Hey guys! I'm Arushi Ahuja, a rising senior. This summer I'm participating in an internship known as PennMed. It is a really giving opportunity for those who are interested in medicine and I'd definitely recommend participating in it if you are interested. Each of the four weeks are modeled after the four years of medical school, and each day there is a different focus. It offers opportunities to be exposed to the practical side of medicine before medical school.
The hospital where I am having most of my classes and labs.
Week 1 - Introductions and Basic Skills
Day 1 - 7/3/17
Today was a very exciting day filled with introductions! In the morning, we were introduced to our TAs (teacher assistants) who are all medical students at UPenn right now and Dr. L, who is a working physician and one of the directors of the program. The 109 of us are assorted into groups of 10 or 11 to one TA. Each TA leads the group in the different activities planned for each day. My TA is named Ryan and he is a rising second year medical student at UPenn.
To start off the program, we learned how to ask the basic health questions required to understand the patient's medical history. A patient's medical history consists of information relating to the chief complaint, the history of the present illness, past medical history, family history, social history, and a basic review of the systems. We also learned how to perform basic physical tests which assess the organ systems in the body. For example, we learned how to execute a sensory test using a hammer on the patient's knee (which you may recognize from a visit to the doctor).
Another basic skill we learned is how to use a stethoscope to listen to basic heart and bronchial sounds. Heart sounds can be heard in the middle of your chests at two points known as S1 and S2. S1 is the louder beat because there is more blood being pumped in that area (it is found in the top of your chest). Bronchial sounds can be heard at the base of your neck (near your collarbones) and on your back.
It was really interesting to learn how to perform these tests on the very first day and I'm definitely intrigued as to what else we are going to be taught during this internship.
Day 2 - 7/4/17
Today we had a small break to go to downtown Philadelphia for July 4. Nothing medical, but it was nice to socialize and explore the city that we are going to be living in for the next four weeks!
Day 3 - 7/5/17
Today was a very fun and interesting day! In the morning, we had a lecture given by Dr. Benjamin Abella, who specializes in cardiac disease, about cardiac arrest and the necessity for CPR. He talked about how there are differences between cardiac arrest and heart attack - mainly that a heart attack is a pumping problem (usually triggered by a clogged artery) and that cardiac arrest is an electrical problem. Because cardiac arrest is an electrical problem, the time frame in which aid can successfully be delivered is very small. The necessity of CPR and the use of the AED is crucial for survival because they give the heart the strength it needs to keep beating. This lecture was especially interesting because as juniors in health we were CPR certified and Dr. Abella was essentially lecturing about the need to be CPR certified. It was very interesting to get a background on the training that I have already received.
The afternoon was the most interesting part of the day. We learned how to do a phlebotomy (how to draw blood), which is used whenever anyone has to get a blood test or is admitted to the hospital. It was really fun because we got to actually do a phlebotomy on a fake arm. The arm had veins bulging out and there was fake blood (made from corn starch, water, and red food coloring). We learned the exact process of drawing the blood from the arm.
We also learned how to take the blood pressure and heartbeat using the instruments. We paired up and we took the blood pressure and the heartbeat of our partners using the stethoscope.
Overall, today was very eventful and I'm having a wonderful time getting exposed to the practical side of medicine!
This is a picture of me doing a phlebotomy (drawing blood) on a mannequin.
Day 4 - 7/6/17
Today we did urinalysis. Urinalysis is the study of urine for chemicals and drugs which relate to other problems in the body. The urine is tested using a testing strip, similar to how liquids are tested for their pH levels. The strip has colors that indicate whether the levels in the urine being tested are normal.
We then analyzed fake urine and tried to match the urine to different real life situations.There were three tests that we gave each sample of fake urine: visual, chemical, and microscopic. The visual test is just a vague estimate as to whether the urine is normal or not, the chemical test tests for glucose, blood, and specific gravity (salt concentration) levels, and the microscopic test tests for whether there are blood cells or crystals in the urine, which would typically indicate a UTI. It was pretty interesting as to how much information could be deduced from urine.
Day 5 - 7/7/17
Today, for the last day of the week, we visited the Franklin Institute. It was mainly designed for kids, but there were a couple exhibitions that were interesting such as a real brain connected to the spine and blood cells flowing.
