spanish, because she offers appointments in Spanish. This surprised me, encouraged my Spanish studies at Princeton, and proved how useful speaking a second language is in any field. Dr. Korenman also told me that the most rewarding part of her job is the relationships she develops with her patients. As a gastroenterologist, she gets to know her patients well because many patients have chronic conditions like Crohn’s disease. In each appointment, I definitely saw the bond that she formed with the patient through honesty, trust, and compassion.

Day 2

On the second day, I met Dr. Korenman at the procedure center at 8:00 am to observe colonoscopies and endoscopies. Dr. Korenman introduced me to the anesthesiologist and the technician who were her team in the operating room. The first procedure of the day was a colonoscopy, and I saw that it was definitely a team effort. Again, I really appreciated that Dr. Korenman explained every step of the procedure in detail.

I admired Dr. Korenman’s meticulousness in checking out every inch of the colon and cleaning it out when the prep was imperfect. She saw polyps that were almost invisible and deftly removed them. Thoughout the day, I observed four colonoscopies, one endoscopy, and two “doubles” (colonoscopy and endoscopy). It was fascinating to see the inside of the colon during a colonoscopy and the esophagus and stomach during an endoscopy.

Dr. Korenman told me that she enjoys gastroenterology because it provides a mix of hands-on work and appointments that allow her to connect with patients and that present the mental challenge of figuring out symptoms. We also had an interesting discussion about women in medicine. Dr. Korenman told me that many women prefer to see a female gastroenterologist, but most gastroenterologists are men, so female gastroenterologists are at an advantage in getting patients.

After she finished the procedures, we returned to her office, where she saw two more patients. One was a patient with Crohn’s disease who had come in the previous day, feeling terrible and almost needing to go to the hospital. Dr. Korenman prescribed steroids and he returned the second day, feeling much better. It was amazing that in just two days, I saw how a doctor really helped a suffering patient.

This Princeternship was an extremely valuable experience because it exposed me to both sides of being a doctor, performing procedures and conducting appointments, and introduced me to the fascinating specialty of gastroenterology. I would like to thank Dr. Korenman for patiently explaining everything she did, answering all my questions, and giving me great advice. I would also like to thank all the staff, doctors, and nurses for being so welcoming and Career Services for giving me this incredible opportunity. I have not yet fully decided between working in medicine and computer science, but I now have a much better understanding of medicine to make that decision.

Daniel Paolillo ’15, St. Lukes Hospital

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Daniel-PaolilloDay 1- Avallone Office/OR @ Warren

Waking up at 5:45 am, walking outside to the car in the dark winter morning, and warm rain drops falling on my long grey winter coat were my first steps toward a great day.  Driving to Phillipsburg, NJ with mist drifting up from the road gave me a spooky feeling. My determination and eagerness for my first professional experience kept me alert behind the wheel.

I was not sure what to expect but I was certain it would be good. I would finally meet Dr. Nicholas J. Avallone ‘97 who is an orthopaedic surgeon at St. Luke’s University Health Network. My Princeternship would expose me to his daily work. I wanted to impress him whenever I could.

I arrived promptly at 8:00 am to his office in the St. Luke’s Orthopaedic Specialists Suite 105. His wonderful staff greeted me with a cup of coffee, showed me around and introduced me to Dr. Avallone’s delightful and super intelligent physician assistant, Andrea. I liked talking with her. She taught me about shoulder shots and frozen shoulder. Finally, Dr. Avallone arrived.

I looked forward to every moment. There were 34 cases that day, which was even a lot by Dr. Avallone’s standards, and 34 cool new things to learn as a pre-med student.

The minutes flew by as I learned about carpal tunnel, foot fractures, shoulder replacements, high ankle sprains, and fractured radial disks. Meniscus tears. Arthritis. The McMurray Test. Knee Joint Aspiration. Even diabetes. Phhhheeww! There was so much for me to learn about orthopedic medicine!

I left with Dr. Avallone around noon to drive to St. Luke’s Hospital on Warren Campus. I got to go into the OR for the first time. I was super excited.

Dr. Avallone introduced me to his patients in pre-op too. I was impressed all day by his friendliness, which never changed around anyone.

In the OR, Dr. Avallone showed me a menisectomy. He also showed me a carpal tunnel procedure. I should have taken notes because there was so much to learn. I was so sleepy on the ride home. I couldn’t wait for Wednesday to come.

Day 2- Avallone office

Today I learned that there’s something StLukespecial about good doctors. The night before I decided to read up on common shoulder injuries,, reading about SLAP tears, rotator cuff tears, collarbone fractures, frozen shoulder, and arthritis. I also learned about reverse total shoulder replacement. I enjoyed soaking in the knowledge, which I wanted to use to impress Dr. Avallone. I read late into the night forgetting that I had to wake up at 5:30 am.

I awoke, showered, drove to his office, and said good morning to Andrea. She told me Dr. Avallone had sixty patients scheduled! That meant he would see about thirty in the morning and thirty in the afternoon. I was bound to come across a patient with one of the shoulder injuries I looked up the night before.

I certainly had chances to ask Dr. Avallone questions based on the patients and facts I learned the night before, and I took advantage of them. But, as fun as soaking up the knowledge was, I distinctly remembered making a special note to revisit before writing my blog. It read, “He enjoys helping people.”

What did my note mean? Well, Dr. Avallone saw sixty patients that day. Half the patients knew Dr. Avallone from previous visits. Some of them knew him from his fellowship with the New York Islanders professional ice hockey team. Dr. Avallone had a humility about himself and the way he conducts his work.  I am sure that he carefully presents himself that way for valuable reasons.

Dr. Avallone loves to throw in a joke too. He is sensitive to emotion. He knows how to empathize with them. Above all, he gives his patients honest explanations out of respect for their health.

When I looked at him interacting with patients, every time I thought about how special it was to learn from him. He wanted to help his patients get back to coaching, get back to exercising, get back to their active lives. He wanted to help them recover. He committed his life to helping other people. That’s what being a good doctor means.