I took today as a travel day, so I didn’t complete a whole lot of work on my intensive fair presentation. However, I did do some housekeeping tasks--I wrote thank you-notes to the many physicians who generously allowed me to shadow them for a day or two, and gathered some materials for my presentation. I also thought a little about the story I want to tell through my presentation and how I’m going to represent each specialty. I’m considering making a triboard, because although it is generic it also allows me to display my thoughts in an organized and straightforward manner. However, I would like to make up an game or interactive activity as well, in order to get my audience members more involved in my presentation. Over the weekend, I hope to do a little extra research on becoming a physician and to work on my triboard.
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Today, I shadowed in surgical pathology. It was my last day at the University of Vermont Medical Center, and I must admit that I was a little sad about leaving the hospital. It has been such an interesting and rewarding three weeks, and I have learned so much about the medical field. I wanted to make the most of my day; my goals were to ask thoughtful questions about what I saw and to observe the way that pathologists worked with physicians from other specialities to improve the health of their patients.
Over the course of the day, I watched as pathologists examined organs, gathering data about their size, shape, and color in order to make a reasonable conclusion about the illness that the patient was suffering from. I learned that surgical pathology is closely connected to the surgery department (this statement sounds a little obvious to me now, but I didn’t put the pieces together before I shadowed). Patients with symptoms that indicate particularly serious illnesses are sometimes sent to surgeons, who remove a part of the organ or tissue that is causing the patient’s problem and send the specimen to pathology for more in-depth analysis. Surgical pathologists then cut into the specimen, taking note of any abnormalities and recording their findings. Organs that show evidence of cancer are often palpated, or touched by hand, in order to determine where the cancer has spread. Most organs, no matter the problem they appear to have, are cut into sections, encased in wax, and inserted into machines for further testing. What I found amazing was that the owners of these organs can survive without them--sometimes the surgeon only takes a piece of an organ to submit to pathology, but other times the whole organ must be removed. I couldn’t believe that, for instance, a patient who had to have a whole adrenal gland removed could live a normal life, but it turns out that each person has two adrenal glands, and can adapt to use only one if necessary. These sorts of examples proved to me that the human body truly is amazing. Overall, I really enjoyed shadowing in surgical pathology. One might think that watching a pathologist cut into organ after organ would be a dull way to spend one’s day, but I actually found the anatomy aspect of the pathologist’s work really interesting. Identifying abnormalities in an organ requires such an in-depth knowledge of the human body. Each pathologist must be able to spot problems in any organ’s size, shape, color, or texture--a tall order for one person. However, this also seems like the kind of science I’d enjoy because it’s so hands-on. Shadowing in surgical pathology also sparked my interest in surgery; pathologists make small cuts into organs but nothing more, and I think that in the future I’d like to watch a surgical procedure (perhaps something that’s not too gory). Although I have loved spending time at the University of Vermont Medical Center, I’m really looking forward to returning home and working independently for a few days; I’d like to gather my thoughts a little and finish up my intensive fair presentation. My day was much slower than yesterday. I think I prefer shadowing one specialty instead of two each day because the extra time allows me to consider my experience more carefully. Today, I worked with Dr. Ulano, a radiologist who specializes in reading scans of the brain and spine. I must admit that I was a little unsure about shadowing radiology again because yesterday I hadn’t enjoyed it as much a I hoped, but I was determined to keep an open mind about it. My goals were to compare and contrast pediatric and neurological radiology, and to find things that I really liked or found interesting about radiology.