Aside from the visit to the museum, we toured the ICU and Emergency Department at the Hospital of the University of Pennsylvania. At UPenn, the ICUs are specialized by department such as the pulmonary ICU, the cardiology ICU, and the neurology ICU. We got to talk to a specialist from the pulmonary ICU about the kind of work that he does and the kinds of situations he has come across. The Emergency Department was also really interesting because patients were being treated in front of us. The person who toured us was a fourth year resident, and she mentioned that she got to experience different kinds of medicine at the same time in the emergency department, which was really interesting.
This week was a great introduction to both the program and medicine and I'm so excited for the coming weeks!
Week 2 - Specialties and Subspecialties
Day 1 - 7/10/17
Today was the most fascinating day yet! We got to see the chest cavities of 4 different cadavers (corpses donated for medical purposes). Inside the chest cavities we got to see the placement of all the major organs such as the heart, lungs, liver, diaphragm, kidney, and spleen. It was really interesting to see the relative connection between the organs. We got to follow the entire digestive system in the abdomen and we learned where all the major veins and arteries were as well. More than the observation itself was the actual feeling of all the organs. We got to hold an actual heart which was honestly the most mind blowing moment for me. The heart was actually the size of my fist and I got to feel how exactly the heart is a muscle. It is amazing how such a small organ is responsible for us to continue living! We also got to observe the different parts of the heart and we saw the main coronary artery that is responsible for a lot of heart attacks. Many heart attacks are a result of the lack of blood flow (because of plaque build up in the coronary artery) to the left ventricle, which is responsible for pumping blood to the entire body. It was so cool to see these different organs in real life as opposed to diagrams for the first time! I'm also very grateful that I've been given this opportunity because many medical students do not get to see the inside of a human body till they dissect cadavers in medical school.
The second part of the day was a trip to the Mutter museum. The Mutter museum was created by the College of Physicians of Philadelphia as a way to preserve interesting artifacts relating to the human body. Dr. Mutter, for whom the museum is named after, collected more than 1200 artifacts from diseases and this museum has all of them on display. It was really interesting to see the evidence of the different types of diseases. One particularly interesting case was the one of the first documented pairs of "Siamese" or conjoined twins. They were joined with skin around the liver area and they spent their entire lives conjoined.
Today was a wonderful start to the second week and I can't wait for the rest of the interesting things planned for the rest of the week!
Day 2 - 7/11/17
Today we started the day off with a series of lectures. These lectures were not related to current medicine but to applications of medicine. We learned about how medicine contributes to forensics in the form of identifying skeletons. Although this sounds quite morbid, there are several characteristics that betray the age (within 10 years), sex, ethnicity, and stature of the skeleton that is being analyzed. Some interesting facts I found were those relating to the sex of the skeleton - although females tend to have larger hips (for childbearing) men actually have the wider pelvis structure! In fact, what does change because of childbearing is the inner diameter of the pelvis in women. It was quite interesting to be taught how to understand skeletons (although I genuinely hope I never have to do so in real life :) ).
We also learned about radiology and the different scans that are performed to detect problems. These scans include the MRI, CAT, PET, CT, and ultrasound scans. Each of these scans is done using a different method whether it is through magnetic waves (MRI) or sound waves (ultrasound). These scans make it easier to see problems in the body because cross sections of the organs are seen. Each of the scans are very helpful in accurately diagnosing patients and are therefore used by almost every department.
The second part of the day was once again spent with the cadavers. Today we spent more time focused on the nervous system, the skeletal system, and the female reproductive organs. We got to see and touch the spinal cord (which is the bundle of nerves in between the vertebrae of the spine) and the brain itself, which was amazing. I was blown away by how I could feel the tissue of an organ that controls the behavior and the personality of a person. We also got to see the basic nerves (the radial, medial, ulnar nerve) that control the motor skills of the arm. We got to actually see the nerves that you can even trace on your arm in the cadaver, which was slightly unnerving but very cool. Some other fascinating parts of the body that we got to see were the femur (bone in the leg) and the important parts of the female reproductive system such as the ovaries and the fallopian tubes.
