Ruina Zhang ’17, Staten Island University Hospital

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.

Arence Paasewe ’16, Staten Island University Hospital

Arence-PaaseweThe first day of the Princeternship I walked through the revolving doors of Staten Island University Hospital full of anticipation. This was one of the few times that I had been inside of a hospital because thankfully my friends and family have not been ill enough to require hospitalization. I walked through the long maze-like halls looking for the radiology department while simultaneously taking in my surroundings and wondering if I could see myself working in a medical facility like this later in life. After getting lost a few times and asking for directions, I finally arrived in the ultrasound area of the radiology department and met Dr. Sanjiv Bajaj ‘02. After a short introduction, Dr. Bajaj offered me a seat and gave me a crash course on radiology. He pulled up patient ultrasound scans on the four computer monitors in front of him, rotating the views in order to see different organs such as the liver, kidneys and lungs from different angles. He explained that ultrasound works by focusing sound waves through a person’s body; bright areas on the scan corresponded to solid locations where the sound can not travel through easily while dark areas showed soft or fluid regions. While this seemed simple to grasp, I was completely lost when I stared at the computer monitor. Although Dr. Bajaj and I were looking at the same images, we were seeing two different things. I saw an endless sea of grey while he was viewing detailed images of various organs. Eventually after seeing enough images, organs began to immerge from the grey.

Dr. Bajaj then shifted to explaining the diagnostic ability of radiology, the aspect which had drawn him to this field. After reading the descriptions of a patients discomfort, he was able quickly list possible causes of the discomfort and find the actual cause in a patient’s image. We viewed many patients possessing gallstones, kidney stones, and fatty liver, a problem which was rapidly becoming more prevalent in the United States due to our diets. Although he never came in contact with the patients during my visit, due to a broken leg, Dr. Bajaj played a vital role in their treatments through his diagnoses, showing me the importance of radiology, a field that previously, I didn’t even know existed.

Around noon Ruina, the other Princetern, and I went upstairs to the conference room to have lunch with residents and attend their noon conference focusing on spinal images. Examples of patient images were displayed by a projector, and one after another the residents located minute details and diagnosed the problems present in each image, describing the diagnoses they would log into a Dictaphone. It was interesting to see a different phase of the radiological track and realize the time, effort and repetition needed to go from a medical student to a certified doctor.

The next day of my Princeternship PaaweweI viewed more images with Dr. Bajaj, but I also asked questions about the medical school, the medical field and life in general. He was open and honest with me and gave me the good and bad aspects of the medical field. He explained that being a doctor was a very rewarding experience; his work had an important impact in the lives of his patients and he had a genuine interest in the work that he was doing, but he noted that it took a long time and a lot of effort to reach the point that he was at. He told us that we should find something that we love and interests us and pursue it. If we were just enticed by the money and prestige, there were many different career paths that could accomplish that goal. This information was reiterated by his mother, a retired radiologist who had stopped by the hospital and many of the other doctors and residents who we encountered.

During one of our conversations, Dr. Bajaj came across the amazing ultrasound image of a baby demonstrating a possible case of anencephaly, a disorder in which a fetus develops without a brain and a large portion of its skull. This was a topic covered in Practical Ethics, a class that I had taken that semester and Dr. Bajaj had also taken when he was at Princeton. This led us into a conversation about the moral dilemmas present in medicine such as the available options for an anencephalic fetus and the complexity of the transplant system in the United States.

On the third day of the Princeternship, we shadowed Dr. Omar who was focusing on neurological radiology and Dr. Sperling in the Emergency Room. Both were experienced in the clinical side of medicine but had different views on it. Dr. Omar initially enjoyed clinical medicine but was disturbed by the small amount of time that could be allotted to each patient. He felt that this was a very impersonal system of providing care. On the other hand, Dr. Sperling loved clinical medicine. He enjoyed talking to patients, even if it was for a limited period of time and believed that patients benefited from being able to share their concerns with a professional if even for a short time. Even though we were in the ER for a short period of time, it was obvious that radiology differed from it greatly.

