Friday, February 14, 2014

MD/PhD with Dr. Peter Rohloff

In Belenpampa today, I did rounds with another new doctor.  I could understand him very well, so I learned about several topics.  I think I have a good grip on the physical exam for the babies, and I have a basic understanding of why each test is done.  I haven’t encountered many problems yet so I don’t know potential pathologies.  I also learned about cells that appear white in the gums of a baby; they could easily be mistaken for teeth starting to come in.  They aren’t pathological, just an interesting side-note.  The med students jokingly handed me a patient sheet to present it to the doctor.  I realized that I would absolutely love to do that.  Presenting patients to doctors on rounds is something I’ll have to become accustomed to at some point, and that would be a great experience to have now.  I think it would also make a good impression on the doctors too, potentially increasing my responsibilities elsewhere.  I’d also like to ask if I’d be allowed to do physical exams of the babies.  I would have people watching me so I would have very little worries about missing anything critical to the health of the child.  They seem to be quite straight forward, and again it would be stellar experience for my future clinical career.  It dawned on me that perhaps I should stay in sala de partos another week.  This discipline is probably the nearest to an American hospital of all in the clinic, and I am learning a lot of deep things compared to the shallow lessons I learned in the others.  It is also a great way to network with many doctors because they rotate rounds with the babies.  Thinking these thoughts was shocking to me because I was so opposed to working here 2 weeks ago.  It’s amazing how fast you can become accustomed to a new situation. 

Additionally, the labor room was busy today.  There were 3 women in the dilation room when I arrived.  Around 10:00 the first one went in.  She had to push for a while, and she experienced a lot of pain, but eventually she got the baby out.  While everyone was watching her I got to do another round of checking the baby hearts with the ultrasound.  I later asked Wilson about why we do this, and he explained that it’s best for the baby’s heart to be between 120 and 160 beats per minute.  Below this range is brachycardia and above is tachycardia.  I’m not entirely sure what happens if we find one out of range, but perhaps I’ll find out later.  I thought it was interesting that the obstetricians always wanted to make sure she kept her mouth shut so that all the pressure would go toward getting the baby out instead of toward making noise.  That was just about the only thing they repeated to the new mom.  Immediately after this baby popped out, another woman entered the room to have her child.  There are 2 beds, so she got into the other one.  Wilson had to go fast to get all the measurements and preparation of the first baby done before the second one entered the world.  The second lady was in more pain than the ones I’ve seen previously.  Or she didn’t tolerate it as well, who knows.  She was shrieking and begging for help and saying she couldn’t keep going because it hurt too much.  Naturally she did eventually finish the job.  As if she had a choice.  I enjoyed watching the preparation and everything they do with the babies, if I stick around another week that might be something I could do as well. 

The rest of the morning was spent hanging out with Wilson, since Andy left to go sleep because he had to stay through the night yesterday.  Great times.  I learned that mixing Quinoa with milk is a delicious combination during our short break.  We visited some other services, then went around taking turns listening to baby hearts in wombs.  Quality day in the clinic.

You are probably wondering why I titled this post with something other than everything I’ve explained above, since it all is important and significant.  Well, today I finally had the opportunity to talk over the phone with Dr. Peter Rohloff, who is the founding doctor of Wuqu’ Kawoq.  He also has a dual appointment at Harvard.  I wanted to talk to him not just because of my summer plans to join him in Guatemala, but also because I love his career trajectory.  His PhD is in the biological sciences, then founded this organization because he saw a need.  He now leads a research group in Guatemala, although it is in a discipline entirely different than his research training.  It is some combination of anthropology and epidemiology and global health and other subjects.  I’m happy to get some exposure to another form of research before I have to choose my PhD.  Anyway, he had some great advice for me as I look forward to my future.  I’ve been unsure of which path I would most like to take as I move beyond my undergraduate.  I love medical care, and while a PhD is great I have been unsure of whether or not it is worth 4 years of my life.  His first caution was that my PhD might come in a different discipline than I will actually work in long term.  That has certainly been his experience.  He actually encourages most of the undergrads he works with not to pursue MD/PhDs, since many people pursue them for the wrong reasons.  He also talked about other ways to get med school paid for without needing to do the MD/PhD route.  It’s essential to have financial options after med school or one can be forced into a discipline that doesn’t involve working in a poor country for little or no pay.  However, all other paths involve some amount of time of approximately 3-4 years.  To me, all this information is a conformation that I should continue along the path of MD/PhD.  If I’m going to have to spend 3-4 extra years to open the door to a career involving global health, I would like to exit those years with skills that will improve my ability to better the lives of people.  I do love science, and I could see a scientific background serving me very well all over the world.  So we talked about PhD’s that would be most ideal for my career.  Bioengineering is an obvious choice for someone with my physics background, and it can also lead to many excellent opportunities globally.  He told me about some of the projects he was aware of coming out of the MIT biomedical engineering department, and they sound exciting challenging, and most importantly beneficial to the poor and marginalized of the world.  I would find a project like that very fulfilling.  The key to me is getting to ask questions that will actually have some kind of beneficial impact on patients, and I’m now confident that I will be able to find a lab where that is possible.  So we moved on to schools.  He likes University of Illinois Urbana-Champaign, which is where he earned his degrees.  It’s not a government funded MD/PhD program, which means that it isn’t as good of a deal financially.  That is a big deal to me.  But I do acknowledge that there are advantages to not having government regulation, and he said that it allowed him a more in-depth PhD experience than he could have got in most MSTP (NIH funded) programs.  MSTP’s will still be the majority of my applications, but I will follow his advice to apply to U of I.  He also mentioned that the other best schools would be the Harvard-MIT dual degree program and the Emory-Georgia Tech joint program.  I don’t know as much about Emory, but I am pretty sure I would enjoy the Harvard-MIT program J  Lastly he talked about some specific challenges I’ll face as an MD/PhD.  For example, I may feel pressured to go for a fellowship, but my age by that time will also push me toward avoiding it.  Who knows, that’s a long ways away.  Global health also doesn’t have a clearly defined specialty of choice.  Radiology could serve me well, since it has a good lifestyle and good pay so I would be more free to pursue other interests like public health even with an appointment in the US.  That would be a good specialty for me since I have such a deep background in imaging.  My main hesitations have always been not seeing how to apply it to global health and not getting to interact with people directly.  He gave a few examples of potential options for how to use that, although it is still largely unexplored.  That doesn’t mean it’s not doable, it just means there’s a need that perhaps I could fill.  Emergency med is also nice because of the flexibility, but I’m not sure I’d like the hours.  I now have more confidence that I could handle the pace and trauma after getting to understand my reaction to shocking situations here in Peru, but again that’s not likely for me.  Internal medicine is also a potential option, simply because of the required depth of knowledge in many subjects.  I would be prepared to handle almost any problem that arose.  I like the sounds of internal medicine because I enjoy complexity and solving problems, which is a huge part of that discipline.  I asked about palliative care because I did like what I saw over Christmas break, and Dr. Rohloff said that is also unexplored.  That was the just of the conversation.  I was very thankful that he took the time to meet with me, despite the my tardiness and dropped calls from dysfunctional Peruvian internet.  He’s used to it in Guatemala.  In summary, I’m happy to say that I now have more direction as I move forward in the MD/PhD application process.  I will probably begin drafting my essays in the near future!  Exciting times J

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