Nicholas Madamidola ’20

Weill Cornell Medical Center, New York, NY

The three Research Associates, from left to right: Alice, me, and Natalia.

This past summer, I worked at NewYork-Presbyterian Hospital/Weill Cornell with three other Williams students who also are interested in health professions. Going in, I wasn’t sure what to expect but coming out I realized that this was the exact type of job I needed at this point in my pre-professional career. I saw first-hand a cross-section of the hospital environment, and learned what being an emergency health care provider entails. The job was based on a rotating schedule that I shared with the other interns and our task was simple: to recruit patients for a variety of research studies being conducted internationally and locally.

The first study called CODA (Comparing Surgery versus Antibiotics) is a national study that is looking at the differences in treatment for appendicitis. Currently, two main treatment methods are employed: surgery and antibiotics. Typically for appendicitis in the U.S. people receive surgery, while in Europe people receive antibiotics. As one may suspect, the costs associated with surgery are far greater than simply administering antibiotics and so the research team is hoping to gain a pool of candidates willing to be randomized for either surgery or antibiotics to see if antibiotics are just as effective as surgery. For those who receive antibiotics, there’s about a 25% chance the appendix will flare up again. Another study called MBOSS (mitochondrial DNA as a Biomarker of Sepsis Severity) is looking at biomarkers that may be helpful to determine the status of a sepsis patient. Another was called the Program for Anxiety and Traumatic Stress Studies. It is a program looking at PTSD from accidents such as falls, motor vehicle accidents, or burns. Participants are screened and interviewed by the researchers to see if they qualify for new treatments that combat the psychological effects of PTSD. Another study called OAR (Ottawa Ankle Rule study) looks at the effectiveness of using telemedicine to determine if a patient needs an X-ray or not for an ankle related injury.

In general, the most rewarding part of this internship was gaining people skills with patients and healthcare practitioners. I spoke with people from many different sectors of the hospital and learned to listen. I’m a pretty social and talkative person outside the medical context, but it’s a little different in the medical context: there’s a pecking order and a time and place to ask questions or advice.

The three Research Associates, from left to right: Alice, Nicholas, and Natalia.

My workflow usually started with checking the boards from the past few hours to see if there were any patients who may qualify for CODA. I would do this by looking for patients with right lower quadrant abdominal pain (the first indicator of appendicitis). I found that for something as relatively simple as appendicitis, patients would be in the hospital for at least five hours before they were diagnosed. I found that a little telling of how a hospital can flow. One reason I suspect it takes so long is because of the sheer number of labs ordered at a given time. NYP is a hospital that practices preventative medicine, and so if someone comes in with something like chest pain or shortness of breath, even if it isn’t absolutely necessary, they may receive chest scans. This, on top of the people who really need
them, probably is part of the reason why results may take longer to receive. In general, the top 
complaint I heard from people was having to wait 
for a long amount of time. I would generally 
sympathize with these people but also remind them 
that they are in a top five hospital in the country and that the health care providers are working as hard as they can to make things efficient.

I had the most fun with a project given to us in the last week that had us speak with patients about the quality of emergency care and the use of telemedicine. These days, it isn’t as common to come to the emergency room for blunt trauma such as an injury from a factory or even car accidents due to a wide array of precautionary measures society has taken to increase safety. Nowadays, people come to the emergency room for things like chest pain, acute illness or accidents. People still come for blunt trauma, but it isn’t as common. Now that we have many, many medications to manage diseases of the major organs like the heart or kidney, people with these conditions are able to go about their lives, however, they can often end up in the ED for reasons related to their chronic condition but may not be life-threatening. Often times, these patients could be taken care of in their homes and don’t need to present to the ED, reducing the cost of care. Paramedics could administer care or contact a doctor via video conference if needed. The study partially funded by Medicaid is hoping to study how people with chronic conditions would feel about receiving care in their homes. As it stands today, the job of the paramedic is to stabilize and to transport to an urgent care facility. The study looks at what would happen if paramedics could do a little more than what they’re currently allowed to. Another part of the study looks at how people would feel about being seen by a doctor in their own home through a video conference under the supervision of a paramedic. By this method, both the patient and doctors would be saving time and money. From the perspective of insurance, they don’t pay for a hospital visit and from the perspective of the doctor, they could just dial in give their input on the case while being able to take care of more patients. There was a wide variety of responses from the patients. Some patients thought it was a great idea, and others were weary of the idea of being given medical advice from a doctor on a screen. Understanding this, I explained to them that if paramedics thought you needed immediate medical care, they would drive you to a hospital.

In my last year at Williams, I hope to use what I’ve learned and infuse it with how I learn in my classes. I became a better listener and developed insight into the dynamics of emergency care. I’m extraordinarily thankful for this opportunity and for allowing kids, like me, to expand our interests and target what it is they want to do after Williams.