Dr Paul Tan, Associate Consultant, Department of Women's Anaesthesia, KKH, talks about his Clinician Scientist Residency training experience in Duke University, Durham, USA.
“Amazon Prime is awesome” was one of my first thoughts when I finally arrived at Durham, North Carolina. I say “finally”, because just getting there took months of planning, multiple medical check-ups, endless administrative nonsense procedures, and loads of emails to people literally half a world away (and through a 12-hour time difference + summer holiday largesse).
But, after surviving that, a 20-hour flight, and two awesome days exploring Manhattan (while avoiding getting mugged on the subway or ripped off at a hot dog stand), I finally arrived at our apartment in Durham lugging two suitcases and 4 boxes of clothes, only to have fantasies of a hot bath and a neck massage by my personal physiotherapist (aka wife) morph into confusion. Wait… didn’t the rental agreement state that the apartment was furnished? Well, apparently “furnished” in American meant refrigerator, cooking hob, and the oh-so-important microwave. WHERE WAS THE BLOODY BED?! Enter the miracle of Amazon Prime. With a few clicks (and my trusty Amex), I had regained some semblance of a furnished apartment (and my sanity) within 24 hours.
Well, apparently “furnished” in American meant refrigerator, cooking hob, and the oh-so-important microwave. WHERE WAS THE BLOODY BED?! Enter the miracle of Amazon Prime. With a few clicks (and my trusty Amex), I had regained some semblance of a furnished apartment (and my sanity) within 24 hours.
Things got better from there. I met the Division of Women’s Anesthesiology the next evening at a bar/restaurant. The food wasn’t worth writing home about, but the company were. What an eclectic bunch. There was Terrence, a Jamaican clinician scientist with a posh British accent (and multiple Berluti bags) who collects discarded placentas for fun research, Ashraf (my research mentor), an Egyptian who trained in the UK before settling at Duke with his family (and his British humour), and Jennifer (my clinical mentor) who has the worst clinical luck and a penchant for neuraxial blocks in obese patients (BMI 70, anyone?). Everyone was brimming with evidence-based knowledge and raring to impart it to the ignorant Singaporean; best place for Asian food – a Laotian restaurant rated 5 stars on Yelp, for instance (totally overrated). From that point, I knew this would be an interesting experience.
Well, in case my bosses are reading this, despite my best efforts, I did glean some clinical and research knowledge when I was there. Although we have fancier toys clinical equipment in Singapore, Duke has the edge when it came to managing complex cases. Severe pulmonary hypertension in a morbidly obese parturient with placenta increta and a cocaine “issue”? Typical Tuesday. Just stick in a thoracic epidural (postoperative analgesia for the midline incision), a lumbar CSE (anaesthesia for the caesarean), coupla of lines, and do the surgery awake in the hybrid OT with on-table embolization, no sweat. Blood loss 500ml, and off to the ward she goes (I’m not kidding by the way, Duke actually pioneered this technique). Their haemorrhage protocol automatically activates anaesthesia, OB, pharmacist (to help with Fibryga), whole bunch of nurses, and ROTEM-guided transfusion (routinely reassessed Q30min by said nurses).
Their research set up is pretty impressive as well. “Collaboration” is not a buzzword, it is their mantra. They have multi-disciplinary research groups that hold regular meetings where anyone can attend (free food), and pitch ideas for future collaboration. Not sure how to do a quantitative mass spectrometry analysis? No worries, there are core facilities for you to outsource your complex research protocols to… for a price, but at least the quality of the analysis is guaranteed. Ashraf was fantastic in maximising my exposure to what Duke had to offer, and arranged for me to meet leading researchers and support staff, with whom I am still collaborating to this day. In fact, the system is so efficient that I could work with them on certain projects from half a world away.
Outside work, North Carolina is an open and forested state, with loads of natural beauty. I don’t think I’ve seen that many trees in my life. My wife and I had great fun exploring the state and national parks, and did a spot of hiking as well. We made friends with a fellow Singaporean and her American husband, who gave us the inside scoop on where to get real Asian food (hint: it isn’t Laotian).
Overall, I am really glad I went through all the initial angst and trouble getting the fellowship started, because it gave me perspective and insight into how other institutions practice medicine, research, and approach complex problems from a systems point of view.
Overall, I am really glad I went through all the initial angst and trouble getting the fellowship started, because it gave me perspective and insight into how other institutions practice medicine, research, and approach complex problems from a systems point of view. The experiences and relationships forged during the short time I was there are incredibly valuable to me, and I am thankful that I was given this opportunity by KK Hospital and SingHealth Anaesthesiology ACP.