What stood out about your MEDI 475 elective (Heart Failure/Cardiac Transplantation)?
When I started my electives, I started with Heart Failure. I thought of Heart Failure because of the fact that the most hospitalizations in this country are diagnoses of heart failure. So, heart failure has the highest number of patients admitted, and that’s why I thought this would be a great elective to go to, and it was definitely amazing.
You see patients with really bad heart failure and you learn about so many new technologies, which honestly I hadn’t seen so much in my own country. You see a lot of patients who have LVAD, or patients being evaluated for an LVAD, you see a lot of heart transplant patients, and you will see them on the daily. You sort of see this whole range of patients starting from when they just start developing heart failure, to the point where they’ve gotten a heart transplant and they’re trying to manage infections, etc. So it’s a whole different range that you’ll be looking at, and going and talking to these patients everyday.
I actually got the chance to go and see an LVAD surgery, which I had never seen before, and it was really cool and it’s a LIFE SAVING surgery, it’s a life-saving technology which is not so common in a lot of parts of the world I’d say. It was amazing to see how patients were being evaluated for it. You’ll also be going to these weekly transplant meetings which are amazing in themselves, because every Wednesday morning you have this group of amazing medical professionals- not just doctors, attendings, fellows and residents, but you also have you know nurse practitioners and psychiatrists and social workers- and it’s amazing how all of these different groups of people come together for the care of these patients. We also have pharmacists who round with us and give advice about the drugs and what effects they might cause and what would be a good dose depending on that particular patient- which honestly, that was very new to me That’s something which is very different from where I am from.
I had this one patient, a very young patient- a young mother, and she had really bad heart failure. And the important thing about her was that she had a lot of compliance issues. She was very iffy about a lot of things, she was questioning about the medicine aspects of her treatment, about side effects, and she was just an all-around anxious person which is pretty normal for someone who is so young and has such a grave disease, so I can understand that. I followed her throughout the month, as she was admitted, to where we identified what was wrong, and so every week we would sort of talk about her in the meetings, and we finally got to a point where we decided to do the LVAD surgery for her and that was a really happy moment for me because I had been with her and I had become so close to her. I had become so close to her family, and every time we’d meet we would hug and she’d be like “You’re my favorite doctor!” and they were just really adorable people- amazing to talk to. And I would spend hours after my rounds in the evenings just sitting with her and drawing out heart diagrams and explaining to her what this does to the heart. So I was really glad that I could see her get the LVAD, have the surgery- and I saw that surgery. Then she came out fine and she got discharged and I was really happy that it turned out really well for her, and hopefully she makes it for a heart transplant which would be the goal for her. So, you see patients for such a long time and you will form bond,s and you will want good things to happen to them, and I think that’s definitely something that you should look out for. It will help you with your communication skills and how to interact with patients and sort of get comfortable with them and make sure they give you good history and not miss out on anything. So, doing more of that I think will help you become a better doctor.
What stood out about your MEDI 414 elective (Pulmonary Medicine)?
My second elective was Pulmonary Consults. I was thinking since it’s a consult service, we would only be consulting on patients that are already admitted and we aren’t really admitting new patients ourselves- I thought this would be a very light elective. But thankfully for me, it was a really HEAVY elective. It went on from like 8:30am-8:30pm. I wasn’t expecting that from consults, but it was like that. There were times when I’d come back at like 10pm, and it has been absolutely worth it. I’ve seen THE MOST complicated cases of lung diseases, like ever. We have seen patients who have lung disease, and you get to see how lung disease sort of integrates with heart disease quite often. A lot of them having lung diseases and sort of going into heart diseases- that is the clinical history for a lot of them, and on top of that they would have multiple surgeries, infections, pneumonia, etc. At the same time you’re looking at whether it’s the heart, or lung, or maybe it’s a mix of both- and for me that was an amazing experience because I got an overall picture of both heart and lung. Patients were so complicated with so many infections and volume overload and you had to basically decide what it could be and just sort of think, what investigations would you think of- and then follow up with them again and again. So, in that way, Pulmonary Consults was really amazing. I felt my attendings and my fellow were so great. They tried to involve me in everything. I wrote so many notes and I sort of really got in touch with my note-taking skills during my second month.
What advice would you give to students applying to these electives?
- I think for UNC, it’s important that you apply early. So, make sure 6-7 months in advance, make sure you send it out and that everything is perfect. But, the people are very helpful- even thorough the entire application process, even if you’re having problems. Rawley was very helpful, and she will help you with everything and has been amazing throughout the whole process.
- I think if you want to work in the American medical system, you need to kind of learn to integrate yourself and you need to know about and understand the whole electronic system. Back in my country, it’s half and half. We have some stuff which is online, but at the same time we have a lot of stuff which is on paper. Residents will still sign out and write daily reports on paper. But here, you’ll see that whether it is adding a new drug or changing a dosage, everything happens online- everything happens on a computer. So, you need to learn to sort of adjust yourself to that system if you’re planning to join the American Medical system, and I feel like in Heart Failure I got to understand that a lot better and know how the system flows.Note taking is definitely something you need to know if you’re thinking of joining the American Medical system. Make sure to ask your fellows, residents, whoever is observing you- ask them about how to write a good note. Don’t just write it and leave it, but ask them for feedback, as them to read it for you. I think that’s how you learn, and that’s a lot of what I did during my second month and I’ve become better and better and writing all kinds of notes.
- When you come here, you will meet so many people from different countries who are also doing this elective with you and I think it is so important to meet with them and talk with them and try to get different perspectives, because they all bring something extra from their own backgrounds, and I think that’s one of the things you should definitely look for and make use of.
I really liked both of my electives, and they gave me two different experiences, but were both really enriching. I definitely feel like I am more ready to join the American medical system. My skills in terms of note taking, history taking, and examinations have really gotten better because I have had amazing residents and attendings and fellows who have always been so forthcoming and very willing to teach. So in that way, it’s been really amazing!