Gastroenterology at St Elizabeth’s, Boston
Clinical Electives! Nine months ago when I first heard about them and started applying, I did not have the remotest idea of where it was going to lead me. The rush of adrenaline felt while applying, the palpitation experienced while opening the replies to my applications and the joy felt at being accepted, were all truly unbelievable feelings! Being accepted by Tufts University for a rotation in Gastroenterology at St Elizabeth’s, Boston was the start of an amazing journey that began several months ago. Having completed my rotation, I am now able to write a report describing my experiences.
The Hospital
Caritas St. Elizabeth’s Medical Centre is a community-based 317-bed tertiary care hospital located in the Brighton neighbourhood of Boston. St Elizabeth is a thoroughly modern inpatient and outpatient facility that is also a major teaching affiliate of Tufts University School of Medicine.
The Experience
I could feel the nervous excitement overwhelm me as I reached the GI Unit at St Elizabeth’s for the very first time. The first day involved meeting with the GI Fellow who was going to be my chief clinical advisor for the next 4 weeks followed by a brief meeting with the program director, Dr Roger Mitty and after that it was straight to work. I was rotating with the GI Consult service where we were expected to see GI consults in the hospital and if required, perform the requisite endoscopic procedures. I was taught the essentials of history taking and physical examination from the GI point of view. Special emphasis was given to delineate the important relevant details from the GI point of view in the history and physical examination of the patient. I was given abundant opportunity to learn and communicate with the patients. Initially I was hesitant in communicating, but with support of my fellow and my attending doctor, my confidence gradually grew and by the end of the elective, I was much more comfortable talking to patients. On a routine day I was expected to see my admitted patients and follow up their symptoms and medications and report any significant changes if they had taken place overnight. Additionally, I was expected to see the GI consults and perform the requisite history taking and physical examinations. Rounds took place in the afternoon where I would present my cases for the attending doctor, followed by a visit to the patients on the hospital floor. I was expected to present a case everyday and I would be questioned regarding the case and its management.
Dr Dennis Lee (Attending)
In addition to the consult service, I was also expected to attend the Joint GI Surgical Conferences, GI Radiological and the GI Pathological conferences. All these conferences had attending doctors, fellows and residents from their respective departments who would be presenting cases .These conferences were extremely interesting and informative, as we were exposed to the more unusual and the interesting cases of the week, enabling us to study them not only from a GI perspective but from a Surgical, Pathological and Radiological perspective as well. I had the distinguished opportunity to present a case at the Joint GI Surgical Conference regarding persistent vomiting in a patient who underwent gastric bypass. The atmosphere in the GI unit was extremely warm and friendly, with everyone from the attending doctors to the nurses and technicians being more than willing to help with problems. During the initial 2 weeks of my elective I was under the guidance of Dr Dennis Lee, and then Dr Michael Foley for the remainder of the elective. Their knowledge and experience in dealing with gastroenterological problems was truly astounding and it was an honour to train under such pioneering doctors. Dr Foley’s sense of humour and his uncanny ability to make even the most troubled patients laugh, momentarily relieving them of their pain, was truly remarkable. I always looked forward to the rounds as they were are mixture of intense discussion and learning combined with a lot of fun. In addition to presenting cases, I was expected to prepare presentations on various topics and present it to the GI Team on a regular basis. I had the chance to witness advanced GI procedures such as APC*, ERCP* and PEG* placement.
Dr Michael Foley (Attending)
During my rotation I had the unique opportunity to interact with patients firsthand and listen to the difficulties encountered as they tried to lead a normal life. However, there was one story which stood out and I can remember it vividly. She was a patient of severe Crohn’s Disease, who had spent the past thirty years with a permanent colectomy and multiple ileostomy revisions. As I walked up to her room I was nervous, at the very least I was expecting an irritated and annoyed patient who would not want to talk to a medical student at. To my surprise I found a quiet charming lady who had long decided that it was she who was going to control the disease and not the other way round. After listening to her about her work as a Medical Laboratory Technician and about her passion for photography I could not help but wonder that here was a woman who has been through pain and suffering but still managed a smile and had a childlike desire to learn! I can never forget the happiness on her face as we managed to discharge her just in time for her photography workshop. With her life as an example she taught me that circumstances can be extremely grim but what matters is not to concede defeat and to stand up to them!
The GI Fellows Erika (L) and Alan (R)
Summing up my experience, the four weeks had a steep learning curve. As a part of your electives you would be expected to make presentations on various topics and your performance is judged on basis of your presentation. To ensure you succeed at this I would strongly recommend future students to familiarize themselves with the common computer programs such as PowerPoint, Excel as well as learn how to use online resources such as pubmed.com and uptodate.com. These skills would help you tremendously help in searching for the relevant information online and in presenting in a simple and concise manner, which is very important. Small details like being punctual, making sure your attire is professional, being courteous and the dedication to work long hours always goes a long way in creating a good impression on everyone around you. Also, Tufts University does not produce housing facilities to visiting students and you would be expected to make your own arrangements. Boston has a wonderful public transport system called the MBTA. Buying a Monthly Link T card will enable you to use the bus as well as the subway systems. It was extremely cost effective and really helped me in my commute everyday and I would strongly recommend it to any future student interested pursuing electives in Boston.
The City
Finally, the elective was not just about going to a great hospital by itself but also to live in and experience the great city of Boston. Bristling with several educational institutions, Boston is a student’s paradise. Its rich cultural and historical heritage can be experienced by walking the Freedom Trail and visiting the Museum of Fine Arts. Boston has a rich sporting history with several teams (the Celtics, Patriots and Red Sox) being among the best in their respective sports. I had the amazing opportunity of attending an Inter-College Ice Hockey game at the Agganis Arena, Boston University between the BU Terriers and UMASS. It was a lot fun and just added to the great experience of living and studying in Boston.
Trinity Church, Boston
I am truly sad that my rotation is Boston is over, but the experience will stay with me forever. I am extremely thankful to have had such a wonderful group of people around me, who helped me immensely in progressing further as a student of medicine.
Purav Mody is a student at the Government Medical College, Surat, India
puravmody(at)gmail.com
Appreciation
I personally want to thank the entire GI team for all their help and cooperation and thank in particular, Dr. Roger Mitty, Dr Michael Foley, Dr Dennis Lee, Dr Alan Bonder and Dr Erika Lee.
Abbreviations
* APC : Argon Plasma Coagulation
* ERCP : Endoscopic retrograde cholangiopancreaticography
* PEG : Percutaneous Endoscopic Gastrostomy