I love coming to the hospital now. I was afraid of the hospital at first because how intimidating it could be. But the team I am shadowing is so welcoming, and I can’t imagine another place to be. When patients ask me where they should go or who should they look for I can clearly answer them. If the doctors I work with forgot their masks or hats or the drops I know where to go to get them. I know which technician I should look for during specific times. The only disappointing part of this experience is that I cannot go to the OR. They placed a new policy that does not allow minors into the OR. Otherwise, I am learning the most out of this opportunity.
Tag: Medicine
Day 6
Today was less busy than yesterday, but we still saw our fair share of patients. The first appointment of the day was an 18-year-old well check, so I stayed in the nurses’ lounge/workspace outside the patient rooms while Dr. Villareal went in to examine the patient. The nurse schedule rotates daily, with each nurse in charge of one doctor’s patients, or working as a general nurse, or floating. Dr. Villareal’s nurse today was JJ, and during the first appointment she showed me how to draw up a vaccination shot. She showed me both half- and one-inch needles, explaining that a longer needle is necessary for intramuscular injections (administered to muscle) while shorter ones would suffice for subcutaneous injections (administered to fat). She took the required vaccine (in this case, meningitis B) from a special refrigerator and a one-inch needle, and connected them with a simple twist. The shot then had to be documented by the identification number on its label, type of vaccine, and patient. This same procedure would have to be done to each shot throughout the day.
There were a few slightly more memorable cases today. One was a two-year-old boy who was the only patient that Dr. Villareal could remember he had sent to a gastrointestinal specialist because of his weight. I saw that he was quite petite, but fortunately he was gaining weight and doing just fine. (Though he was in the 1st or 2nd percentile for weight, the important thing was that he stayed on his curve without major fluctuations.) Another patient was a 16-year-old boy who was abnormally dependent on his mother. Usually, when the nurse calls teenagers back from the waiting area, she asks their parents to wait outside; this boy insisted that his mother come (and couldn’t accurately say which medications he was taking). When time came for his one shot, it took JJ at least ten minutes of talking to him and soothing him, plus Dr. Villareal going into the room and distracting him, before he would sit still and relax enough to receive his vaccination. Overall, there are so many stories a doctor encounters in just one day, which I think is one of the best parts of the job. I can’t wait to see what the rest of my time here holds!
Day 5
It may be Monday, but the clinic was still as busy as ever. Starting off with many new patients, most were there just for abnormal blood counts, which mainly resulted in anemia or iron deficiency. We then went and saw some follow up patients, and saw a young lady of 24 years who had just had a pancreas transplant for pancreatitis. She is also diabetic and has stomach issues. Her doctors sent her to the clinic because they were worried she might be anemic. I was surprised how many patients came into the clinic and did not have an issue at all. The checkups were quick and easy.
The main excitement of the day was a bone marrow biopsy I got to see. Now, I’ve never been one to get queasy at the sight of blood or needles, but this procedure kinda got me. The doctor first started off with some numbing medicine, but the needle was so deep that it was tapping on the pelvic bones. She let me feel the place where the biopsy would be taken, the flat bones in the lower back, and she then proceeded to take out a ginormous hollow needle to take the biopsy with. The needle was twisted into the bone, going all the way through to the marrow in the middle, and then was aspirated to retrieve the liquid marrow. At the end, she also took out the piece of bone she went through, and it basically looked like a little tube of bone. I was shocked at how easily she was able to go through the bone, because I always thought there had to be drills or hard tools involved. It was definitely an experience I won’t forget.
Fun Facts:
- You know if a biopsy sample is good if there are sand-like particles in the blood.
- Sometimes when people age, their bones become like Swiss cheese with holes and the biopsy needle just crunches the bone when going through.
- According to the nurses, men always faint at the clinic, but women never do.
- Radiation is dangerous because the radiation affects anything behind, in front of, or around the targeted area, resulting in organ damage sometimes.
Day 4 – Service Focus
This week, Dr. Lawal has a “service” week. The daily schedule on a week like this encompasses a morning filled with procedures followed by patient visits in the afternoon. These patient visits involve meeting with them in the hospital to check in with their symptoms and treatment. Interestingly, today there were numerous procedures done, all focused on EGDs (esophagogastroduedenoscopy) which involves inserting a scope down the esophagus and into the stomach. Attached are pictures that depict healthy and unhealthy portions of the esophagus and stomach. A condition I was introduced to today was esophageal varices, swollen veins along the lining of the esophagus. If the varices become too invasive, small bands can be placed around some of the tissue, cutting off blood supply and preventing extensive bleeding (or perhaps the esophagus even bleeding out). I specifically thought our trip to the intensive care unit was the most interesting. I had never been in an environment like this before and being introduced to the different technology and care provided to patients was reassuring. I am excited to meet more patients outside the OR, so hopefully I will get more exposure to them tomorrow.
