Tag Archives: Massachusetts General Hospital

Yende Grell ’16, Massachusetts General Hospital

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Yende-GrellDay 1

We met Suzanne Morrison ‘89, our Princeternship host at 9 am sharp. As we commenced our “2-cent tour” as Suzanne likes to call it, and walked through the bustling halls of the Yawkey Center of Massachusetts General Hospital (MGH), I could imagine myself, chart in hand, comfortable scrubs on, one day roaming the halls of a great institution such as this one. The presence of residents and students was refreshing, and it reminded me that both as an aspiring and actual physician you are continually learning. Suzanne showed us the Lunder, Ellison and White buildings of MGH.  From the 22nd ‘VIP’ floor of the Ellison Bbuilding we saw a magnificent view of Boston and Cambridge. The highlight of our tour was when Suzanne took us to the Ether Dome, which served as the operating room of MGH and was the sight of the first anesthesia administration by Dr. W. Morton using Ether.

We then spent the rest of the day with Bobby Lucas ’13, a research coordinator and Princeton alum. Go Tigers! Bobby and his research partner Jordan were working on a variety of studies including the PROMISE program aimed at effectively and efficiently collecting patient reported outcome measures,and the Radiostereometric Analysis (RSA) Distal femur study. I really enjoyed learning about the RSA Distal femur experiment that tracks the movement of beads in patients with distal femur fractures to measure healing. These beads are inserted at time of surgery when the bone is still soft and spongy. We had the opportunity to see the set up of the process that uses X rays to measure the healing of these fractures. A shot is taken of the femur, then one with pressure against the femur. The beads in both films are observed, and based on how much they move, one can see how much the bone has set since the last films. This method is being used currently in hip replacements, and it was great learning about such an innovative approach.

Day 2Grelle 1

My day started bright and early at 6:30 am. I met my host for the day, Dr. Torri an obstetric anesthesiologist, and was immediately struck by his warm, bubbly personality and beautiful Italian accent! He took me to rounds with his other attending Dr. Leffert and a few of his residents. Although a lot of the medical jargon flew right over my head, Dr. Torri took the time to explain the terms that had just been thrown out. He would do this throughout the course of the day, also showing me diagrams in anatomy textbooks, incisions on models, and diagrams on a white board.As an obstetric anesthesiologist Dr. Torri’s day consist mainly of administering epidural and spinal analgesia to women in labor. I saw at least 4 of these procedures done, and the extreme intricacy and dexterity involved. A local anesthetic is first given to the area in the lower back, and then the actual opioid analgesic must be inserted into the epidural space. This space is tricky to locate and is found between the lumbar bones, between the yellow ligament and dura. Once the epidural space is found a catheter is placed in it to allow for the continuous supply of the drugs. I also had the opportunity to observe 2 cesarean sections, one of which was the delivery of twins. These twins were forced to be delivered by C-section since one of the two was breached and there was an obstetric complication called vasa previa which increases the risk of fetal vessel rupture. This was my first time seeing a surgery firsthand, and instead of feeling queasy or uncomfortable, I thought it was amazing, and even got teary eyed when the babies were pulled out.

Day 3

My day started again at 6:30 am with rounds on the orthopedic trauma service. I spent the morning with nurse practitioner Kathy Burns checking up on patients and attending interdisciplinary meetings. I was not familiar with the nurse practitioner specialty before then, and was amazed by the great amount they can do, including prescribing and diagnosing. Kathy has been in healthcare for almost 29 years and is great at her job. We saw patients with external fixators, fractures and those in need of knee and hip surgery. The interdisciplinary meetings were very interesting to me. During these meetings members from various services like orthopedics, occupational therapy and physical therapy all report to each other about patients and come up with decisions on course of treatments and discharge. It makes sense that orthopedic patients need to be assessed and treated by physical and orthopedic therapists since having injuries to your bones affects your motor skills which in turn affect your basic life functioning.

I spent the afternoon in Pediatric Orthopedics with nurse practitioner Allison and Dr. Rebello. I was surprised by the variety of cases we saw. I went in expecting pediatrics to involve things like children with broken arms and feet and simple fractures. Yet I saw a neonatal case where a swollen fetus foot was being explored as an indicator for other complications and a post-surgery cerebral palsy patient was being treated for left leg spasms. The cerebral palsy patient was an anomaly for Dr. Rebello who had never in his career seen a response like this to the surgery. This patient was in a great deal of pain, and the pain service had to be called in for a consult. Despite some of the difficult things I saw, I found that working with children was very uplifting. Most of them were bright and funny even when in pain, and come on, they’re so cute!

