gossip

03/29/2011

Today is a usual day. I saw a patient from Hongkon in the morning and another in the afternoon with fellow, Kit. He said it’s the first time in his fellowship that he met with people speak Cantonese. By the way, Hit is one of the 3 fellows who will quit GI consulting 3 days later. He is happy to go back to research works and is will to teach me as a 2nd year fellow.

My job is really easy but rewarding. Kit looked through patient’s situations on the LMR---records on computers and wrote a initial note within 5 mins… Then we went to the tower---hospital ward---to see the patient. He just said hi and told the patient the necessity of upper endoscopy in Cantonese. No physical examination or history collection. He said I have to go through all the details when I see new patient by my own.

三月 30th, 2011 in | 阅读(141) | with 0 comments

First Day in BWH

03/28/2011

It’s my first day in BWH. There’re 3 fellows and 1 attending for GI consult. The 2nd year fellow is from Hongkon and he is very nice to me. He explain the stuff that they talk about to me, whenever he thinks I didn’t catch the meaning. The other 3 fellows are kind too. The attending is a little bit serious. However, when I asked a question, he just stopped and explained to me. They said, “Just interrupt us and ask if only you didn’t understand.” Unfortunately, the team will all change after 1 week. I hope the lucky will last.

In BIDMC, I was a visiting student, too. However, my account on the computer can be used to see all the results and write notes, even make orders. In BWH, my account is limited. I can’t see the images and even some whole chart. I don’t think it’s a big deal. I’m even not eager to have my own patient, because I think in the first day I learned as much as the whole month in BIDMC. Following patient is not so interesting in consult, because you just focus on one point and patient’s condition is not so changable as been considered intactly.

American hospital is different from Chinese hospital. In BWH, only the general medicine, cardiology, and oncology/BMT department have inpatients. Other divisions, like GI and nephrology, only have clinics and consults. All the patients come into the hospital as patient of the 3 major department. If they have any tiny problems like constipation or cough, consult is needed. American physicians think it’s save their time. But I think it splits the “patient” into “problems” and may cause over-consulting to patient and over-specialized for doctors.

三月 29th, 2011 in | 阅读(116) | with 0 comments

One morning in clinics

03/17/2011

It’s St. Patrick’s day, an Irish holiday. My fellow wore a green T-shirt and green socks. It’s ridiculous to wear a green hat in China. You know it.

Actually it’s my second time in clinic. The previous one is prostate cancer. Today is thorasic oncology clinic. I saw patients with NSCLC, thymoma and esophageal cancer. A more interesting case was HELLP syndrome in the afternoon consulting. Hemolytic anemia, elevated liver enzymes and low platelet count presented in a pregnancy-induced hypertension.

Let’s see how a patient go for clinic. First, the appointment is scheduled ahead of time, mostly arranged in clinic last time. Patient arrived at 9 o’clock, for example. He can wait in the lobby with chairs, TV, water and even cookies. The nurse will record the vital sign of patient, and lead him to exam room. Patients are sent to any exam room, while doctors are all working in their office and goes to see the patient later. Fellow comes first, ask about the symptoms. Then fellow leaves to talk about the patient’s situation and treatment with attending, and then they see the patient together. One doctor will spend more than 30min to explain what is PET scan.

三月 18th, 2011 in life in Harvard | 阅读(169) | with 0 comments

Happy Time!

Today we came out for trips! There’re 3 destination: Museum of fine art, Harvard, MIT.

It takes 15 mins’ walk to MFA. Using the ID card of Harvard student, ticket is free. If you pay $20 to get in, you can visit again in 10 days freely. The museum has 3 floors while we only have 2 hours. I only have time to enjoy the beauty of exhibitions in the 1st floor. I will come back sooner or later, since it’s free~

In the front of MFA there is a bronze sculpture: an Indian riding on the horseback is making a deep breathe. I think it presents freedom.

An ancient god or evil.

Art of Europe. Virgin and child.I can’t imagine how the scupltures can be so lifelike and perfect.

We took the Green Line (subway) to Harvard Square. Harvard is not like Tsinghua University. It is composed of several schools and institutes. All these components located not far from each other but there is actually traffic way across between them. The architectures are the same as Tsinghua, built up with red brick, ancient and beautiful. The church here is also amazing.

This used to be a church. Now it serves as a lecture hall and dining hall. This room is full of solemnity and godliness. There are a lot of Harvard students or graduates laid down their lives in the war. Their name are recorded on the wall.

MIT is not far from Harvard. It’s small in size but with more scientific atmosphere. It’s buildings are monstrous or weird. Maybe that’s how “the big bang theory” comes out. I saw some of MIT students were deeply involved in playing counter-strike like games using guns with sucking disc…

三月 6th, 2011 in life in Harvard | 阅读(123) | with 0 comments

Insight

It’s the fifth day in the US. I’ve got a couple of trifles to talk about.

We hema/onc consulting group consists of Dr. Frankel, the attending; Dr. Warner Jeremy, the fellow; Kevin, the resident; and we two medical student. We go along through the east and the west campus of Beth Israel Deaconess Medical Center, doing consults about hematology and oncology. Today I took the new patient’s history, did physical examinations, presented the story to my attending and wrote initial note. All done alone! It’s really a great honor to sign on the medical record of American patient. Although my note needs modification to a certain degree, i really appreciate that the fellow just put my name on the record when he cosigned my note.

