Weill Cornell Medical Center, New York, NY
This summer I was a Research Associate (RA) volunteering in the emergency department at NewYork–Presbyterian, Weill Cornell. The department conducts an array of clinical studies, and I had the role of identifying eligible patients who came into the emergency room as well as enrolling them if they qualified. In addition, I also worked to help patients with any general needs, whether that meant getting them water, finding their nurse, or making arrangements for them to have a night-duty nurse.
The eight clinical studies, which the RAs were responsible for, are truly wide-ranging. For example, one study identifies older patients who come to the emergency room because of an accidental fall and looks to compare their injuries to injuries of a separate cohort of victims of elder abuse. As RAs, we not only interviewed the patient through an extensive survey but also photographed visible injuries with the consent of the patient. Another study looks for patients who have ankle and foot injuries and asks them to participate in a telehealth exam in addition to their in-person one. This study aims to assess the success of patient diagnosis through a video chatting interface. As RAs, we guided the patient through both exams and followed up with both doctors to compare diagnosis results.
Some days the ER presented a hectic portrait: nurses and PA’s scrambled around the attending doctors, while the attendings scrambled around to patients. On these busier days, I often only had a few moments to inquire the staff about a patient. But other days it was less so: the nurses seemed more relaxed and the attendings had more time to chat. Nonetheless, the overall environment was always conducive to volunteers and pre-med students who wanted to experience a clinical setting in real time. Many were supportive of our endeavors and were open to answering any inquiries.
Dr. Steel was one of the attending physicians I got to know quite well. I had initially bonded with him over the fact that I had just finished my year abroad at Oxford (through the Williams-Exeter program) because he too had attended Oxford as a medic at University College. As a result, when I was not on shift he allowed me to shadow him. The most noteworthy thing I admired about Dr. Steel was his attitude towards his patients. He always saw the patient as an individual more than just their condition and adeptly intertwined casual conversations into his diagnosis to make sure the patient felt comfortable and relaxed. Furthermore, he reassured patients of their care and provided them credibility.
As I became well accustomed to my duties I also started finding additional ways to help patients, including approaching patients to answer questions or to simply keep them company. Interacting with patients in such ways other than for recruitment purposes helped me understand better the personal frustrations and concerns patients were having. Initially, my general and extremely vague impression of patients was that they were impatient individuals. This was because I had overheard many conversations in which nurses or other healthcare workers would complain about a patient constantly nagging for results or for discharge paperwork. However, spending more time with the patients and seeing the process from their perspective helped me create my own opinions about the matter. I realized it was not necessarily the length of the wait time patients were concerned about. Many patients were understanding of the fact that there was an order to things, that many other patients needed to be helped simultaneously, and that in an emergency room as large as ours a queue was inevitable. However, patients felt anxious and exasperated when they felt they had no control over their health. Many were not told an approximate wait time for results, nor told why they were waiting at various points of their care, or when they could expect to see a physician. Therefore, many found themselves waiting for hours on end behind a curtain of uncertainty.
My most memorable patient interaction was a very frail older woman who—I later discovered during our conversation—was a former vocal coach on Broadway. As I was walking past her room, she had called me over with a very troubled expression. She had just found out she was going to be admitted to the hospital overnight and was afraid to be left alone, but moreover, extremely worried that no one would be there to care for her if something had happened. She had a health aid worker by her side but the health aid was clearly apathetic and was also leaving around 8 p.m. that evening. Prior to me, she had spent hours trying to flag down someone to inquire about her situation, but had failed to stop any one of the nurses that continued to briskly walk past her room. I reassured her that her nurses would check in on her more frequently once the ER became less busy into the night and that they were always monitoring her status through the computer system. Understandably though, this only provided her some comfort, and she followed by asking her health aid if she could call her friend. To my frustration, the health aid refused to let the patient use her phone and deferred her reasoning to there being a lack of cell service in the building. At this point, I felt uncomfortable because I could feel the tension in the room, but I pulled out my phone and dialed the number the patient gave me. The health aid rolled her eyes and walked out. Nonetheless, I was able to contact the patient’s friend and we collectively worked to get the nurse the patient needed. By the end of the two-hour period I had spent with her, we were able to find a nurse and the patient endlessly thanked me, even offering to give me professional singing lessons free of charge. Even through a simple task, the patient’s worries had been dispelled and she was no longer afraid.
Through the program, I learned a lot about the logistics of running clinical studies: the standard operating procedures that entail, how to gain an individual’s consent, how to approach doctors and patients, and how this all fits in the broader scheme of improving healthcare. Identifying eligible patients required that I understood how to read the patient board and patient medical records. Therefore, I became familiar with various medical abbreviations such as DVT (deep vein thrombosis) or SOB (shortness of breath) and learned to read medical exam results. However, direct patient interactions like the one described above were experiences that truly solidified the notion that I was working in a healthcare setting that required me to insert myself directly into the hub of patient care.
In high school, I first had the opportunity to do wet-lab research with Dr. Tim Greten of the Thoracic and Gastrointestinal Oncology Branch at the National Cancer Institute. I was able to extensively learn about immunology and the specific techniques widely used in the discipline. The following year, I worked with Dr. Gregoire Altan-Bonnet of the Cancer and Inflammation Program at NCI, and was fortunate enough to make a contribution to a Molecular Cell publication. Last year, I volunteered at the Mansfield Kaseman Health Clinic where I worked as the assistant to the executive director and as a receptionist. However all those experiences were much more peripheral than this one at Weill Cornell.
Thus, as a student aspiring to become a practicing physician, this internship was a great opportunity for me to participate in a setting I saw myself the most in in the future; and I wish to thank my alumni sponsors and the ’68 Center for Career Exploration for this experience.