Keira Thompson - Boston Medical Center
This summer, I had the incredible opportunity to work with Dr. Stein, a hand and upper extremity surgeon, within the Orthopaedic Surgery Department at Boston Medical Center. Over the 7 weeks of my internship, I learned so much about orthopedic surgery and patient care more broadly as I observed and participated in over 100 surgeries and 400 clinic appointments.
BMC is known as a “safety net hospital,” and the patient base, coming from a variety of income levels and immigration statuses, often does not have many other places to turn for medical care. Throughout my internship, it was incredibly fulfilling to work alongside a team that truly upheld the hospital’s mission, “to provide exceptional care, without exception.”
Each morning, I began with board rounds at 5:30am. In these meetings, the residents that were on-call in the ED (Emergency Department) the night before reviewed all of the orthopedic cases that had come in. For operative cases, the surgical plan was then determined. I saw cases ranging from the dislocation of a total hip replacement, to a gunshot wound, to an arm amputated in a motor vehicle accident.
After board rounds, my day officially began. Dr. Stein spends half of the week in the operating room, performing surgeries, and the other half in the clinic, meeting with patients. On OR days, I observed around 8 surgeries a day. It was fascinating to experience how every member of the surgical team works together to care for the patient and ensure the surgery runs smoothly. I even had a role to play, helping the med student and resident to prep the patient before surgery and tying the surgical gowns for Dr. Stein, the resident, and med students after they scrubbed.
Given Dr. Stein’s area of specialization, I observed many surgeries of the hand and upper extremity. These included more common procedures such as carpal tunnel releases, as well as cases such as a distal biceps repair, a repair of the sensory branch of the radial nerve, a finger amputation, and a wrist fusion. Every case was fascinating, and Dr. Stein, the residents, and med students were all incredibly helpful in explaining the specifics of cases to me. I also observed surgeries in other orthopedic specializations, plastics, ophthalmology, and urology. Two surgeries from other orthopedic specializations I particularly enjoyed were a shoulder surgery that involved a bone graft and a surgery of the cervical spine.
On clinic days, I helped the med student or resident conduct initial patient evaluations and exams before presenting cases to Dr. Stein. These days were very fast-paced, with my generally seeing around a third of the total 85 patients a day.
In many clinic appointments, we encountered a language barrier. My very first case in the clinic, I acted as the translator between the medical student and a Spanish-speaking patient. Another afternoon, a patient in the clinic only spoke Amharic, so the resident and I had to make do with hand signals until an interpreter could be reached to effectively translate the patient’s symptoms and treatment plan.
I also saw that often in these appointments, patients would discuss not just their symptoms, but also their employment situation, homelife, or struggles with substance abuse. I quickly learned that beyond just the clinical aspects of each case, taking the time to understand the patient as a whole person, often with complicated life circumstances, plays an equally integral role in providing the best patient care.
The final part of my internship consisted of working with Dr. Alyssa Rothman, a resident, on a case review to be published through AAOS, which runs continuing medical education for orthopedic surgeons. Our case focused on the diagnosis and treatment of perilunate fracture-dislocations. In this type of injury, there is displacement within the carpal bones that make up the hand and fracture of one or more carpal bones. We looked specifically at a patient, who Dr. Stein operated on, that sustained this type of injury when he was hit by a car while crossing the street. The process of creating this publication was fascinating. I studied the patient’s files, analyzed his x-rays, and read through medical journal articles on current treatment techniques. I then worked to compile this information for the case review, while Alyssa created the accompanying quiz that would be taken by orthopedic surgeons for continuing medical education credit. An excerpt of the case review I produced, along with pre-op and post-op patient x-rays, are below.
I have learned so much this summer working with Dr. Stein and the BMC Orthopedic Surgery Department, and I loved the experience. I am so grateful to Dr. Stein and the entire Boston Medical team I worked with for welcoming me into their community and being so willing to guide me. A special thank you to Geegee (med student), Max (med student), and Diana (resident) for your support. And thank you to Mr. Schlenker and Rivers for offering this amazing opportunity.