In American hospital, the rank of doctor has little to do with “professor”. After medical students graduate, they match a hospital to do the residency for about 3 years. They should finish the step 2 and step 3 USMLE test to get their lisences. The nest grade is fellow, some guys who work in special department like hema/onc. At least in my team, the fellow in American is just like the consulting doctor or deputy attending doctor in China. It’s the busiest group.

I have to admit that there are some details in the ward that really advanced. For example, the stuffs used in bone marrow biopsy are all packed in a pagage, even the sterilization cotton swab with disinfectant and lidocane. The mask is with eye shield. The sharps container is just fixed on the wall of each ward. You don’t need to write down patient’s name every time but just use a metal sheet with the name and ID number on a raised surface. The clinical chart is sorted by little colorful tags: lab result, orders, medical history, etc. The totall number of residents, fellows and attendings is no more that that in China. But there is actually more computers—nearly 10—for doctors, including consulting doctors.

There is also interesting case. I’ve got one yesterday. Not only that the case is rare, but also the treatment is courageous.

She is a 61 yo woman with diplopia and ataxia. Her symptoms first began 12/17/10 when she had acute onset leg weakness and ataxia that was diagnosed first as a TIA, for which she was given Aggrenox and discharged.Her symptoms returned 10 days later, at which time she was diagnosed with BPPV and treated with the Epley maneouver and physical therapy. Her symptoms gradually improved over the next month, but in January 2011, she began having slight double vision. Three weeks ago, these symptoms dramatically worsened, and she says her gait was "gone". She could not walk, write, or read because of severe ataxia and double vision. She was found to have inflammation on CSF, and was treated empirically with 3 days of steroids for possible MS without any improvement. 2/16/11 she was transferred to the BIDMC for further management. Here, final CSF studies showed a high anti-Yo titer suggesting a paraneoplastic disorder. MRI of the breast, pelvic U/S, CT chest and torso CT/PET did not show a convincing cancer source. CA125 in blood was normal. After consultation with Dr. Posner at Sloan-Kettering, the decision was made to go ahead with laparoscopic oophorectomy with Dr. Awtrey 2/28 as the most likely source. Preliminary pathology came back today suggesting fallopian tube carcinoma extending into the tubal serosa, likely stage Ic cancer.

Unfortunately the data are not encouraging regarding recovery of neurologic function for paraneoplastic cerebellar degeneration, despite the use of plasma exchange and/or cyclophosphamide. The hope is that treating the underlying cancer and suppressing the antibody will prevent progression of the cerebellar degeneration. To that end, completing the surgical staging and using adjuvant chemotherapy may be helpful. In most of the case series, the syndrome was associated with at least stage III cancer, thus stage I cancer would be unusual.

Tomorrow is the day for Harvard and MIT. Ready for pictures! Yesterday i lost my way back. However, I run into a church. It called Mission Church. Unfortunately i forgot to take pictures. Fortunately photos on the website also can’t reveal its amazing grace. I may not go back to visit the church because it already has impressed me very much.

三月 5th, 2011 in life in Harvard | 阅读(107) | with 0 comments

the first day in America

Let me see what I have done for my first day. First I went to the BIDMC, found Ashley and got my pager and ID card. Then I was send to the fellow, Dr Warner, who is a consulting doctor for outpatients of Hem/Onc. We consulted an African American lady in the morning, and took part in a meeting in the afternoon with lunch. I asked for leave to finish the stipend thing in Kari's office. In the afternoon we just kept waiting for Dr Warner and he took us to the attending, who took us to the new patients we have seen in the morning. I left in almost 7pm and bought a short whitecoat for $21.

my first day offers a challenge. I need to inquire the patient, do the physical examination and write a consulting note on an advanced software alone. Then I will present the situation to the fellows and recheck the consulting and notes together. Then in the afternoon we will present the situation to the attending.

There is another student from Brazil. He is in his last year of college. He applies and affords the clerkship all by himself. Brazilero seems to be similar with the English, at least more similar than Chinese.

Today is my first day, so we just see the patient together. It's a 57F complaints of back pain and psychiatric problems. It turns out to be hypercalcinemia caused by breast cancer, maybe with T12 vertebrae metastasis. What's the most impressive thing is that the attending is very patient and friendly when the patient keeps saying "I'm tired","I'm hungery". She complains about no dinner. Then the doctor just walked to the workaround, found someone to get a packed food for her, and brought it to the patient himself, saying "we can't cure your tired, but we can stop the hungery." The relationship between doctors and patients is really intimate, even the consulting doctor.

Also, in PUMC the patient is destined to be inquired, physical examined and even operated by the medical ungraduated students. However, in BIDMC it's absolutely different. When we meet the patient, the first question is "do you mind if these 2 medical students stay here". If the patient doesn't want to meet the student, he will just meet the doctor exclusively.

I've just got my April's rotaion schedule, which is my first choice of April. It's in the BWH. Google map says it's only 8 mintues to walk, and i will check this out.

三月 1st, 2011 in life in Harvard | 阅读(120) | with 0 comments