Dr. Rebello and I then chatted about a children’s book that he recently published called Dare Bone’s Big Break. I would recommend it to anyone with children or who works in childcare. He uses humor and rhymes to explain what actually happens when a child breaks a bone, and how it is treated. He explains that his aim with this book is to help children become familiar with and comfortable in using medical language and terms. He believes that if this sort of language is introduced and understood at an early stage in life, then children will be better versed in their understanding of the body and less frightened to go to the doctor. Writing this book was his passion, and he says it is the first of many such works to come.

I ended my day by accompanying Dr. Rebello to check up on a post-surgery patient. This patient was born with no arms and had surgery to correct a hip complication that would allow him to walk more comfortably. When we visited he was cheerful in spirit and was excited by the thought of soon going home. I loved seeing the interaction between this patient and his caregivers and his great optimism despite his circumstances.

All in all, being at MGH for 3 days was an eye-opening learning experience for me about the field of medicine.  I learned so much from the physicians and nurse practitioners that I shadowed, and I want to thank them for being so patient with me, a pre-med student who was not accustomed to the medical jargon. This Princeternship has shown me that medicine is multi-faceted, and requires a team-based approach. I have also come to see the more personal side of medicine, hearing the stories of physicians and seeing their interactions with their colleagues. I would definitely recommend this Princeternship to anyone interested in medicine. This experience has only confirmed my interest in medicine and my commitment to pursuing it. A big thank you to my host Suzanne who gave me the opportunity to come to MGH and shadow these amazing physicians, and to Bobby for all his help.

Ming-Ming Tran ’15, Massachusetts General Hospital

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Ming-Ming-TranDay 1: Wednesday, January 29, 2014

The first morning , I met Bobby Lucas ‘13, the research coordinator of the Orthopaedic Division at Massachusetts General. Bobby led me off to explore the various wings of the hospital, including the orthopaedic surgery wing.. On the way, we acquired a set of scrubs for me to wear in the operating room.

After returning to his office,  Bobby talked about his duties as a research coordinator. There were two types of studies: retrospective and prospective. He and his fellow research coordinator, Jordan, had to get both kinds of studies approved by the IRB (Institutional Review Board) first, which would make sure that humans were protected from physical or psychological harm. The former involved simply using data from past hospital medical records, and so required relatively little documentation, but the latter needed to collect data from current patients, and so necessitated an entire thick binder of regulatory-related documentation to follow. Bobby demonstrated the sorts of data he would collect in a retrospective study, using medical records numbers to search for medical records and then put information, such as condition x days after treatment, or whether surgery was necessary for patients with a certain injury, into an Excel file. Afterwards all the columns containing identifying information would be deleted, so it would be completely anonymous.

Then he showed me some prospectiveTran 1 studies they were working on, one of which was about the relationship between the patients’ perceived level of information about their injury on their first visit and their level of information later. These would generally be simple questionnaires that he handed to patients and asked them to fill out.  It would generally be fairly easy for him to find willing volunteers while they are sitting in the waiting room. Bobby and I talked to one such patient, and the process was simple: explain the study to the patient, hand them waiver and questionnaire, and come back for the papers five minutes later. Occasionally though, the prospective studies get more involved, like one study in which surgical patients volunteer to have chips embedded in their bones that light up brightly on X-rays, so that in later follow-up visits the doctors can take X-rays to study how the chips moved when stress was placed on the bones. This means that Bobby or Jordan would have to make sure that all the necessary equipment is in the operating room, and then be sure that the surgeons place the chips in the correct places.

After learning about these studies, we then headed to lunch in the hospital cafeteria (which had excellent soup and pizza), and then I met Yende and Peter, the other two Princeterns. Bobby took me and Peter to watch some surgeries in the orthopaedic wing. We first checked a TV near the reception desk to see what surgeries were scheduled for that afternoon and where. Having acquired a target, we put on more sterility gear in addition to our scrubs, namely, hair nets, face masks, and interestingly, shoe covers. It felt bizarre, because in research labs so often the most critical piece of protective equipment are the goggles, yet here the only thing left uncovered were the eyes. It struck me that perhaps it was because in research, we try to protect ourselves from the experiment, while in medicine, we protect the patient from us.