I arrived at UVMC in the morning and found Dr. Ulano’s office fairly easily--fortunately it was located in the newer part of the hospital. In a nutshell, we spent the day examining scans on computers in a dark room. Dr. Ulano would start by skimming through a patient’s medical history (past illnesses, symptoms, etc.) before pulling up his or her scans on two large computers. Each scan showed a slightly different view of the patient’s body, providing the physician with a variety of information about the patient’s condition. One interesting thing about the scans was that they weren’t just pictures--they were clips or videos that the physician could look through to see how the bones, organs, or tissue moved. I asked Dr. Ulano how it was possible that the scans could move, and he explained how CT and MRI scans worked in great detail, even drawing up a diagram for me. Essentially, the CT and MRI machines rotate around the patient’s body, which allows them to take a series of images which can be processed by a computer and layered together to create a video. I found the science of CT and MRI scans fascinating, even though it seemed really complicated. After looking through a patient’s scans for a couple of minutes, Dr. Ulano would dictate his findings into his computer and send them on to the physician in charge of the case. I thought looking at brains and spines was much more interesting than looking at pediatric scans. Neuro-radiology just felt a lot more specialized than pediatric radiology; I really like the idea of becoming an expert in a certain area and admired the work that Dr. Ulano was doing. I definitely enjoyed my shadowing experience today more than I did yesterday, but by the end of the day I had made the same conclusion: radiology may not be the specialty for me. I think I’d love to take a class on the science of CT and MRI scans in college; I found even the short introduction that Dr. Ulano gave really interesting. However, I don’t much like the idea of sitting in a dark room all day without any patient interaction, and radiology feels a little isolated from the real action in the hospital. Radiologists do not necessarily have to spend all of their time alone in their offices, though. I learned today that many radiologists have outside obligations like teaching at UVM’s College of Medicine or doing administrative work. It seems that the more I learn about the medical field, the more I like it--I think I’d really enjoy teaching students about medicine as well as practicing it. Tomorrow, I’ll be shadowing surgical pathology, which I’m excited about because I enjoyed working with pathologists so much last week. Today was a little more hectic than the previous days I had spent at UVMC because I shadowed in both microbiology and radiology, spending a half day in each department. I knew that shadowing in these specialities wouldn’t involve a lot of patient interaction (which has quickly become my favorite part of the job), but I was excited to experience something new. Although these specialities do sound very different, they share a tendency to play a behind-the-scenes role in the medical field. My main goal for the day was to learn as much as I could about how microbiologists and radiologists support physicians, but I was also really curious about how radiologists interpret CT and MRI scans--they have always looked really complicated to me.
I found my way to the microbiology lab in the back of the hospital this morning and was immediately directed to the “benches,” or the small, cubicle-like spaces where the lab technicians work. For the first three hours, I rotated around the lab, spending about a half-hour at each “bench.” This way, I got to interact with a number of lab technicians and learn about all of the different functions of the lab. Some of the smaller departments within microbiology that I shadowed in include virology (dealing with diseases like influenza and herpes) and parasitology (dealing with parasites like roundworms and ticks that find their way into the human body). Each of these sub-departments has the same purpose: to figure out how best to treat patients based on the organisms (bacteria or parasites) that are present in their bodies. The departments take different steps to accomplish this, but the general process they follow is the same. Essentially, the microbiology lab receives hundreds of samples each day (urine samples, blood samples, swabs, etc.) which they must test for various sorts of bacteria. Oftentimes this testing involves spreading some of the sample on a number of different petri dishes. Each of these petri dishes is treated with a different antibiotic or chemical; the way that the sample grows on the dishes gives the microbiologists an idea of what sort of bacteria is present and how it might be effectively treated. Bacteria is also sometimes placed on slides and inserted into high-tech machines to be identified. After a couple of hours of work, the microbiology department began “rounds,” where a pathologist, two senior lab technicians, and two residents rotated as a group around the lab, stopping at each “bench” or cubicle to discuss current cases and findings with the technician who was working there (cases being samples of bacteria from patients). I got the sense that “rounds” were not just about double-checking the technicians’ findings, but also about building a sense of togetherness--the people in the microbiology lab seemed really comfortable with working together, often joking around and helping each other out. After my lunch break, I headed downstairs to what a sour receptionist called “the bowels” of the hospital when I asked for directions to the radiology department. The physician I was shadowing was Dr. Hildebrand, a radiologist who specializes in reading pediatric scans. I quickly realized that radiology is isolated from the rest of the hospital in many ways--not simply in terms of location, but also in terms of the department’s lack of involvement with patients. Of course, radiologists are reading patient scans, but they never see patients unless they make a concerted effort to do so. For this reason, the job didn’t seem quite as emotional as the other specialities I shadowed: scans of patients with lots of difficult problems were described as “cool” and often shown to nearby