This Princeternship was my first shadowing experience and I am very thankful to Dr. Bajaj, Mrs. Bajaj and the kind staff of the Staten Island University hospital for sharing their workplace, time, knowledge and advice with me. I also appreciate Princeton Career Services for making this possible. I got a lot out of my Princeternship, but the two most important pieces of advice I took from the experience were to find something that interests me and pursue it, and to enjoy my time at Princeton, not allowing pursuit of medical school to dominate my life.

Kevin Shi ’15, Staten Island University Hospital

Kevin-ShiThis Princeternship at the Staten Island University Hospital took place under the guidance of Dr. Sanjiv Bajaj ’02, who serves as a radiologist and Chief of Ultrasound. Along with another student, Blake Feldman, I participated in a three day survey of Dr. Bajaj’s job. I had never shadowed a doctor before, and it was an immensely rewarding experience to not only learn what a doctor does on a daily basis, but also see the special nuances of radiology, which is a personal field of interest for me.

When I first arrived at the hospital, I looked around for Dr. Bajaj and was told to find him in the “bullpen” which, as I learned, is a term for a radiological reading room. As I first entered the bullpen, I got to meet a variety of radiologists all viewing different scans of patients. There, Dr. Gail Yarmish introduced me to the basics of understanding CT scans. Soon after, I got to meet up with Dr. Bajaj and Blake and I followed along as Dr. Bajaj progressed through his workload. In general, Dr. Bajaj looked through scans, pointed out abnormalities or features in the images he saw, and recorded his observations and recommendations using a speech-recognition system. Though he could have worked in his office, Dr. Bajaj explained that he liked working in the bullpen because he got to talk and discuss cases with the other radiologists present, ultimately offering the most accurate diagnoses. Similarly, Dr. Bajaj called a lot of physicians to discuss diagnoses and treatment plans. That day, Dr. Bajaj was on call and worked through a variety of scans exhibiting many conditions. Through abdominal CT scans and chest X-rays, I had the opportunity to look at interesting cases like surgical complications and cancer as well as less problematic things like pregnancy and bone deterioration, which Dr. Bajaj assured me was something quite typical with age. As Dr. Bajaj examined the scans, we discussed epidemiology and the causes and treatments for some of the disease states he recognized. In particular, I recall learning about nutrition and how poor eating habits can lead to liver damage. Lastly, I observed Dr. Bajaj fill out an ethical examination, something that was mandatory for doctors.

The next day, Blake and I attended a radiology meeting for residents. There, an attending physician brought up case studies for residents to discuss. The format of the meeting was kind of like a seminar and kind of like an exam in which residents were asked to correctly diagnose or observe things from a scan. Apart from this, I got to meet Dr. Omar Arnuk, a neuroradiologist, and got to observe his job to some degree. He mostly looked at MRI’s of the brain. In particular, he brought up an interesting case study in which, though it was dangerous, surgery was successfully performed on a homeless man who had a minute abnormality in the brain. The surgery was undertaken because, though it would have been safer later on, the patient was assumed not to be coming back. I thought this decision of a risky surgery was particularly moving. Rejoining with Dr. Bajaj, I observed him work through scans and we discussed why he chose radiology as a field. He explained that it appealed to him to work on the diagnostic arm of medicine, and though some did not like the lack of patient interaction intrinsic to his role, he still got to see patients and had other forms of interaction such as health education.

On the last day, I met Dr. Bajaj at the nearby radiology clinic. Here, I saw him do a fluoroscopy test on a patient who had trouble swallowing. Using oral contrast that showed up vividly on the scanning device, he was able to see the blockage in the passage of fluid in the patient’s digestive tract and recommended action for her esophagus. I also got to meet a technician and view how a CT scan is conducted in practice. We discussed the technology and 3D-picture construction the machines performed. Next, I sat in on another radiology meeting, this time discussing a more powerful MRI machine and the possibilities it offered. I was not able to understand too much of the talk, but the intimate link between technology and medicine that radiology offers was exciting to me. Afterwards, I met up with Dr. Bajaj again and, after a few scans, it was time to say goodbye.