Overall, I enjoyed my experience with the cadavers even though I was a little nervous to be seeing the organs of a person who was alive at one point. The heartwarming thing about the cadavers was that the people themselves consented to be cadavers and donated their bodies to science. These cadavers are used to study the relationship between organs and it is really important that we continue doing so to figure out solutions to new problems that arise.
Day 3 - 7/12/17
Today we had a series of lectures relating to seizures and other basic procedures before actually getting to attempt the procedures. The talk about seizures was actually quite eye opening, because the doctor explained to us that even a small lapse in speech and movement can be called a seizure. Many seizures are not the typical lack of movement and speech. Seizures themselves are categorized into three main categories: focal, generalized, and unknown. The focal seizures are those that are affected directly by a lack of a signal in the brain. These are the seizures during which patient may still be aware. The generalized seizures become slightly more difficult to control because the entire brain is experiencing the lack of a certain signal. The unknown seizures are those where it is hard to tell whether the brain is affecting the seizure at all. All three types of seizures do not necessarily have to include a lack in control over limbs. The main characteristic is that seizures are sudden and temporary. I was very intrigued to learn all of this because I had the common perception that a seizure has to look a certain way, but this is clearly not true.
We learned how to do a lumbar puncture (spinal tap) and a nasogastric tube insertion in the second part of the day.The process of the lumbar puncture requires a small amount of CSF (cerebral spinal fluid) to be extracted, which then gets tested. The spinal tap commonly happens when testing for meningitis. Meningitis is an infection in the CSF, which is why it is important for it to be tested. The procedure itself is quite dangerous, because the needle has to be inserted between vertebrae and has to avoid the spinal cord. Thankfully, the patient usually receives a local anesthesia so that they do not feel the needle going in, but it is still quite risky because there are many nerves in that area and the smallest mistake could result in a very big problem. We got to practice the procedure on dummies, which had the vertebrae outlined and I did get to extract (fake) CSF! It was very fun.
These are pictures of me doing a spinal tap on a dummy.
We also got to learn how to insert the nasogastric tube into the stomach, usually used to feed patients who are unable to chew food by themselves. The tube is also used to measure whether there is any blood in the stomach. Testing this process out on the dummies was very fun because the mannequins did not have the bag (representing the stomach) attached and we basically stuck a tube inside the patient and pretended to hear the proper sounds that indicate whether the tube is in place. It was a fun ending to an eventful day.
Day 4 - 7/13/17
Today we had a series of lectures on the subspecialties of cardiology, pulmonary disease, and gynecology. The cardiologist gave an interesting lecture about the minimally invasive procedures that are currently being developed and used to solve problems that would typically require an open heart procedure. This includes valve replacement inside the heart. This minimally invasive technique that is now becoming popular is a lot more affordable for patients and it has a quicker recovery time as well. There are not as many risks in this procedure as there are with open heart surgery. It was interesting to hear about this procedure because heart disease is a huge problem in our society currently and many people need procedures like this to be performed.
Another doctor lectured us about the four most common types of pulmonary disease: asthma, lung cancer, emphysema, and pneumonia. It was interesting for me because I myself have dealt with pneumonia and asthma for the past few years and I got the perspective of the inner workings of my body while I'm dealing with those problems.
Lastly, we received a lecture by an OBGYN. She described her journey to become an obstetrician and then explained some major procedures she has to perform on a daily basis including delivering babies. She also described how being an OBGYN allows her to have long term relationships with her patients, which she found very satisfying. This lecture was really intriguing for me because it is a specialty that is generally frowned upon but she explained how it is very rewarding to see women with their babies and it is generally a field where there is a lot of happiness as opposed to other specialties where there is a lot of tragedy. I found that aspect of it really inviting.
Day 5 - 7/14/17
Today was a simple, but very fun day. In the morning we learned about infectious diseases and watched an episode of "House" that dealt with a type of infectious diseases. Following this, we had a lecture about HIV and the different treatments that are being discovered to eventually get rid of HIV. The doctor explained how HIV is still a very big problem, especially in developing countries and how it is important to raise awareness about it. It seemed an interesting field to look into if research is a passion because there is a lot that is still unknown about HIV.