radiologists because they were so interesting. Of course, I understand the wow factor of a case you haven’t seen before, but I wouldn’t use the word “cool” to describe them--I’d say tragic. This says more about me than it does about the radiologists; my only point is that I knew almost from the start of my shadowing experience that radiology might not be the department for me. I also didn’t like the idea of sitting in a dark room for hours on end. However, I tried to keep an open mind. Over the course of the afternoon, I saw a number of scans of spines (which Dr. Hildebrand said were especially difficult to interpret), as well as various birth defects. One interesting thing about reading pediatric scans is that as children often grow out of problems, some abnormalities on pediatric scans can be dismissed because of the patient’s age. To me, radiology looks really difficult--on the scans, I could identify some of the organs (like the lungs) but most parts looked completely unfamiliar to me. All in all, I’m not sure that I could see myself working in microbiology or radiology in the future, but I did enjoy doing something a little different. Of course, having a positive shadowing experience is great--you figure out that you love a certain specialty, and make plans to shadow it more in the future. However, negative experiences are just as important--knowing what you don’t want to do allows you to better isolate the things you do want to do. Today, I learned that I might want a job with a little more patient interaction, which I think is a valuable takeaway; I’ll use it to cater future shadowing experiences. Tomorrow, I’ll be shadowing neuro-radiology, which should be similar to pediatric radiology but perhaps a little more interesting because it’s more specialized. Today, I shadowed Dr. Kaminsky in UVMC’s Intensive Care Unit. I must admit that I was a little nervous about the day; I steeled myself as I walked through the hospital doors, preparing to see people at the very worst parts of their lives. There is something deeply unsettling about the sight of human I hooked up to machines, pale and feeble and helpless. For me, it is easier if I know their stories, if you know that they once traveled the world or wrote novels for a living--they seem a little less vulnerable. I was worried that I wouldn’t hear these stories in the ICU (as I had in the clinics) and that I’d simply move from one grey hospital room to the next, watching as Dr. Kaminsky examined each critically ill patient. My goals for the day were to observe how physicians limit their emotional involvement and to learn a little about what kinds of diseases bring people to the ICU.
I arrived at UVMC and found Dr. Kaminsky examining patient scans in the back of the ICU, surrounded by residents and medical students. It appeared that each resident was responsible for one or two cases; as Dr. Kaminsky pulled each patient’s X-ray or CT scan up on the computer, one resident would step forward to interpret the images. I realized that the residents were undergoing experiential learning--guided by Dr. Kaminsky, they were essentially acting as physicians. I found this really interesting; perhaps attending school for so long (after college, those who wish to become physicians must spend years in medical school and then in residency) wouldn’t feel tedious if I weren’t stuck in libraries and classrooms, but on the ground in hospitals. After considering all new scans, Dr. Kaminsky and his residents began “rounds,” which essentially involved moving through the hallways of the ICU, stopping at almost every room to discuss each patient’s condition--any changes that had occurred overnight and the patient’s major problems. I had previously assumed that these discussions were for the benefit of the residents and medical students (a certain teaching method), but what I didn’t realize until today is that these discussions also help the senior doctors, called attendings, to get a sense of each patient’s condition. The medical profession involves a lot of teamwork; meeting with colleagues to talk about patients and how best to treat them is how physicians think through difficult cases and avoid mistakes. Surprisingly, my day involved absolutely zero patient interaction. I’m sure that physicians who work in Critical Care do see patients, but the morning rounds were all about discussion. I think this sort of teamwork is something I’d really enjoy--it’s really interesting that physicians of all ages have the opportunity to share cases and learn from each other. I also realized that the ICU isn’t nearly as fast-paced as I thought it might be. The patients did have serious conditions (often having to do with their hearts), but the physicians who treated them were always calm and careful. Although I’m not sure I would enjoy working in the ICU (simply because of how emotional it could be), I was really impressed by the way that Dr. Kaminsky and his residents handled each case, and by the richness of their discussions about each patient. So far, all of the specialities I’ve shadowed involve some sort of patient interaction (I’ll include today’s experience in this category because I’m sure that Dr. Kaminsky does interact with patients after rounds). Tomorrow, I’ll be spending time in microbiology and radiology--specialities that rarely involve speaking directly with patients--which should be different and interesting. Instead of heading to the great glass hub that is UVMC, I drove today to an unassuming brick building downtown to spend some time at a local medical organization called ThinkMD. My guide for the day was Ezra Mount-Finette, the son of my independent study sponsor. He works closely with his father and Think MD’s co-founder, Dr. Barry Finette, to improve global healthcare. Global health is not exactly a medical specialty in that one cannot decide to study it exclusively during medical school. In fact, those who work in global health have expertise in a traditional specialty (cardiology, pulmonary medicine, etc.) as well as the tools and resources to treat patients in other nations. I have always thought of working in global health as a potential career, so I was excited to explore ThinkMD today. My goals were to get a sense of ThinkMD’s mission and to learn about how physicians work in other nations.