Our first surgery was the setting of a right ankle fracture, of a pedestrian hit by a vehicle. Before the surgery there is an official “pre-surgical huddle” in which the doctors and nurses confer to be sure everyone is up-to-date, on things as simple as which ankle is the one being operated upon, to things such as which sort of operating table should be used. We watched, fascinated (and trying to keep out of the way), as two surgeons literally took a drill to a man’s bone in order to insert a plate and screws. Despite the businesslike atmosphere of the operating room, everyone was not completely formal—there were still lighthearted discussions of who had eaten at which restaurant the night before, and the nurses were kind enough to turn on cameras that were placed directly on the lamps so that we could have a better view of the surgery. This did not mean, however, that the surgery was not skillfully done. Great precautions were taken to keep the surgical area sterile, with blue sheets covering most of the patient’s body to prevent contamination. I was surprised by how little blood there was—use of a tourniquet beforehand meant that when the patient’s leg was cut open, there was almost no bleeding at all and his muscles were pale in color. More shocking, however, was when the surgeons pulled out a drill and simply began drilling screws into the patient’s bone. I kept wincing and expecting something to splinter, but everything went as planned. Afterwards I was amazed at how well the surgeons had aimed the screws in order to realign the bone, despite only having glances at X-rays to compare. To confirm that the job was properly done, a large X-ray machine (wrapped somewhat comically entirely in plastic to prevent contamination) was brought in that could examine the patient directly on the operating table before he was finally stitched up.

The second surgery we watched was a much shorter and less involved procedure. A patient got an external fixator removed—a metal contraption that stabilizes bones,  but has to remain outside the body yet screwed to the bone. The original installation was done overseas, and the surgeons noted how loose the screws have gotten, but despite this,  the patient’s pelvic bone fracture had healed and the surgeon simply removed several screws and twisted the metal rods out of the patient’s abdomen. I watched with some confusion and incredulity that doctors could actually drill metal rods and plates and screws into people’s bones and instead of harming the bone, it would help it to heal.

Tran 2Day 2: Thursday, January 30, 2014

The second morning was an early one—6:20 am meet up with Bobby in order to go to x-ray and card rounds. We listened to the attendings discuss the patients who had come in the night before, looking at their X-rays and debating appropriate treatments and approaches to take. It was quite an intimidating gathering of minds! Afterwards, I met Kathy Burns, the nurse practitioner, who had been in rounds, and she and another doctor, Dr. Smith, embarked on their whirlwind schedule of patients to check up on. There were a huge variety of patients, seemingly all in different floors of different buildings, and I marveled at their ability to remember which patient had what condition. Incidentally, both of the patients whose operations I saw yesterday were on her list, and they were doing just fine. In addition, we met a skier in an accident who was close to my age, an elderly 80-year-old man who thought he was still in his house, a surprisingly sprightly 94-year-old woman, and a woman who had a bone infection and possibly needed amputation. In addition, Kathy also had to conduct more miniature rounds throughout the day for different wings of the hospital, keeping the various departments informed about the discussions during rounds, including physical therapists and nurses.

Kathy led me to meet Suzanne Morrison ’89, the program director who has been our main contact for this Princeternship.  After lunch, Suzanne took me to the Ether Dome, a historical landmark of Boston, which contains pictures and displays related to the history of anesthesia. I laughed upon seeing that seven years after a famous scientist had said that surgery without pain was unattainable, anesthesia was first used in a surgery—and it was successful. Next, she took me to meet briefly with Dr. Torri, the anesthesiologist whom I would shadow the following day. We agreed on a meeting time and place, and then Dr. Torri had to go attend to surgeries while Suzanne finally took me to the Paul S. Russell, MD Museum of Medical History and Innovation, affiliated with Massachusetts General, which contained all sorts of cool exhibits about the first microscope and how social movements affected the hospital.

Day 3: Friday, January 31, 2014

On my last day I met Dr. Torri at 6:45 am in my scrubs. As we headed to the operating room, he explained to me that he was only scheduled for one surgery that day, but it was a fairly major one. The patient was one of those strange luck stories that you read about in Reader’s Digest—he had been a pedestrian in a car accident, and while X-rays of his chest were being taken, the doctors noticed something in his spine. It turned out to be a cancer in one of his vertebrae, and required two major spinal surgeries. If it had not been for the accident, the cancer might have been asymptomatic for several more months! The first surgery had already been performed ten days prior, which removed the spinous processes of the affected vertebra and fused together the other vertebrae around it, and today’s surgery was to remove the entire vertebral body and replace it with a metal support.

