Written by Kenmont Group

Guest Post: Learning from the Specialist – My time at Richmond ENT

By Ava Torjani – Princeton Class of 2018

When I was first offered the Princeternship at Richmond ENT, I was given the perfect reason to be excited for an otherwise lonely spring break back at Princeton. I have had previous work experience in medicine but never in the field of otolaryngology (a.k.a. ear, nose, and throat), so I was really happy to learn about something completely new. After calling Dr. Armstrong to confirm dates and logistics, I truly felt privileged by this opportunity not only because of all the different types of surgeries and consultations I was allowed to observe, but also because of all the additional help he offered ranging from accommodation and transportation.

So there I was, about a week or two after the call, entering the ENT office at Richmond after an early morning 5-hour train ride with hardly any sleep. Dr. Armstrong and the entire ENT staff were extremely friendly and welcoming, which instantly made me feel comfortable being in a new and different setting. The first day was primarily filled with consultations. I shadowed the nurse practitioners, Amy and Becky, who performed check-up procedures on the patients. My favorite was the nasal endoscopy – even though it seemed slightly painful and uncomfortable for the patient, seeing the real-life anatomy of the nose was incredible. After several patients, I picked up on the routine used to examine patients: Feel the outer regions of the sinus and tonsils with hands; check the ears and nose with an otoscope; check the inside of the throat; check the heartbeat with a stethoscope; and, if needed, perform a more thorough examination of the sinus using a nasal endoscope. What I particularly liked was how the patients were constantly asked for consent, informed comprehensively of all the risks associated with procedures, and how they felt about being examined with a certain method. It was a true display of quality patient care, no wonder the clinic always tended to be busy!

It was only the first day and I had already observed a wide variety of cases including allergiessinus and ear infections, skin lesions, and asthma. I never knew how diverse and demanding the field of otolaryngology actually was until that day. This became especially clear to me while I was reading brochures in between shadowing, which provided extensive information on problems such as swimmer’s earsleep apneaskin cancerhearing aids, and many more. For me particularly, the best aspect of this field was that it includes both surgery and consultation, which is exactly what I’m looking to pursue within a medical career.

The second day began with surgery in the OR at 7:30 a.m. I was thrilled to be wearing scrubs because it momentarily brought my future aspirations to reality. I first observed Dr. Armstrong placing tubes into a child’s ears. Unlike my last internship I was able to stand closer to the operation table and see more clearly what was happening. Moreover, I was allowed to look into the eyepiece of the microscope he was using to insert the tubes; I could see the ear drum, which was pink and opaque due to infection, as opposed to a healthy, translucent one. He would explain the steps he was taking and why they were necessary, which made me feel a lot more engaged in the surgery itself. Later, I was offered to stay with Dr. Winslow, a pediatric urologist, and observe his surgeries. I particularly enjoyed the kidney de-flux operation, which involved the use of X-ray and a less invasive technique. We also had a fun and interesting conversation about my home country, the UAE! The OR room was a lot more calm and relaxing than I had expected, though that may be because it is an outpatient hospital that deals with fairly less traumatic cases. The hardest part of observing surgeries for me was standing up for a very long time, especially since I wasn’t doing anything to distract myself from it.

However, one of the OR staff members, Wendy, really helped by teaching me about the different types of surgical instruments used for various operations. It definitely made the complexity of the surgical procedures (slightly) more understandable.

I then spent the rest of the afternoon in the ENT office. There were many cases on sinus infections that required CT scans. Dr. Armstrong explained how the scans are examined; of course, I couldn’t completely understand what was happening due to my limited knowledge of medicine, but I did learn that grey was bad whilst black and white were generally good. I also managed to observe biopsies of skin cancers and observe the throat of a patient who had tonsillitis. Throughout this day specifically, there were many referrals being made depending on the patient’s case. This made me realize how well connected and interacting the medical community is, which grew my motivation to pursue this career. Once again, throughout all the consultations, Dr. Armstrong was very informative and answered all my questions. He presented medical concepts to the patients and myself in a comprehensible manner, which made the learning experience very interesting and enjoyable.

I spent all of my last day at the outpatient hospital in the OR and was very lucky to have observed different types of surgeries. The day began with ear tube placements for children and progressed to more complex sinus and oral surgeries in adults. I really liked the optics used to look inside the nose, especially when the procedure used a screen because I could fully see what was happening. At one point, the lights in the operating room were turned off and I could see the red lights of the surgical instrument inside the patient’s forehead! However, my favorite surgery involved the removal of a soft palate tumor in the mouth, which was almost the size of an egg!

Dr. Armstrong and I at the ENT office!

Each day at the office included interesting cases and procedures. It was clearly evident that all staff members where passionate about their work and I only hope that I feel the same way about my own career in the future. I am truly grateful for the experience that Dr. Armstrong and his staff had given me and truly valued every aspect of it to the fullest. There is so much more I want to write about but for those of you still reading, I think this more than enough information to process for now! This internship assured me that all the challenges I would face in the next four years would be worth it in the end and I am truly grateful for the experience. As a result, I now feel more confident in overcoming them and hope that it all works out!