𝐁𝐫𝐨𝐨𝐤𝐥𝐲𝐧 𝐔𝐒𝐂𝐄 𝐇𝐞𝐦𝐚𝐭𝐨𝐥𝐨𝐠𝐲 – 𝐎𝐧𝐜𝐨𝐥𝐨𝐠𝐲 𝐓𝐞𝐥𝐞𝐦𝐞𝐝𝐢𝐜𝐢𝐧𝐞 𝐚𝐧𝐝 𝐡𝐚𝐧𝐝𝐬 𝐨𝐧 𝐫𝐨𝐭𝐚𝐭𝐢𝐨𝐧 𝐟𝐞𝐞𝐝𝐛𝐚𝐜𝐤 𝐛𝐲 𝐃𝐫. 𝐕𝐢𝐝𝐲𝐚 𝐕𝐢𝐬𝐰𝐚𝐧𝐚𝐭𝐡𝐚𝐧 𝐝𝐮𝐫𝐢𝐧𝐠 𝐂𝐎𝐕𝐈𝐃-𝟏𝟗 𝐜𝐫𝐢𝐬𝐢𝐬 :

CLINICAL ROTATION DURING A PANDEMIC

-Vidya Sankar Viswanathan

I had never imagined that my first US Clinical experience would also turn out to be the most memorable one, accompanied by a roller coaster of emotions. I commenced my Hands-on rotation in Hematology-Oncology at Brooklyn Cancer Care, on 2nd March 2020 oblivious to the global contagion that was about to throw the US and the entire world in disarray.
Hematology-oncology was always the specialty that enthralled me the most. While intellectually challenging, it was also unique with a plethora of active researches, numerous drug developments, and an ample scope for innovation. Most importantly, Hematology-Oncology fascinated me for the reason that it offered physicians, an opportunity to comfort and energize patients who undergo prolonged chemotherapies. Perhaps there could not have been a better place for me to gain my first US clinical experience than Brooklyn Cancer Care under Dr Ratesh Khillan.
Even before meeting Dr Khillan, I understood what makes a physician extraordinary. Every single patient eagerly awaited their turn to meet and interact with him, often enquiring his well-being. What amazed me was his ability to embrace patients, lighten the mood and reassure the patient, apart from explaining the diagnosis and treatment plans articulately. Dr Khillan juggled his patient consultations with devoting time to go over our notes, sharing feedbacks and squeezing in time to share his journey and a few pearls of wisdom.
On my first day, I was introduced to the EMR (Electronic Medical Recording) system used at the clinic and shadowed an experienced extern, until I became confident of seeing patients on my own. The day usually started at 9:00 AM. Upon reaching the clinic, in my assigned room I would go over my patient notes from the previous day. It was an extremely busy clinic and each extern would see an average of 7-8 patients. Once the patient’s vitals were collected, I would then take the history, update the patient notes in the SOAP format (Subjective, Objective, Assessment and Plan) followed by discussing the plan for the patient with Dr Khillan. If a patient required a diagnostic test to be ordered, I would coordinate with the staff. Between patients, I would get some time to complete the patient notes. Throughout my rotation, I saw a wide range of cases ranging from hematological malignancies like Multiple myeloma and CLL to solid tumors like anal cancer and Gastric adenocarcinoma, often looking up and learning about the treatment protocols and chemotherapy regimens. One of the interesting cases was of a young man who presented with unexplained dizziness, which was initially understood to be due to a blood neoplasm but supposedly was due to an underlying neurological cause. Upon being emphasized on the importance of following up on a patient’s investigation results, I immediately started to check for any updates on my assigned patients, and discuss with Dr Khillan for further plans. In this rotation, each student was made an integral part of patient care and was thus able to build beautiful doctor-patient relationships. Everything was systematic at the clinic and the staff actively helped me in settling in. I also observed the chemo infusion process, learning about the various infusions, chemotherapy regimen and pre-medications.
Slowly, I gained confidence in taking a history, typing notes and worked on my accent, given that it was my first clinical rotation in the US. During the latter half of the rotation, due to the ongoing COVID-19 pandemic, we started having teleconsultations, which helped me overcome my inhibition in interacting with patients virtually and improve my communication skills over phone.
The busy days taught me to always be on my toes and to squeeze out time between patients to complete the notes. Dr Khillan and the MAs would check my notes at the end of the day and constantly give me feedback on how I could improve. I noticed a huge improvement by following their advice, when I compared my first few notes to those which I wrote towards the end of my rotation. The responsibilities given to me were beyond what I had shouldered up until then. Whether it was seeing patients back to back on a busy day or following up on a drug order for a patient, it brought forth my shortcomings and helped me to push beyond my comfort zone.
The cherry on top certainly were the Clinic staff and fellow externs. The entire Brooklyn Cancer Care felt like a family, with fellow externs always ready to help each other out. Everyone believed in acting together as a team. From having residency Match conversations to getting photographs clicked in Protective equipment and following the COVID-19 statistics every day, the whole team made the entire experience a memorable one.
This place has helped me get a grip on the US Healthcare system and even more importantly it has strengthened my passion for Hematology-Oncology