Monday, April 16, 2007 at the University of Michigan’s Otolaryngology Dept.
Today I was paired up with Dr. Bradford. She had just gone on a Spain trip where she apparently had a blast! She loved every minute of it, except the windy weather. She even brought back treats for the clinic (apparently the staff eat there all day!). Anyway, Dr. Bradford is a Head and Neck Cancer Surgeon. I saw a total of four patients; three of them have already received surgery and were just on his 6-month or annual check up.
An older man sat in the adjustable chair with his wife sitting in a nearby chair. Dr. Bradford gave him a thorough exam to make sure that the cancer hasn’t come back. What is even more exciting is that he has made it through 5 years without any complications! A nurse went and got the “5 Year Survivor” pin for him to wear (he was very enthusiastic and happy about that).
The second patient was a younger man who had cancer on the back of his tongue. The surgery left his back third tongue darkened AND the ability to make saliva. Who knew that saliva was such an important thing? During surgery, one of the surgeons couldn’t save his saliva gland. However, the couple said that was a small price to pay since the man was still alive and healthy. The only thing he has to do was to carry a bottle of water everywhere he goes (and of course, drink a sip every 70 seconds or so). This couple showed me that it can truly make a difference to find a way to make life to its fullest (instead of feeling like life isn’t worth it anymore and moping about it).
The next patient was another check up after her surgery. Dr. Bradford looked at her eyes, nose, mouth, and lastly, the ear. This older woman had cancer on the upper part of her ear so Dr. Bradford had to remove part of her ear. Dr. B tried to make the best of things by saying to this woman that her hair blended in and people couldn’t really see anything different (too bad that means she always has to have a hair down, but I guess you have to make the best of everything in order to save your life, right? Everyone believes that they will do great things, or at least have the potential to do wonderful and life changing things, especially parents of children). It surprised me to see that her upper ear removed.
I learned about Dr. Bradford’s work schedule. She has clinical time to check up on patients or diagnosis them on Monday and Wednesday. On Tuesday and Thursday, she has surgeries. On Friday, she researches cancer in the lab. This type of schedule is popular among the surgeons in this department, though some may not do the research part. Some may have Wednesday mornings as clinical time and Wednesday afternoons as surgery time (and alternate on other times). Dr. Bradford seems like a very intelligent individual who cares deeply about her patients who have Head or neck cancer. However, if there’s anything that is not within her specialty, she will push those patients away and care about them less.
For example, a patient came in and claimed that she got really dizzy when she stood up. Dr. Bradford asked a couple of questions and she automatically assumed that the patient just stood up too fast and told her to stand up slower. The patient explained that she had talked to her primary care physician who referred her to an ENT doctor. Now, I know that Dr. Bradford is a Head and Neck Cancer doctor, but I don’t agree that she should turn the patient away and say that ‘dizziness is not my specialty but I believe that you just need to stand up slower.” I assume that Dr. Bradford is really great at what she specialized in, but not too much more outside of that range. It was very pleasant watching Dr. Bradford work with patients.
Tuesday, April 17, 2007 at the University of Michigan’s Otolaryngology Dept.
Today I watched Dr. Hogikyan, who is not only a doctor, but also a voice professor at the UM, work with people’s voices. There were a total of two patients. However, they were two completely different patients (quite drastic).
The first patient is very interesting. A resident first attends to the patient (a medical assistant helped seat the patient in the rooms. The MA must also write down which room the patient is in on the pages posted on the board in the office. Each wing (there are four) has different kinds of patient. Each room even has different models of the ears, nose, and throat). But before the resident goes inside, he reviews the questionnaire and history of the patient available to him. Once he’s inside the room with the patient, he questions the patients history again, this time with the patient saying the answers because sometimes what the patient writes does not coincide with what the patient’s actual condition.
What I saw kind of stunned me (though I couldn’t act that way). An older woman had a tube with a circular thing around that padded the opening of her throat. This is what led up to this. This woman had a heart problem so she had to be put under general. After the heart surgery, the doctors wanted to take her breathing tube out. But there’s a catch! Her throat is too narrow. The doctors felt that she wouldn’t be able to breath without the tube because her throat wall would collapse. Thus, the doctors solved this life-threatening situation by putting a trac in. This saved her life. She was just happy to be off the OR table and be alive. But now, after a month or so, she wants more. Wants to be able to talk. This is the situation: there isn’t enough air in the voicebox to produce any air. The reason why there’s not enough air is because the tube in her throat is too large and doesn’t allow airflow on the outer area of her throat.
This woman came with her husband. She couldn’t talk. Of course, she could mouth things out. But in order to convey her concerns, her husband spoke for her (most of the time). Her husband obviously really cares about his wife (they can’t even sleep laying down). What made me frustrated was that the resident said that the patient didn’t have a problem, but her husband had all these complaints. I felt uneasy being in the room where it was a little hostile (since the patient wanted something more than the physician believes is good). However, after I stepped out of the room, Dr. Hogikyan told me about the situation (how it’s really great just to see her breathing and alive). Proceeding with another surgery is risky because her weakened, scarred, and thin tubes may collapse.
The next patient was very different. She’s actually a professor at the University of Michigan. She felt that her throat was scratchy. So this was what we did. We went into a special voice room (you even have to punch in a password). Inside, there’s a small keyboard, a computer, a TV that’s hooked up to the lighted tube (with a camera). Now, this camera is amazing! You can see the vibrations in her voice box as she sang different pitches. The vocal ‘folds’ (since they really aren’t chords) bloat up to allow the air pass through at different intervals.
It’s great to know that Dr. Hogikyan can use his talent in voice and doctor skills to really enjoy his job to the fullest.
Thursday, April 19, 2007 at the University of Michigan’s Otolaryngology Dept.
I spent most of my time today with a medical student, Dr. Jones. When I first saw him, he was examining x ray photos of a man’s head. He was making measurements and consulting a book. He then walked over and talked to another doctor. Lastly, he chatted with Dr. Marentette, his attending physician. They finally went together to see the patient. There was a mass on the left back side of his head. The mass was under his periosteum since I could still feel the skin move across the mass. The MRI also showed the mass had actually craved part of the skull away. If the mass were in the skin, the mass would be hard and skin would not be able to slide over it. An appointment was made. Also, Dr. Jones took some liquid out from the mass (by reverse injecting). This was a pretty neat process that I hope all health sciences students see.
Friday, April 20, 2007 at the University of Michigan’s Otolaryngology Dept.
Dr. Krishnan attended to an old lady. She had hearing problems! Dr. Krishnan did not want to diagnosis without a CT scan of head. Later I asked him why he didn’t want to make any judgments before seeing a CT scan. He replied that usually 9 out of 10 times, patients don’t have any problems, but that 1 out of 10 people do have problems inside their ear. Sometimes a tumor may start growing there. Overall this clinical was an eye opening one. I learned about the health system inside the ENT clinic, how the doctors, nurses, MA and PA act when they aren’t with the patients. I recommend this placement for those who may be interested in surgery or how the clinic works.