The afternoon was the best part of the day. We learned how to use an ultrasound machine and used it to see our own organs, which was very cool. We used the machine to see the heart and we actually saw the blood going in and out of the heart. We also saw the thyroid gland and the kidneys. Seeing the organs actually working and doing their jobs was really cool because we had seen the organs on the cadavers earlier. It was very interesting to draw the comparison between them and it was honestly very mind-blowing to see the heart actually working in the human body. Seeing these organs in both states was the best part of this program so far and I am really grateful that I've been given this opportunity.
Week 3 - Surgery or Psychiatry?
Day 1 - 7/17/17
Today we were introduced to the fields of psychiatry and surgery. We were lectured about the field of psychiatry and the different ways in which psychiatrists diagnose their patients. Psychiatry involves a lot of observation and it is not very hands on. The doctor explained how there are four main categories in which diseases occur: mood, behavior, cognition, and psychosis. He explained how observing, rather than talking, reveals a lot about the patient. For example, say a patient comes in with a neat and clean appearance but a somber tone in their voice. Their diagnosis would involve mood in some way, because a clean appearance would generally correspond to a content person. Every disease that the psychologist diagnoses is connected to the signals in the brain and it was interesting to learn about what observations can reveal about the inner workings of the brain.
In the afternoon we learned how to do basic stitches and sutures. These stitches are commonly used when healing a deep cut but some of them are also used during surgery. We received small slabs of foam (representing the skin) and needles with nylon thread, which is actually used when stitching up patients. It was really fun to practice the different stitches and gave hands on insight into surgery.
Day 2 - 7/18/17
This morning we learned about adolescent development and plastic surgery. The lecture about adolescent development was very interesting because the doctor was essentially talking to us about our own development. He explained how the portion of the brain related to risk taking and complex connections is developed during the teenage years. It was a very intriguing to hear about my own brain's development and imagine the stage at which my brain is at right now.
We also had a lecture about plastic surgery this morning. The plastic surgeon told us about how plastic surgery as a field actually extends beyond cosmetic surgery and involves reconstruction, which is the process of replacing tissue using viable tissue from another part of the body. He showed us some (graphic) pictures of patients who have needed surgery to replace tissue and also explained how the tissue used to replace tissue is usually from an area where the tissue is not as required, such as the thigh. There are not as many veins and arteries in the thigh so it is easier for the surgeons to manage the transfer. The procedures are very difficult and they require a lot of time and effort, which was evidenced by the fact that the doctor himself had a 15 hour surgery and had stayed up till 4:00 doing surgery before he gave the lecture to us.
In the afternoon we tried our hands at a small test used to clear surgeons for performing minimally invasive procedures known as laparoscopy. This procedure involves small cuts in the abdomen and tools are inserted to perform the surgery without actually cutting the patient open. Because of the limited vision surgeons have while performing these procedures, they have to clear a test where they transfer small toys from pegs to other pegs within 48 seconds using small tools. We were given the chance to try to do it as fast as we could, and my time was 2 minutes. It was very fun because we competed against each other to see how could get the fastest time, which was 1 minute 15 seconds. I really enjoyed the exercise and it was really fun to use the instruments that surgeons use while operating.
Day 3 - 7/19/17
Today was so exciting because we got the opportunity to watch a live surgery. The surgery was the whipple procedure, which is performed when there is a problem in the pancreas such as a cyst and it is hindering the function of the gall bladder and sometimes even the small intestine. The procedure involves removing the gall bladder, part of the small intestine, and part of the pancreas. The surgeon who was performing the procedure was very experienced in the procedure, which is rare because the procedure is very difficult. The patient himself had had his gall bladder removed from before and the surgeon removed part of the pancreas which had a benign tumor. It was so cool to see the surgery up close and we got to see exactly what the surgeon's view was because we were watching on a tv that broadcasted the procedure from a camera hooked up to the light in the operating room. We saw every single incision and cut and got to see the pancreas with the tumor that the surgeon cut out. It was amazing.
In the afternoon we watched the movie "A Beautiful Mind" starring Russell Crowe. The movie was about a schizophrenic math genius who had to deal with the hallucinations that go hand in hand with schizophrenia. It was really interesting to watch it because we got to watch it with a medical sense and actually identify his symptoms.