LIJ Cardiology Internship: Week 1 & 2

It is impossible to write about everything I have learned because I have never learned so many interesting things in one week! My nerves ran high the first day due to the fact that I thought I was out of my comfort zone in a department where I barely knew anyone. Looking back now, it is humorous. Everyone is so welcoming and eager to teach and explain. I am starting to see that the hospital environment is completely within my comfort zone.

Every few days there is a morning conference at LIJ, and every Wednesday there is a lunch conference. They discuss things like interesting cases from over the weekend and unique EKG's that might be on the board exams. Sometimes presentations are given about the histories of certain procedures and the risk/benefit of one's that exist. The main thing I have observed is that there is no step by step guideline for the doctors to follow. Every patients situation brings it's own complications and the cardiologist has to factor everything together like age, allergies, chronic disease, family history, previous visits, and so on for each decision they make. It might seem like an implantable cardioverter defibrillator (ICD) should be introduced to someone because of frequent fribrillations, but they have a history of dementia and live alone in a trailer park. Some doctors might not see this as a ethical thing to do because the patient might not understand what is being put in them. There are so many decisions the cardiologists have to make in such intense situations.

My first week I spent on the cardiology consult service with one of the first year (now second year) fellows. This is a service where a few of the patients are directly under your care (primaries) and the rest are under the direct care of another physician and you are examining them only in terms of cardiology (consults). It is a very busy service, with a lot of patients, but each patient gets the time they need to be examined. After my week on the service, I was able to see the routine the fellow undergoes everyday which is to meet with the resident and get the vitals of each patient, and then go through each patients case with the attending physician to make a plan for the day. Once that was completed, we were off to visit each patient. Sometimes you would go to see a patient and they might be getting an Echocariogram or be in the Catheterization lab and you would have to come back. Sometimes they would be asleep and you would have to wake them up. At other times we would be going in to recommend procedures like valve replacement surgeries and pacemakers. Each patient has a story and a reason why they are there, and that needs to be understood before entering the room.

Dr. Slotwiner who organized this internship with Dr. Shanies, has been nothing but nice, helpful and motivating. Spending the week with him in the EP lab (electro-physiology) was a great experience. I got to stand in on an EP study and the implantation of a pacemaker device, which was one of the most amazing things I have ever seen. It is unbelievable how something so small can do so much! Not only can it pace the atrium and the ventricles separately, it understands threshold limits, and has a memory for when the heart has fribrillations and palpitations. I also was able to see an ablation, where an ectopic beat is corrected non-invasively!

My experiences thus far in the LIJ cardiology department have been nothing but excellent. I look forward to the weeks to come and to the new things I will learn.
-Stephanie Lombardi