The organization was buzzing with activity, but Ezra Finette managed to find a quiet conference room for us to talk. My shadowing experience today took the form of a drawn-out question and answer session: I would ask a broad question about Mr. Finette’s work or ThinkMD’s mission, and he would answer it in detail, scrolling through pages of data analysis on his computer or showing me ThinkMD’s website as he did so. Essentially, ThinkMD’s mission is to bring advanced healthcare to people suffering from insufficient or inadequate medical treatment. These people often live in poor nations where physicians who can provide proper care are few and far between. One might assume, as I did, that improving global healthcare would involve transporting American physicians to these nations; instead, it involves technology. Over the past three years since its creation, ThinkMD employees have been working to implement and improve an app called “MEDSINC,” which can be now installed on any iPhone or tablet. MEDSINC essentially turns regular people into physicians (well, almost). The application allows anyone, even those with no medical training, to offer a possible diagnosis for a sick person by filling out a series of questions and waiting as the application uses a complicated algorithm to produce a list of diseases that an individual may be suffering from. In order to be sure that people use the app correctly, ThinkMD sends one or two employees (equipped with the application) to countries in need, where they teach groups of people how to make a diagnosis with MEDSINC. After training, these people go back to their communities to teach others how to use the app and to begin improving the health of those around them. Mr. Finette’s specific role within ThinkMD is to analyze the accuracy of MEDSINC by sifting through piles of data provided by those who use it. One interesting fact about global health is that the phrase “global health” is a contradiction. Healthcare problems are often related to government policies or environmental issues, both of which are concerns that must be addressed at a local level; so, global health really starts with improving the health of individuals within various communities around the world. In recent years, ThinkMD has implemented MEDSINC programs in communities in Bangladesh and plans to expand to Ecuador in the future; however, there are some barriers to further expansion (especially expansion to countries in South America and Africa). There is, of course, the language barrier--although the MEDSINC app can be used in any language, the ThinkMD employees who teach people in other countries how to use MEDSINC must be able to speak the local language or must find translators. In addition, the governments of many countries are unstable or hostile towards Western influence; entering these types of countries would risk the success of the ThinkMD project. Those who work for ThinkMD take into account all potential barriers and risks before selecting a country to work in. All in all, I really enjoyed speaking with Mr. Finette and observing some of the work he does for ThinkMD today. My visit sparked my curiosity about other approaches to improving global healthcare and about the future of healthcare--if regular people are given access to relatively straightforward applications that allow them to accurately diagnose sick people (like MEDSINC), what role will physicians serve? Will medical school continue to be as rigorous as it is today? Learning a little about ThinkMD also opened my eyes to the large world of global health. I had initially thought that the only way to improve global health would be to send physicians to places in need. However, I learned that this isn’t always possible (because of a language barrier or a shortage of physicians), and it was really interesting to hear about a different, technology-oriented way of helping sick individuals in other nations. I’m looking forward to shadowing Dr. Kaminsky again tomorrow, this time in the ICU instead of the Pulmonary Clinic. Today, I shadowed Dr. Markus Degirmenci in General Medicine. Originally, I had the impression that Dr. Degirmenci worked in a smaller Primary Care clinic, as Dr. Luria does, but I quickly realized that this was not the case. Dr. Degirmenci actually practices General Medicine at the UVMC hospital; all my expectations for the day (many of which were concerns that it would feel repetitive of the day I spent at Dr. Luria’s Primary Care clinic) were forgotten as he led me to the first patient’s room. My overarching goals for the day, adjusted to fit my new situation, were to learn about how hospitals function behind the scenes and to take note of how attendings, residents, and medical students interact with each other.
