Weill Cornell Medical Center, New York, NY
This summer, I was a Research Associate with Weill Cornell’s Emergency Department in New York City. Along with three other Williams students, I worked in NewYork–Presbyterian Hospital’s Emergency Room recruiting patients for various clinical studies. These clinical studies included some of the following: a study characterizing accidental falls in older adults in comparison to prosecuted cases of elder abuse; a clinical drug trial for patients who, due to experiencing an accident or injury, later may be at risk of developing Post-Traumatic Stress Disorder; a study examining exercise as a treatment for post-concussive symptoms; and finally, a study examining the wellbeing of older adults after an emergency room visit. Day-to-day, my work entailed combing through the Emergency Department’s board, identifying patients that were potentially eligible for a study, approaching their attending physician for permission to speak with the patient, and (if appropriate) speaking with the patient. On certain days, I also worked from an office making follow-up calls for the study of wellbeing in older adults after an emergency room visit.
I was thoroughly impressed with both the clinical research conducted at Weill Cornell Emergency Department as well as the functioning of NewYork–Presbyterian Emergency Room. First of all, our supervisor was incredibly supportive and accessible. I also thought that each of the research projects could have a clear and important role in shaping future clinical care; moreover, for the most part, I found that their purpose was accessible and easily understood by the participants in the studies. To me, this indicated that these studies had been designed with patients in mind.
As someone who not recently been to an emergency room, it was initially completely overwhelming. However, on the whole, doctors, nurses, and other clinical staff mitigated the effects of this chaos by being patient, kind, and helpful. Moreover, I was for the most part impressed by the quality of care that patients received, and how patients flowed in and out of the emergency room and urgent care, which is for patients who are less severely injured.
From identifying patients from the board and approaching eligible ones, there were certain patterns of ER utilization that became imminently clear. Some ailments troubling patients had started long before the emergency department. For example, many patients had Type 2 diabetes, or a history of cancer. For these patients, visits to the ER could be directly associated with such illnesses, such as patients presenting with diabetic ketoacidosis or those who came for complications of chemotherapy. For others, however, there were not as obvious ties; these patients simply seemed at higher risk for visits to the emergency department due to a decline in overall health. For other patients, this first emergency department visit perhaps was a signal of the start of decline rather than a step along the path. This contrast was imminently clear when I approached patients who had experienced an accidental fall. For certain patients, they had a complicated medical history and were already in ill health; for others, beginning to experience falls catalyzed a decline in functioning.
Interacting with these two types of patients made me acutely aware of the inequities of aging in America. These two groups were not separated by their nature. By and large, patients who agreed to participate in research studies were gracious, kind, and patient. What often did separate them was socioeconomic status. For the most part, patients that were whiter and wealthier were healthier than those who were not. And this discrepancy in health could not be remedied in one visit to the emergency room. For these patients, the separation in their trajectory happened long before they walked into the ER. And if the goal of medicine is to strive for a high-quality, healthy life for all patients, these observations pose two fundamental questions:
1. What can be done to better the health of patients after they leave the ER?
2. What can be done to better the health of patients before they come to the ER?
In my time at Weill Cornell, I saw that there were steps being taken towards addressing the first of these questions. Social workers would strive to ensure that patients were going home to a safe environment. Within the hospital, referrals would be made so that after an emergency department visit, patients could follow-up with an appropriate doctor with the assistance of patient navigators. However, by nature, the answer to the second of these questions lies beyond the realm of the ER.
My time at Weill Cornell and NewYork–Presbyterian strengthened my already-existing commitment to addressing this second question. I have wanted to be a doctor since I was eleven, and my commitment to medicine has only deepened in my time at Williams. Throughout college, I have become a member of the Rape and Sexual Assault Network, shadowed a hematologist-oncologist, conducted psychology research regarding depression, tutored at Berkshire County Jail, and been a Junior Advisor. I have realized that the common thread of my interests is vulnerability. All of the individuals that I have seen through these experiences, including at Weill Cornell, have been vulnerable in some way. And medicine, at its core, addresses the most underlying vulnerability: human mortality. However, not all patients are equally vulnerable. On top of being mortal, we all have different, intersecting vulnerabilities that can manifest themselves both in our health and in the healthcare we receive. And these vulnerabilities compound among those who are socially, emotionally, and financially disadvantaged—a compounding that was laid stark in the ER. Seeing patients in the ER has only strengthened my commitment to assisting those for whom the playing field is not level in living a healthier life.
I intend for this strengthening of commitment to manifest itself in a multitude of ways in my final year at Williams. Since my sophomore year, I have conducted psychology research regarding the epidemiology of depression. In particular, depression is of interest because of its ubiquity, stigmatization, and the debilitation it causes; furthermore, depression disproportionately affects women and people of color. I hope that by better understanding the development of depression, I can better recognize and prevent its onset in future patients either by addressing it myself as a psychiatrist, or being intimately aware of the appropriate steps towards prevention and treatment. I intend on continuing this commitment in the form of a psychology thesis. Furthermore, last year, I was trained to be an abortion doula with the Berkshire Doula Project. I fully intend on actualizing this training and helping to empower women while they are undergoing a stigmatized medical procedure; and beyond this, I am fully committed to prioritizing women’s health, whether that takes the form of becoming an OB-GYN or simply being acutely aware of the inequities in women’s healthcare. In sum, my experience at Weill Cornell has only sharpened my commitment to tackling social vulnerabilities in the context of medicine. Without the generosity of the Class of 1951, I would have been unable to have such a sharpening of my interest. With this experience, I feel even more prepared to approach medicine as a holistic, intersectional field that extends far beyond the science involved.