I did a four-week elective in liver diseases at Mount Sinai Medical Center. This hospital is located in the upper east side of Manhattan. My main goal was to catch a glimpse of how things were like in US hospitals and compare this with Australia. I also wanted to see some high tech stuff. The liver diseases department at Mount Sinai deals mostly with liver transplant patients. Here is the hospital’s description about its liver transplant center:
Mount Sinai is one of the nation's leading adult liver transplant centers, performing more than 130 liver transplants yearly with outstanding success rates. The program began in 1988 when RMTI founder Dr. Charles Miller performed the first liver transplant in New York State. Since its fledgling days, the program has grown to become the third largest in the world.
After all the painstaking J1 visa application process, I finally arrived at the JFK airport in New York City at the end of November. When I came out, I was surprised to find that it was not as cold as I imagined it to be (although it turned unbearably cold within a few days). A family friend picked me up and brought me to the accommodation which the school arranged for me. It was a nice and spacious two bedroom apartment near the hospital. I lived in one bedroom and another visiting student lived in the other. We shared the living room, kitchen and bathroom. The accommodation costs visiting students $900/month.
I arrived in NYC on Sunday night and began my elective on Monday. There was a terrible 11 hour jet lag. Therefore I would recommend future students to arrive at least two days before the elective starts. On Monday, we had an orientation day where we sorted out visa issues and had some training sessions on patient confidentiality (there is a strong emphasis on this) and how to use the hospital computer system (things are more computerized in the US).
On Tuesday, I reported to the Liver Diseases Division. The Director of Advanced Hepatology Fellowship recommended me to spend approximately a week in each of outpatients/consults, pre-transplant, post-transplant, and inpatients. Things I did included interviewing and examining patients in liver clinics, liver consultations, attending pre-transplant and post-transplant clinics, following up and presenting some inpatients during ward rounds, and attending conferences/meetings. I also saw histology reports on liver biopsies. I watched procedures like endoscopies, liver biopsies and paracentesis (=ascites tap). A fellow taught me how to operate the endoscope and let me play around with it. I also got to do some paracentesis.
I noticed some interesting things:
- Multicultural doctors: There was a fellow from Egypt, and another from Puerto Rico. One of the fellows did his medicine degree in Israel but is an American Citizen. Some attendings (=consultants) also came from different places, such as Ireland and Argentina. The doctors are generally very nice.
- Many of the patients were Hispanic and it was very useful to know some Spanish.
- Cranky patients: Most patients were fine, but here I met some of the crankiest patients I’ve ever encountered. Some of them had been waiting for a long time and had no idea what was going on and got very angry. Some African-Americans were particularly scary because they scolded at you with long strings of words and looked as if they were about to hit you any time.
- German visiting students: I saw many German visiting students on my orientation day. A German girl (D) moved into the same apartment unit as me on the 2nd week of my elective and she also happened to be doing the same elective as me. She was very nice and was a great companion.
Some of the particularly memorable things included:
- The New York transit strike: This three-day-strike happened on the last week of my elective, where I was supposed to do inpatients. Therefore it didn’t really affect me much hospital-wise. There were very few patients in outpatients though. The taxis charged ridiculous fares. I had to do something in midtown one day and walked from 96th Street to 41st Street and back.
- Dr. Bach’s clinic: When I attended her clinic, it seemed like it was going to be a nice relaxing day because there were many cancellations. However, a patient had a stroke in the waiting room! So things turned pretty hectic and she finished late.
- Dr. Dieterich’s clinic: He was a very nice and humorous Professor of Liver/Gastroenterology. His clinics were very interesting. He had many HIV/HCV patients. I got to see a “Pill Cam” video. He also told us where to get free food, so we were very well fed. We attended a Christmas party where we ate nice buffet. We also attended one of Dr. Dieterich’s dinner talks but it was on the day of the transit strike so only D and I turned up (by taking the taxi) and we had great food!
- Endoscopy: I saw a man with actively bleeding esophageal varices.
Outside the hospital
New York City is the largest city in the United States. Indeed, one of the first things I noticed about Manhattan was that everything looked very big: big buildings, long streets, etc. I toured around NYC whenever I had free time. I did not go out much during weekdays because I could not tolerate the freezing weather at night. The school had a recreation office where you could buy tickets (for things like museums, operas and concerts) at discounted prices. The beauty of staying in New York for one month was that I could visit many different attractions and explore the city at my own pace. Places I visited included: The Empire state building, Wall Street, Trinity Church, World Trade Center site, World Financial Center, Statue of Liberty, Ellis Island, United Nations Headquarters, Bronx Zoo, NY Public Library, Rockerfeller Center, Times Square, Chinatown, Little Italy, Central Park, etc. I visited several museums and watched an opera at a discounted price ($25 US). I also visited many shops and was able to find some bargains.
At the end of this elective, I flew over to Los Angeles for a change and stayed at another family friend’s home for a week. During that week, not only did I visit the downtown, Hollywood and Beverly Hills area of LA, I also went to Las Vegas, Disneyland, and the Universal Studios.
Overall I found the stay in New York a very enriching experience and recommend this elective to future students.
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