I essentially spent my morning following Dr. Degirmenci on “rounds,” which involved moving from room to room, checking in on patients and sometimes discharging them from the hospital. These patients, unlike those in the clinics I had visited, did not have scheduled appointments with Dr. Degirmenci. Instead, they had been admitted to the hospital because of some acute and pressing health problem so that they could be given immediate care. For this reason, the hospital environment felt more stressful than the clinics (even to me--and I wasn’t providing care). Every decision had to be made quickly and carefully; there was no room for mistakes. The lives of these patients were truly in the physicians’ hands. As a physician who specializes in General Medicine, Dr. Degirmenci tended to visit patients who had problems with their digestive systems (oftentimes these were problems with their intestines, stomachs, or bladders). However, each patient was a different case. Some of the cases were sad; I must admit that it was hard for me to see people lying weak in hospital beds, plugged into machines or covered in tubes. The physicians, however, did not seem upset. They cared for their patients, of course. I could see that in the way the physicians spoke to their patients, touched them on the shoulder, shook their hands, and spoke at length with their worried family members. Yet they did not let their emotions get the best of them, which I assume is a necessity in the medical profession--a physician who tears up at the sight of an IV could certainly not earn the trust of his or her patients. As part of fulfilling my goals for the day, I carefully observed the way that attendings, residents, and medical students interacted with each other. Discussion is a huge part of the medical profession; I noticed that physicians talked each case over aloud, and often contacted colleagues in other departments to get advice on particularly difficult cases. The hierarchy that we see in medical television shows is very much a reality in the hospital: students are visibly lower on the medical food chain than residents, who are, in turn, inferior to attendings. Attendings have the final say--almost like veto power, no matter how much research the resident or medical student has done. Undoubtedly, the residents and medical students are doing valuable work (senior residents, in particular, have a lot of independence), but it is also obvious that the attendings are in charge. I don’t question this system, for I know that it has produced millions of incredibly capable physicians; I only wonder if it’s something I would enjoy being part of. In the afternoon, I attended a medical school class taught by Dr. Sharon Mount, the pathologist I shadowed last week and my independent study mentor. It didn’t feel all that different from my high school classes (it was 90 minutes as opposed to our 85), besides being much more focused and specialized. The students went over three or four medical cases over the course of the class, reviewing new vocabulary and looking at slides that revealed the causes of various problems when placed under microscopes. Overall, the hospital environment was very different from the clinics that I had visited. Although it was interesting to spend time in the hospital, seeing patients for short amounts of time and listening to conversations about cases between colleagues, I’m not sure it’s a place where I would enjoy working. It would certainly be challenging in positive ways, but I’m also sure that it would be emotionally draining, especially over time. It’s odd that the General Medicine specialty didn’t make nearly as much of an impression on me as the hospital environment did. Tomorrow, I will be shadowing Dr. Gagne in Radiation Oncology, which will be another interesting experience. I spent my day shadowing Dr. Kaminsky, a physician who works in the Pulmonary Clinic that I visited yesterday with Dr. Garrison. I must admit that although I was excited to meet Dr. Kaminsky (a family acquaintance), I was a little worried about spending a second day in Pulmonary Medicine. Up until now, I had done something different every day; I predicted that my second day in this specialty would feel repetitive of the first. Therefore, my learning goals for the day were to make my experience with Dr. Kaminsky as different from my experience with Dr. Garrison as I could. I planned to ask different questions--yesterday I had asked Dr. Garrison a lot about the science of Pulmonary Medicine, and today I wanted to learn more about the mechanics of the job, and why Dr. Kaminsky chose this particular specialty. I also wanted to learn more about the patient-physician relationship, and decided I would closely observe the way that Dr. Kaminsky interacted with each person he visited today.
It turned out that my prediction of a dull second day in Pulmonary Medicine couldn’t have been more wrong. Dr. Kaminsky and Dr. Garrison do share an expertise in Pulmonary Medicine, but my experience with Dr. Kaminsky was very different from my experience with Dr. Garrison (and neither, of course, were unpleasant). Of course, the general structure of my day was the same. I arrived at UVMC around 9:30 a.m.; Dr. Kaminsky reviewed the first patient’s chart with me before heading into the exam room, where he discussed the patient’s medical history, current prescriptions, questions, and concerns before developing a plan of action with the patient. This plan of action often involved lifestyle changes or prescription drugs (maintaining the use of one or taking a new one), and was always geared towards relieving the patient’s symptoms as well as addressing the symptoms’ underlying cause. Yet the cases I saw in the Pulmonary Clinic today were very different from those I saw yesterday. Almost all of them were related to asthma (as opposed to conditions caused by