Jul 21, 2011

New York New York: Pediatric Hematology/Oncology

It seems only proper I talk about my electives here just in case people get the wrong impression I'm here just all play and no work. I applied to 2 pediatric rotations in New York-Presbyterian Hospital, teaching university of Cornell and Columbia University - my first two weeks with pediatric hematology/oncology and second two with adolescent medicine. Don't ask me why these three - they are a combination of self-interest, unavailability of similar courses at where I trained, and location.
New York-Presbyterian Hospital (NYP) is one of the proud tri-instutitions, situated at Upper East Side, that forms the glamor of Weill Cornell Medical College, the other two being Memorial Sloan-Kettering Cancer Center (MSKCC) and Hospital for Special Surgery (HSS). Residents and fellows essentially share these three hospitals - you can see all their various name tags and badges showing the different typography and design around their necks.

This is what greets you when you enter 68th Street on the 6 line. If you think subway stations in Kuala Lumpur are filthy, this might redefine it.

Upper East Side or UES is a very affluent neighborhood. We have St. Patrick's Cathedral, Sotheby's, Frick's Museum, American Art Society, and Rockefeller University all within walking distance. All 3 hospitals occupy a large space from 72nd to 68th - 4 blocks essentially, overlooking Roosevelt Island. You'll know you're in hospital territory when you see people wearing blue or green scrubs walking around seeking food or coffee.

Being in an affluent neighborhood and in New York has its perks. NYP is one of very few hospitals in New York in the black, one of the top ten hospitals in the US, and one of the best children's hospital in the New York area. Next door MSKCC is famed for its cancer and transplant techniques, which unfortunately I have little interest in. HSS is known for its orthopedics.

As one walks through 68th street you'll first be greeted by MSKCC in its red brick facade. My Romanian colleague says it looked like a factory. I personally think it reminds me of Nazi Germany. MSKCC's interesting history dates back to Nixon's War on Cancer and our naive believes in the 70's that cancer, like common cold, could be "cured". I recommend reading Siddhartha Mukherjee's The Emperor of All Maladies: A Biography of Cancer.

Further eastward NYP greets you with its slogan "Amazing things are happening here". Unlike Taiwan, where hospital lobbies resemble a luxurious Shangri-la, it's a humble yet functional common space where thousands pass through each day under the names and portraits of affluent donors. Clinic and office spaces overlap considerably, ancient elevators zip up and down 30 floors, coffee pots and laundry, patient and clinicians, Rolls Royce and wheelchair all come and go.

My first rotation here working under Dr. Bussel

Given the multicultural background and global patients they receive, lingual communication becomes an important issue. The hospital provides free interpreter services to patients who cannot speak English. During my stay there I acted as a Chinese interpreter (with some medical knowledge), and had patients speaking Bengali, Spanish, Hebrew, and Polish.

Some may imagine hematology/oncology as a sad place with dying patients and despairing families. The inpatient might be so but definitely not the outpatients. Some children with chronic hematologic diseases are so well-managed they are a picture of perfect health. The only difference is they have to come every once in a while for some infusion or medications - spending as long as 6 hours in the solarium watching TV and eating free ice creams every Mondays, Wednesdays and Fridays.

The exam and interview rooms are equipped with basic sphygmomanometer, otoscope and ophthalmoscope, a (very slow) computer for the charts, and lots of room for family to walk about and talk about almost anything.

Medical care costs a bomb in the US, but it is also of very good quality. Doctors see an average of less than 7 patients each session (morning or afternoon), and so they get to spend up to 30 minutes with every patient. Besides addressing their medical issues, some clinics are simultaneously attended by social workers, physical therapists, and dietitians - integrating wholesome care into a single session.

Dr. Mitchell

I witness the integrated clinics of hemophiliacs with Dr. Mitchell. It was an eye-opening experience attending a pre-clinic round - where everyone is briefed on the 4 patients coming in tomorrow, the nurse-social worker-fellow-physical therapist-attending sequence interviewing patients, and a debriefing round at the end of the day. Essentially, the patient gets an update about his medical condition, a social worker addressing his everyday issues, a therapist to help him cope with pain or disability, and finally the attending physician summing it up for him and helping in making decisions. For the medical team, we get a complete history and ernest communication with all the meetings, and needless to say, a better understanding of the patient's non-medical conditions - which plays an important role in adherence to therapy and drug compliance.
This week I'm starting adolescent medicine, working with teens with obesity, pregnancy, eating disorders, and HIV/AIDS. Similarly it overturned my previous assumption that teenagers are uncommunicable, reserved, and difficult; they turned out to be bubbly, chatty, and open-minded. We'll talk more about that next time.

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