James Week 1

6/13/2011:
The day began with a brief orientation which introduced me to the complexity of the hospital layout, it was practically a maze with no exact maps/blue prints anywhere or common directories. After understanding what was needed of me for the summer I met up with my clinician Dr. Leifer. Dr. Leifer is the director of stroke and graduated summa cum laude from Harvard medical school. I sat in the corner of the room while he met with out patients and new patients (6 patients all together), almost all the patients he saw were either post stroke or had symptoms of stroke. I took many notes during this time and actively listened to each case (which subsequently gave me headache). It was very interesting to see the full body test and general symptoms for a stroke. For the most part the vocab was understandable since everything had to be understood by the patients. A case presented itself to Dr. Leifer which he has not seen before, the patient was given percocet for migraines which is not a good thing, the patient was also taking 5/day and came into the office wanting more. Dr. Leifer saw that he was addicted and had to subtly try and persuade him to take a different medication. After seeing patients he gave me a book to read and told me about my research project, experiments that deal with how certain medications affect platelets.
6/14/2011:
Today I awoke at 6 AM to be ready for rounds at 7:30. At rounds I met with Dr. White the attending and 8 of the residents on the neurology team. The first part of rounds is a sit down with the attending and all the residents going through most of the new patients one by one and then dealing with the patients that had any problems the night before. During this portion it was very hard to keep up with notes, mostly due to the amount of jargon they used for symptoms and diagnoses. It was astonishing how the residents memorized everything about their patients even though they each had 10 patients. The format was - name of patient, age, complete history, why they were in today/symptoms, resident explanation for the symptoms, medications they are on, and what tests they have had or are signed up for. Then the attending will put in her diagnosis based on all the information just given to her. Next we went to Morning Report. This is held in a large conference room with everyone from the neurology department. They look through specific cases that are hard to understand and would be good for others to learn from. The patients radiology records are put on a large screen and each patient is discussed and the heads of the department tell us their thoughts. After Morning Report we did clinical rounds, going to each in patient that we discussed and making sure they are OK. They also are told what the next step is going to be such as tests that need to be done, medication they may need, or images that need to be taken. The last trip for rounds is radiology, in the dark room we sit down with the radiologist and go through each patient getting his professional opinion on the images. This is probably my favorite part of rounds because you can actually see where the problems occur and the differences in the brain, the resolution on these images is just astonishing. After rounds I tried to meet up with my clinician, though he had a lecture to give that I was able to sit in on. It was a great lecture about current stroke diagnosis and treatment.
6/15/2011:
Today I went to rounds again, same as yesterday. During today's rounds there was a very interesting case with a patient that had large cancerous cysts that were filled with a fluid that needed to be drained. The interesting part of this case was although these cysts were about the size of the patients left frontal lobe s/he still retained cognitive function and most motor control. My colleague was actually able to see the surgery which was very interesting to see how the patient was from the time of admittance all the way through surgery and recovery. Next was grand rounds; this is a more formal lecture of a neurological disease, more science than medical. Today's grand rounds were on Parkinson and new target proteins. After rounds I met up with Dr. Leifer for out patient clinical.
6/16/2011:
I started with rounds, but had to leave early to go to a required ethics course. After the course I returned to see my clinician and he met with two patients. I then went to the mandatory conference for summer immersion students.
6/17/2011:
Today I went to rounds and saw an interesting case of endocarditis which caused multiple emboli strokes which were easily seen on the brain MRI. I tried to start my research project, however, everyone was extremely busy this week. I hopefully will be starting my project next week. I also look forward to seeing a few surgeries and explaining some interesting cases in better detail as I learn more of the jargon.