smoking). One interesting fact about asthma is that it has no cure: it can only be controlled. However, there are dozens of medications that can be used to control asthma, which is fortunate because oftentimes one medication is not enough to alleviate a patient’s symptoms. These symptoms can include wheezing, shortness of breath, and sinus problems. In addition, the severity of a patient’s asthma does fluctuate based on his or her environment. Many patients find that their asthma is worse in the winter because of the cold weather, or that dust or pollen tend to trigger their asthma attacks. Of course, many diseases can be tied in some way to outside factors, but there is a particularly close connection between asthma and the environment, and I’m curious to learn more about why this is so. In order to decide how severe a patient’s asthma is, physicians often order breathing tests, which reveal how well the lungs are functioning. Many of the patients that I saw today received the good news that their lung function was improving; seeing the smiles on their faces only confirmed for me that the work of a physician is incredibly rewarding. I also noticed that Dr. Kaminsky’s patients truly trusted him, offering their thanks at the end of the appointment and breathing sighs of relief as he developed a comprehensive plan of action. I really admired the way he worked with patients: he answered question after question even if it prolonged the appointment past its end time, listened carefully as each patient explained his or her medical history and concerns, and was always incredibly caring. His presence itself was calming, suggesting without a doubt that he always had his patients’ best interests in mind. After a busy, fast-paced day (there was no break, even for lunch!), I headed home a little before 4:00 p.m. Today was probably my favorite day so far. I really enjoyed working with Dr. Kaminsky and experiencing the Pulmonary Clinic again--it truly was different the second time around. I was intrigued not only by asthma but also by the way that Dr. Kaminsky interacted with his patients, and I’m looking forward to shadowing him again (this time, in the ICU) on Monday. I think that I might consider working in Pulmonary Medicine as a potential career, but of course there are so many specialities that I have yet to experience. Up until today, I had only seen older patients (usually above 50 years old), but today I saw a 21-year-old patient; this visit sparked my curiosity about pediatrics, and I hope to set up a shadowing experience in that specialty in the future. Tomorrow, I will be shadowing Dr. Degirmenci in Primary Care, so I’m excited to continue comparing my experiences and recording my thoughts along the way. Today, I shadowed Dr. Garth Garrison in Pulmonary Medicine. After a refreshing weekend at home, I was very much looking forward to spending another day at the University of Vermont Medical Center. As a high school student, the luxuries of life as a physician (especially in the beautiful city of Burlington, Vermont) are certainly not lost on me, and there were many times this morning when I thought, I could get used to this. The Medical Center is such a positive environment (for working and for learning), and simply by sitting in on patient visits I can tell that a physician’s work is incredibly rewarding. My overarching goals for the day were to note the similarities and differences between the Pulmonary Clinic, the Pathology Lab, and Dr. Luria’s Primary Care offices, and to absorb as much as I could--I resolved to make mental notes about how Dr. Garrison interacted with patients, what sort of diseases were most common, and how the clinic functioned as a whole.
I arrived at UVMC around 9:00 a.m.; helpful receptionists directed me to the Pulmonary Clinic, where I met Dr. Garrison shortly before the first patient’s appointment. He quickly reviewed the patient’s chart on the computer, tilting the monitor to allow me to read the patient’s history and pointing out concerning spots on the patient’s CAT scans. I then followed him down winding hallways to the exam room, where he conducted the first patient visit. I noticed similarities between his bedside manner and that of Dr. Luria: both physicians use a lot of care when interacting with patients and making diagnoses. They truly try to get to know their patients, reaching below the surface to learn about their patients’ families, jobs, and feelings--partially to gather as much information as possible in order to make the right diagnosis, and partially to form that special connection between physician and patient that is so important in the medical profession. I imagine that the tendency to use this sort of care in patient visits is a characteristic that many physicians share. Over the course of the day, Dr. Garrison saw a total of 7 patients (roughly one every half hour). Each patient had a slightly different case, but a history of smoking was often the underlying cause of their problems. I knew that smoking was a dangerous, but seeing its real-life effects on those who practice or have practiced it stripped away any of its remaining glamor and exposed it for what it truly is: a harmful, addictive habit that hurts even those who manage to successfully quit it. I also noticed that Dr. Garrison followed a similar procedure in each exam room: first, he discussed the patient’s condition and medical history; then, he asked the patient a number of questions (about symptoms, pain, and possible causes of their problems) and conducted a short physical exam; and finally, he developed a plan of action with the patient. This plan of action usually involved further testing, a new prescription, or a follow-up visit. I learned that although physicians do tend to think quickly and on their feet, the choices they make aren’t always easy. Deciding what course of action to take, for