First we went to visit the patient in the pre-operating room. Dr. Torri made sure that the patient was comfortable, had enough pain medication, was fully informed about his surgery, had up-to-date allergy information, and the like. I had never really thought about how personable a doctor has to be, even if most of the time his patients are asleep! Dr. Torri also allowed me to listen to his heartbeat with a stethoscope, which was much more exciting than I expected—it boggled the mind that I was literally listening to the sound of his heart valves!

Before the operation could begin, the staff needed to prep the operating room. There were discussions about the type of bed desired—one that could hold the patient laterally, but was also X-ray transparent—and Dr. Torri needed to collect together all the types of chemicals he needed,  which included anesthetics, muscle paralyzers and medications that could regulate blood pressure. There were at times ten people in the room at once, which required an incredible amount of communication, as they worked together to go through the necessary safety procedures, determining the ideal set up of the bed and anesthesia machines and equipment, etc. I met Shauna Williams, the other half of Dr. Torri’s anesthesiological team for this surgery, and she too answered all of the questions I had about their procedures.

Dr. Torri put the patient to sleep and the nurses and orderlies had to roll the patient gently onto the operating table, then attach several more lines to him. Dr. Torri explained that this was so that if the began losing a lot of blood, they would be able to intravenously give him more blood quickly. The total came to five IV lines attached and resulted in a maximum flow rate of 450 mL/min—almost half a liter per minute! Dr. Torri then explained basics such as needle size (larger number means a narrower needle), how to determine a good vein for an IV,  how to insert the needle, and how to set up an IV bag of saline solution. I stood back and simply marveled at how many people were necessary to help one man, with nurses and Dr. Torri integrating the intubation already attached to his hospital bed into the equipment of the OR, taping the patient’s arms down with foam, and checking to see that all the lines were not crushed by the patient’s own weight. Things I had never thought of—like taping the eyes closed to protect the cornea—were all taken care of systematically. Like the surgery I had watched the first day, the patient was once again entirely covered in blue sheets, until the small section of his body to be cut up seemed unconnected to the man I had talked to a few hours before.

Eventually the surgery itself began and I was able to watch the electric knife sweep through the skin and simultaneously cauterize as it cut, so it bled very little.  I saw just how strong bone could be when the surgeon began taking a saw to it in order to remove the cancerous vertebra, and just how dangerous cancer was when said vertebra was removed but the surgeons told the nurses not to touch it even with gloves on, and had it wrapped in a towel then put in a separate container. At this point, the portable X-ray machine is brought in again as a checkpoint for the surgeons, and then replacement of the vertebra with a metal bit begins. This however requires a bone graft in order to help the bone to grow around the implant, and for that the surgeons turn to the iliac crest—the part of your pelvic bone that sticks out on the hip. They removed bone by scraping tiny scoops of bone off the iliac crest and putting it into a container. After enough was collected, it was put onto the implant. Final X-rays were taken, and a doctor stitched up each layer meticulously. Dr. Torri woke the patient up and told him that the surgery has gone perfectly.

Dr. Torri was soon paged for another surgery. An older woman with severe back pain was to have some of her vertebrae fused. As a former pediatrician, this patient was much more informed  and quickly told Dr. Torri what he needed to know. She also warned him repeatedly that she might lose blood pressure very quickly, and Dr. Torri promised to watch out. Dr. Torri warned me that this surgery was likely to go late, perhaps until 6 pm, and so I told him I needed
to leave earlier than that to catch a train After the patient was fully under and the surgery was about to begin, I took my leave of Mass General sadly.

I would highly recommend this Princeternship, because of the abundance of helpful staff around who are willing to explain everything and the wide variety of patients to encounter. I am definitely much more informed about what a hospital environment is like and what being a doctor actually entails, and I have gained a lot of confidence in my decision to be premed. Thank you in particular to Bobby, Ms. Burns, Ms. Morrison, Ms. Williams, and Dr. Torri for your patience and help, and I really hope I can return one day, either just to shadow or perhaps even as a real medical student!

Peter Yao ’16, Massachusetts General Hospital

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Peter-YaoDay 1

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.

Day 2

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.