Last Day at Southern Dermatology :(
Today was my last day at Southern Dermatology where I worked with Dr. Boyse and her amazing co-workers which i have grown to really enjoy their company while working. I was able to shadow a dermatologist today who performed Mohs’ surgery and showed me how they remove cancerous sites on the skin and determine whether or not they have to continue to cut around the site to fully eradicate the cancer. The most common types of cancer I saw was invasive squamous cell (invasive meaning it reoccurs) and basal cell carcinoma. To be able to figure out whether or not the patient was cleared was a whole other process. Using Pathology, Dr. Wilmoth (the Mohs’ surgeon), would figure out whether or no the cancers were still in the tissues of the skin.
Dr. Wilmoth, would first cut the cancerous skin sample out of the patient’s existing cancer-targeted area to then be brought to the lab to be observed. When he arrived in the lab, he cut it so that the epidermis would be exposed and then handed it to his partner who would actually begin slicing the skin sample into thin layers for futher examination. Through a series of freezing the sample, shaving it, placing it onto slides, preserving it by dipping it in different chemicals, the skin samples of each patient went through that process and at the end of the day ended up in about 9 slides (or so) showing the skin sample its different edges. Dr. Wilmoth then walked me through what a basal and squamous cell carcinoma looked like. That morning however, he had many patients that all read positive on their cancer and had to have more of their skin removed. The coolest part about it was seeing how quickly and precisely Dr. Wilmoth could identify the cancers and continue on to view or “study” the next patients slide. I really loved being able to shadow Dr. Wilmoth the last day as he was under stress but did take the time to explain and show me what he was doing while executing it.
After all of that intense work, I returned back to the skin exams and cosmetic procedures on Dr. Boyse’s side of the clinic. Once again, I had a great time being able to help send labs down to triage, retrieve samples of cremes for patients to try and stand-in on skin exams one last time. I had a great lunch and it was a very fun last day with them! I hope to be able to come back and shadow with them or even work as a medical assistant before med school if I decide this is where I would really like to do!
Day 5– Duke Work Experience
I started my day by attending a weekly meeting in the Duke OCU building. In the meeting, there were several patients that were discussed and a team in Florida called in as well. After the meeting, I rode over to the Children’s Health Center with Dr. Page to shadow Dr. Martin, one of the attendings. In the clinic, I observed follow up visits for three patients and then learned to read their lab results.
In the afternoon, I headed over to North Pavilion and observed in the Carolina Cord Blood Bank. There, I watched the freezing of cord blood as well as the various tests that the lab did on the blood to make sure it was viable. Similar to the stem cell laboratory, sanitation was very important. Lab coats were a must and shoe covers were also very important. As seen in the picture, all the lab technicians would work at lab stations with hoods to keep the blood sample as clean as possible. Seeing the whole process of the cord blood transplant really allows me to value the work of those that often are not recognized.
Tergus Pharma Day 1
Our first day at Tergus began with an eventful tour through the maze of laboratories and offices that wind through the Tergus campus. This company was definitely much bigger than Integrated Laboratory Solutions. Each lab featured at least a dozen high perfomance liquid chromatography (HPLC) and even gas chromatography machines, among a plethora of other costly lab equipment. Dozens of cubicles lined office rooms, and scientists and other employees alike milled about, test tubes and vials in hand. Clearly, Tergus was what it claimed to be–an efficient, cohesive workplace. I was impressed.
Our first activity of the day was led by Srikanth, a scientist who deals with the formulation of topical products–creams, ointments, spreadables. These skin-based items are what Tergus specializes in, and Srikanth demonstrated a hydrogel mixture for us. Hydrogels, as the name sounds like, includes jelly-textured substances such as hair gel. Today’s recipe amounted to 300 grams, with 1.5 grams of carbomer-980 (a polymer), 10.0 grams of glycerine humectant (the stuff that allows the formula to penetrate the skin), 1.5 grams of trolamine (a material that rebalances the pH to around 7, which is perfect for the epidermis), and around 287 grams of purified water, of course, to make up the majority of the formula. In the end, we each received a crimped tube of the hydrogel mixture as a souvenir–it’ll stand proudly on my bookshelf with all my other odds and ends.