I am extremely grateful to Dr. Bajaj, his colleagues at Staten Island University Hospital and Princeton Career Services for guiding me through this experience. I learned a lot about a branch of medicine I would like to pursue. Grounding myself in a hospital environment, I was able to see how a radiologist acts through not only analyzing scans and performing tests on patients, but organizing information with other physicians and working on a team. Radiology, having a diagnostic role, is something I did not truly understand, either technically or personally before this experience. Dr. Bajaj’s actions and advice on the role and responsibility of a radiologist and doctor as a whole are things I will not forget and will carry on my own journey as a pre-med student.

Blake Feldman ’17, Staten Island University Hospital

Blake-FeldmanDuring the past Spring Break, I had the pleasure of spending three days at the Staten Island University Hospital with Dr. Sanjiv Bajaj ’02, a remarkably capable and experienced radiologist. As a pre-med freshman, I still have yet to decide on my ultimate medical career goal, so I used the opportunity to learn about the field of radiology. This experience was a perfect glimpse into the duties and day-to-day work of a radiologist.

The Staten Island University Hospital is fortunate to have a large and expansive imaging department, with several of a variety of imaging machines, skilled technicians operating those machines, and experienced doctors analyzing those images. After a harrowing journey into Staten Island from Princeton, I headed into the very heart of that imaging department. There, I met with Dr. Bajaj at about 10 am, though he had already been up and about for two hours prior to my arrival. On the first day, the other student, Kevin, and I spend the majority of our time in what was called the “Radiology bullpen.” The bullpen was the major hub of the radiology department: images from everywhere in the hospital would be uploaded to the hospital’s network, where they would then be downloaded, viewed, and analyzed by experts.

The bullpen was equipped with four work stations, each with two large monitors, two larger monitors, and a very comfortable chair (a necessity when one spends a good deal of time sitting and analyzing images). Additionally, each workstation had a dictation microphone with which the radiologist could turn speech into text on the screen. This allowed Dr. Bajaj to quickly document his thoughts and observations without being slowed by the time it would take to type.

Several other people, doctors or graduate students, would also work with Dr. Bajaj in the bullpen, gaining experience by analyzing images and observing Dr. Bajaj. Occasionally, Dr. Bajaj would look at the dictations of the graduate students and make small constructive comments on their work, ensuring that those students are well prepared for their future careers.

The work consists of viewing and analyzing images including ultrasound, CT scans, various magnetic resonance imaging scans, and more. The images displayed abdomens, skulls, chests, and the occasional arm or leg. Dr. Bajaj was able to make out discrepancies in the images, subtle patterns of shading or brightness that indicated to him symptoms, and he used that information to diagnose the patients. To me however, most of the images looked remarkably similar, I was unable to make heads or tails of all but the simplest of x-rays. Because of the wide variety of possible images, Dr. Bajaj and the other radiologists have to have an excellent knowledge of numerous types of scans, as well as near perfect memory for internal human anatomy. I now understand that to pursue such an avenue of medicine would require a great many years of difficult study, hopefully with successful results.

Kevin and I sat with Dr. Bajaj until about 10 pm that evening, stopping only once to grab a sandwich from a nearby café and then eating it in the bullpen. The volume of images to be viewed was enormous, and the work required Dr. Bajaj to eat at his desk, but he remained positive. Dr. Bajaj told us that for him, radiology was a great job. His favorite thing to do was to diagnose patients, and that was the brunt of his work, just viewing images and making diagnoses. He wasn’t missing the human interaction component of medicine because he was constantly interacting with students, either teaching or supervising. He seemed quite happy to do his work, which was very nice to see.

The next morning, we continued the work of the previous evening, tearing through image after image and observing Dr. Bajaj’s work. After some time, Kevin and I left Dr. Bajaj temporarily to work with another expert, Dr. Omar Arnuk, a neuroradiologist. Dr. Arnuk, as opposed to ultrasounds, spent the majority of his time looking at CT scans in the brain. Because CT scans show the density of material, Dr. Omar was able to see fluid-filled spaces and areas of blood flow in the brain. His highly specialized knowledge of the brain allowed him to see subtle differences in the images on his monitor which allowed him to diagnose the possible ailments of the patients.