instance, was in some ways very complicated, especially when dealing with “nodules” or spots on the lungs that are potentially cancerous. It is important to treat problems before they cause especially unpleasant symptoms or irreversible damage, but many treatments often have problematic side effects that might not be not worth suffering through for a problem that hasn’t yet manifested itself through obvious symptoms. Those who specialize in pulmonary medicine often have to make this trade-off and find the right timing to get more tests or prescribe a new treatment. I ended my day before 3:00 p.m., and headed home to enjoy the (relatively) warm weather; 30º feels balmy after temperatures of -10º! Overall, I really enjoyed spending the day with Dr. Garrison. Although Pulmonary Medicine is much more specialized than Primary Care, seeing patients never felt redundant--each case was unique, and each person had different experiences to share. In addition, Dr. Garrison was incredibly knowledgeable in regard to all aspects of Pulmonary Medicine; I think that becoming an expert in something, whether it’s Pulmonary Medicine or not, would be exciting and rewarding. I also found the connection between Radiology and Pulmonary Medicine really interesting: Dr. Garrison used the patient’s CT scans as a guide for each appointment, evaluating them carefully and basing his diagnosis partially on what he saw in them. To me, the CT scans weren’t easy to read, so I can infer that medical students must complete a lot of Radiology training regardless of what speciality they would like to go into. I’m looking forward to getting a better sense of what Radiology is all about when I shadow in the department later this week. I’m spending tomorrow in the Pulmonary Clinic, as well (although with a different physician), so I’m looking forward to gathering more information about the specialty! I spent today shadowing Dr. Sharon Mount in Pathology. In the morning, I arrived at UVMC equipped with some background knowledge about the speciality, and, admittedly, a bias. I had enjoyed my day with Dr. Luria so much that I wasn’t too excited about spending hours in a lab, examining organs and breathing in formaldehyde instead of interacting with patients. However, I tried to keep an open mind, my goals being to look for things I liked about the specialty and to learn as much as I could about the daily work of a pathologist.
My day began with a tour of the Pathology labs and offices. Dr. Mount introduced me to many of the physicians we passed along the way, all of whom were friendly and welcoming. She then handed me a pair of scrubs, which I put on (very official, very comfortable!) before following her into one of the labs. I spent a couple of hours in the lab, watching as residents inspected diseased organs, making cuts and recording observations. Their purpose was to figure out what, precisely, was wrong with each organ. They would often cut samples of different parts of an organ and submit these samples for further analyzation. Once submitted, the samples would be encased in wax, then dyed, then dipped in water to create slides. These slides were brought to pathologists, who would look at the samples carefully through microscopes. The process of analysis was long and complicated, and the pathologists in the lab helpfully tried to explain to me what they were doing, but I must admit that the medical jargon that rolled off of their tongues was very much over my head. Even so, I was able to get a sense of how they went about examining each organ. I was allowed to touch some of the organs, which I was reluctant to do at first (the idea of touching a gallbladder or an eye, even with gloved hands, was terrifying) but then eager to continue because it added to my understanding of what was wrong with each organ. Pathologists rely a lot on their hands in making observations about specimens. I then observed a biopsy of a liver and watched as a pathologist examined the sample through a microscope, projecting what she was seeing onto a television so I could see. It appeared that there wasn’t anything horribly wrong with the liver, but it was interesting to watch the biopsy all the same. We broke for lunch for about an hour; afterwards, I spent some time in the “Pathology Museum,” which is essentially a room filled with organs with various problems (unlike the organs in the lab, these were older organs from closed cases). Dr. Mount was helping another physician find some examples of diseased organs to show a class of medical students; I was allowed to look on as they selected organs that exemplified melanoma, or pancreatic cancer, or hypertension. I had learned about some of these diseases but had never seen how exactly they impacted the human body, so this was a really valuable learning experience. I ended my day a little after 3:00 p.m., which felt like a luxury after going home at 5:00 p.m. yesterday. Despite my initial bias, I really enjoyed my day in Pathology. It was educational as well as fun; although I didn’t experience the social side of medicine as I had yesterday, I did learn a little more about the (obviously close) connection between science and medicine. I’m not sure Pathology is for me--I must admit that I couldn’t shake the feeling that touching real organs was in some way sacrilegious. However, shadowing Dr. Mount did spark my curiosity about the study of disease, and I’d certainly like to learn more about how common problems like hypertension impact the human body. On Monday, I’ll be shadowing a physician who works in the ICU as well as in a pulmonary clinic, which should be an equally interesting experience. I’m very grateful that the independent study structure allows me to experience so many different sides of medicine; I feel already that I’m getting a very rounded perspective of the medical field. |
AuthorKiran Dzur |