After a quick lunch, we were back to action. One of the highlights of the afternoon was helping out with the janitorial checkups–we made sure the eyewash stations and showers were running smoothly. These checks are part of good lab etiquette, and I’m glad I got a chance to practice them.
I had a lot of fun today, and I was surpised that this Monday has passed so quickly. I look forward to what tomorrow holds.
Day 5
Today was our busiest day yet, since two out of the four doctors were out of the office. In total, we saw over 30 patients (for comparison, we only had 18 on Friday). Because the schedule was so full, we were moving from appointment to appointment with hardly any time in between. There weren’t too many particularly salient cases that stood out to me except for an operation that I watched two nurses perform. A nine-month-old girl had come in for a sick visit, and Dr. Villareal suspected that she might have a urinary tract infection. However, because there was no way to get her to pee into a cup for a urine test, the nurses had to use a catheter. Honestly, it was kind of horrifying to watch — her mother had to pin down her arms while one nurse held her legs and another nurse numbed her and inserted the tube. On top of that, it took multiple tries to properly insert the tube, and the baby was crying and screaming the entire time. The nurses finally succeeded, but overall it was very uncomfortable to watch; however, I’m glad I did so I could experience the procedure. The poor girl also had to get her blood drawn (sample results included in pic).
Other than that, there were just a lot of well and sick checks. I think at least half of the sick visits ended in a strep test, with a couple being positive. We also saw a few newborns — seven days old and four days old — and I learned that babies actually lose weight in the first few days after they’re born because of fluid from the womb.
Lastly, there were a few more cases of troublesome parents/patients (nothing new there). There was one mother who insisted on seeing a neurologist for her son’s panic attacks, even though all the doctors and nurses had tried to tell her that a psychiatrist would be much more appropriate. She tried to call the neurologist herself, and lo and behold, they refused to see her. She then approached the pediatric office again, only to be refused again. There was also a 17-year-old patient who had suddenly requested to switch from pills to liquid after seven years of taking the same medication. (Dr. Villareal was certain it was because he wanted to do something malicious or abuse the drugs.) It showed once again the difficulties that doctors have to deal with on top of the already challenging process of checkup and diagnosis. I’m excited for the rest of my time here!
Raleigh’s finest: Southern Dermatology!
At Southern Dermatology today, I was put to the task as an intern by helping around with menial tasks around the office. This morning I helped send lab reports down to triage (where the workers would assess the patients problems and assign treatments to them), helped receive samples from the supply cabinet, and I even let patients know that Dr. Boyse was with another patient and that they’d be attended to in no time. I truly became familiar with the place that Dr. Boyse was happy I could participate in all the activity, making me feel like a true medical assistant. Throughout the day I stood in on many Botox procedures and skin exams; hopefully I will be able to see Mohs’ surgery with another Doctor. Once again, I had a lot of fun learning through modules, listening to Dr. Boyse explain common skin diseases, and eating the delicious Italian lunch we had today! Tomorrow is my last day at Southern Dermatology and I’ll be sad to leave because everyone was very inviting, willing to answer all my question no matter how confusing it may be. I can’t wait for the last day because I know it’ll be the best one yet, so I can’t wait for it!
Day 4
Today, I was still at the UNC Hematology and Oncology Clinic, which they nickname Rex Hemonc for short. Today was pretty normal, nothing out of the ordinary, but I did see a woman with blood clots in her calf. Most other patients were just new hematology patients, or just follow ups before they went for their treatment.
One case that stood out was this man with cancer who didn’t speak any English. We had to get a Chinese interpreter on the phone to translate for us. I speak a little mandarin, but definitely not enough to help translate! It was pretty cool to see how the doctors are so willing and ready to help all their patients, no matter their language or age. They also don’t discriminate based on the patient’s ability to pay, and they even have programs that help patients cover treatment costs.
Other than that, most patients were just referrals from their primary doctors who had an abnormal blood count, and the doctors just wanted to rule out cancer as a suspect. I’ve realized how scary the word “cancer” is in society, and I am guilty of this as well, but with modern medicine and technology, I’ve realized throughout this week that cancer is not always very severe. Many cancers have upwards of 90% cure rates, which is pretty amazing considering how complicated and different each cancer case is.
Fun Facts:
- Women who take estrogen-containing birth control are 4 times more likely to get blood clots
- Pet scans use radioactive liquid to show where tumors may lie in the body.
- The kidney, brain, and bladder all light up a lot on pet scans.
- Alex Trebek is in remission from Stage IV pancreatic cancer (yay!)