Week 8:
Smooth Sailing

August 4, 2019

This was one of the busiest weeks of my internship this summer and simultaneously, went by the fastest. Over the weekend, I brought Penny up to Breckenridge with me. We spent Sunday smooth sailing on a pontoon on Lake Dillon. It was so much fun to fish and be out on the water with the gorgeous mountains in the distance. We also went up the mountains by taking the Breckenridge gondola and had an awesome time going down the alpine slide at the top. Overall, it was a great weekend and Penny and I got to know each other more outside of work. Over the course of the summer, we have become close and I am thankful to have shared such an incredible experience with a new friend. We laugh at Zumba together, talk about interesting cases on the way to and from the hospital, and I have learned a lot more about China and Chinese culture.

On Monday and Tuesday, I was determined to get as much work done as possible with more charts, starting on my final PowerPoint presentation, and working on the manuscript for the project since the rest of the week was full with shadowing and meetings. I got through a lot of charts and found some interesting cases that I can add to my project. One of the cases included a little boy who sustained a Salter-Harris IV fracture to the distal femur and received an Open Reduction Internal Fixation operation. Two years after the first surgery, an Xray revealed that he had a fishtail deformity. This is very rare but can happen as a result of AVN (avascular necrosis) when the bone tissue starts to die from lack of blood supply. This leads to a deformity of the bone that resembles a fishtail. The case really emphasizes the importance of studying these fractures to try and make complications less likely as they can have such detrimental and lasting affects. This case is especially important since the child is still so young and has a lot of growth left.

Last week, as a result of my flat tire, I was unable to make it to the Sports Medicine Clinic to shadow Dr. Wilson. This week, I was successful in making the 30 minute drive South to the Children’s Hospital Clinic in Centennial, Colorado. I had an amazing time observing Dr. Wilson as she saw 8 patients in the afternoon with a wide variety of injuries and ages. It was also fun because each child had a different athletic interest. One of the patients was a softball player with a sprained elbow from pitching, another patient did rodeo and presented with a mysterious swollen knee. The swelling only happened occasionally and there was never any pain so Dr. Wilson asked lots of questions to try and figure out what it might be. The highlight of my time was an adorable little boy who had fallen off a chair and sustained a calcaneous fracture in his heel (this kid was seriously the cutest). He showed me his little book with animal pictures and laughed as he roared like a lion and snapped his teeth like an alligator.

I really enjoyed the variability of sports medicine and admired how Dr. Wilson knew something about each type of activity the kids participate in. She knew softball terminology even though she had never played and since the patient was a pitcher, she looked up more information about types of softball pitches before going into the room. Dr. Wilson said that it is always awesome to see a child’s face light up when you know something about their sport and then ask them to tell you a little bit more about what they do. It helps them see that you respect them and care about what they are passionate about. From my observations, I think that this made the child or adolescent more likely to talk about what was wrong since they felt listened to. I also appreciated how Dr. Wilson completed the exam and then laid out all of the options she had. She let the family decide with her what was the best course of treatment.

Out of all my shadowing experiences, this was definitely one of my favorites because I can really see myself working in sports medicine. I felt like I could relate to the patients and loved getting to talk about different activities and observe Dr. Wilson formulate a plan so that the patient could get back to doing what they love. Dr. Wilson also worked with two Athletic Trainers while I was there. The AT saw the patient initially, gave a briefing to Dr. Wilson, then took notes in the room while Dr. Wilson completed the exam. They all worked so well as a team and I could tell that they have a lot of fun at their job.

On Thursday, I spent the whole day in and out of the OR for a few different surgeries with Dr. Miller. She is my PI for my project for the summer. I was extremely excited since she has been in and out of the hospital most of the summer so I got to finally observe her work and talk to her more. The first surgery she performed was an amputation of two toes on a little girl. Dr. Miller’s primary research interest is in genetic conditions. The little girl had a condition known as Parkes Weber Syndrome which affects the vascular system. Vascular abnormalities known as capillary malformations and arteriovenous fistulas (AVFs) can occur and lead to abnormally large appendages that may require amputation. I also observed Dr. Miller perform a bilateral knee arthrogram. In this procedure, a type of contrast dye is injected into the joint. After the dye is injected, an MRI is taken and the contrast medium helps the doctor visualize the ligaments and cartilage to make a more accurate assessment of any damage to the area.  Finally, I saw an intramedullary nail removal. Following a fracture, sometimes a metal rod is placed inside the bone canal. In the procedure I watched, the rod was removed after the bone had healed.

I only have one full week left at Children’s Hospital and I am amazed at how fast it has all gone by and how much I have learned. I will be going to the mountains one more time this weekend before getting as much work done on my presentation and manuscript as I can next week! Hopefully there is more smooth sailing from here!