On the final day, Kevin and I were able to see actual imaging take place. We sat with an MRI technician and observed patients enter the machine and watched as images of their internal anatomy appeared on screen. We learned that the MRI scanner technology is able to take an image and from that image extrapolate views from the top, side, and front, giving radiologists a great deal more information to work with. The imaging procedure was very short, safe, and remarkably effective, making the MRI an excellent medical tool.

Viewing the work of Dr. Bajaj and Dr. Arnuk, SIUSand spending time in the SI University Hospital has given me a wealth of experience for a possible career in radiology. Before this opportunity, I had only vague thoughts about the daily work of a radiologist, and the education the job required. Now, however, after observing and speaking with hospital staff, I have a much greater appreciation and understanding of the radiology field, and will one day be able to make a more informed decision about my career path.

Andrew Chan ’14, Staten Island University Hospital

andrew chan 1This January, I spent three days shadowing Dr. Sanjiv Bajaj ‘02, section chief of ultrasound in the Department of Radiology at Staten Island University Hospital. During my Princeternship, I was given the amazing opportunity to observe Dr. Bajaj and various residents at work in the Radiology department of their hospital. I soon learned that Dr. Bajaj’s primary role as a radiologist is to “read” a variety of medical scans and determine whether a patient’s internal organs show any evidence of abnormalities. By synthesizing information from a variety of sources, such as each patient’s medical history and prior radiological scans, radiologists are able to play a critical role in diagnosing patients with a wide array of conditions.

In some sense, radiologists like Dr. Bajaj are analogous to detectives in that they try and to piece together a set of clues to “solve” a patient’s case. In addition to diagnosing individuals, alternative possible explanations, known as “differentials,” for a patient’s condition can also often be ruled out with the help of radiological scans. Radiologists look at scans in specially-designated “reading rooms,” where a series of four dedicated monitors can display current and prior patient scans, as well as notes made by the technicians performing those scans and information regarding their medical history.

Not long before my visit, Dr. Bajaj had been seriously hurt, forcing him to use a pair of crutches to get around the hospital. When others invariably asked about his leg injury, he would sometimes describe the damage using the precise medical language he also employed while “reading” a radiological scan. Because of the secluded setting in which radiologists “read” patient scans that seem to depersonalize the doctor-patient relationship, my first impression was that radiology was a particularly disconnected specialty, as the tangible physical separation from patients implied a mental distancing from the practical and interpersonal aspects of medicine.

Yet, my time at the hospital showed me that my naive judgments were flawed and did not reflect the realities of being a radiologist. Even though his injury prevented him from interacting with patients and performing scans on them, it was clear from watching Dr. Bajaj interact with others that what a radiologist does is readily applicable to everyday life and that medicine is an inherently practical fieldnot at all disconnected from the interpersonal aspects of medicine. And if not for his injury, Dr. Bajaj would typically perform all of the radiological scans on his patients himself, as he says that he enjoys interacting with his patients. Medicine, after all, is about patient care. Similarly, in contrast to my expectations that radiologists are more reclusive than other types of physicians, Dr. Bajaj is the definition of outgoing. His sociability and enthusiasm can’t couldn’t even be contained by the crutches that keep kept him physically confined to a desk for the large part of his day during the time I visited.

Overall, my Princeternship was an invaluable experience, and I know that my time at Staten Island that provided me with a much more detailed and nuanced view of the inner workings of being a doctor at a major teaching hospital. I also received a tremendous amount of advice about medical school and about life from Dr. Bajaj and the residents in the Radiology department there, and for that I am incredibly grateful. I am especially thankful for all of the time that Dr. Bajaj devoted to allow me to shadow him during the week. This experience was more than I could have asked for, and I’m glad I was given the opportunity to delve more deeply into the world of a physician.