Doctors' work up close and personal

The Maui News
Sunday, July 10, 2005

by staff writer CLAUDINE SAN NICOLAS

WAILUKU -- In one room, the "interns" were applauding the successful surgical removal of an inflamed appendix.

In another, they bore witness to the birth of a healthy baby boy in an emergency Caesarean section.

And in the next, they received confirmation in a biopsy specimen of what one doctor had suspected all along – his patient had cancer.

All of it was part of a day in the life of an intern at Maui Memorial Medical Center.

Eight people, representing different parts of the island's community, accepted an invitation to walk alongside doctors for one morning at the Valley Isle's only acute-care hospital.

The Maui Mini-Internship Program coordinator and founder, Dr. Barry Shitamoto, dressed his participants in personalized hospital coats, provided them with manuals outlining the goals of the project, instructed them about proper medical protocol and showed them photos of previous internships.

Among their many purposes, the mini-internships spotlight the physicians; promote better understanding and communication between doctors and the community, allowing both sides to learn from each other; provide community leaders knowledge to assist them when making decisions about health care services; and get doctors more involved with the community.

The 2005 interns said the program's mission had been accomplished, and then some.

"It was really quite inspiring to see how the staff moved and worked with such amazing grace," said David Cole, president and chief executive officer of Maui Land & Pineapple Co.

Cole had been among the interns led into the obstetrics department where Dr. Aaron Altura performed an emergency Caesarean. Waiting in the wings was Dr. William Kepler, the pediatrician required to be on board and whom the interns dubbed "the catcher."

The interns stood behind the surgical table in full view of Altura's cut over a womb, where they saw a head turned and guided out, and then the full body of a newborn baby boy lifted out. Within seconds, the baby began to cry and a nurse documented the time of birth at 11:31 a.m.

The interns clapped. "Welcome to Maui," Cole said.

Kepler took the baby in a warm blanket and marched him over to an infant-size tray, where he wiped off bloody fluids from the crying baby's head, shoulders, stomach, arms, hands, fingers, legs, feet and toes.

"It looks like I'm being hard, but really I'm just stimulating the body," Kepler assured the interns.

Kepler called on the baby's dad, draped in the same sort of blue surgical jumpsuit and cap that the interns had donned, to cut the baby's umbilical cord. The dad initially said no, but after being assured that Kepler would help, he did the honors.

"That was amazing!" Maui County Council Chairman Riki Hokama exclaimed after he left the surgical room, knowing that both mom and baby were in good condition.

Later during a debriefing session, Hokama said he was "completely affirmed" by the quality of the medical professionals and their supporting staff at Maui Memorial.

"It's obvious. There's a well-coordinated operation here," Hokama said.

Earlier in the day, Hokama had seen a doctor address the need of an indigent patient and another oversee the care of one who could pay for expensive medical services. Both patients, according to Hokama, received the same quality of care and attention.

"I thought that that was very important," he said.

In commenting on their experiences, Hokama and Cole both highlighted the professionalism of the doctors and their supporting staff, including nurses, technicians and assisting physicians.

The mini-internship program began about five years ago, with Shitamoto and others picking each time a select group of residents representing Maui County's multifaceted community. The interns were matched with physicians from various departments including cardiology, surgery, forensic pathology and the Emergency Department.

This year's program started Thursday night with a gathering at the Dunes at Maui Lani Restaurant, where former interns, including Jeanne Skog of the Maui Economic Development Board, developer Everett Dowling and attorney Martin Luna, shared their experiences.

This year's mini-internship closed with bento lunches, "graduation" certificates and a gift of a stethoscope for each participant. The tab was covered by the hospital, participating physicians and staff, and the Maui Memorial Medical Center Foundation.

Along with Cole and Hokama, this year's interns included Alexander & Baldwin Inc. Vice President Meredith Ching; Maui Memorial Foundation board secretary Ululani Correa; Pioneer Inn controller Rebecca Lennon; Maui News Staff Writer Claudine San Nicolas; award-winning Hawaiian entertainer Willie "Willie K" Kahaiali'i; and radio personality Alaka'i Paleka, whose white hospital coat was labeled with her better-known alias, "Morning Goddess."

Attorney Tony Takitani, an intern who has participated every year since the program's inception, also came along for the day.

"They say I'm the 'no child left behind,' " Takitani said, joking in reference to the education reform act signed into law by President Bush.

Interns met up with their escorting doctors as early as 7 a.m. and didn't leave their sides until about 12:30 p.m., when all of the program participants sat down for lunch and a debriefing session.

Interns were impressed by the work carried out at Maui Memorial.

Paleka said the experience had her considering a job in politics because she could then "give you guys all the money you desire." Instead, she offered up her talent as a skilled speaker who could do public service announcements about the importance of preventive checkups for high blood pressure, diabetes and cholesterol.

As a major employer on the island, Cole said, he and other corporate executives could pledge to help things get better at the hospital.

Correa said she came away with a "huge awareness and appreciation" for the staff and the importance of the work of the Maui Memorial Foundation and its support as a fundraising arm for the hospital.

Willie K also helps with hospital fundraising by sponsoring an annual golf tournament for cancer patients.

As an entertainer, he said, he's able to "make people happy for a couple of hours."

But doctors have a job that impacts people "for the rest of their lives."

He said he saw a balancing act between the need to be a skilled physician and a caring medical provider.

"You have to keep your mind focused so you don't make a mistake, and then you have to turn around and be their friend."

Kahaiali'i recommended that a similar mini-internship be provided to the island's youth so they could be instilled with an appreciation for the work done at the hospital.

Lennon said she had previously been to the hospital only as a visitor to patients.

"My perceptions have totally changed," she said.

In the emergency room, she became aware of the diversity of cases and the people that come to the hospital for help.

Lennon said she saw people with physical ailments, others with possible mental health issues, and still others who had nowhere else to go for help but the hospital.

"It was a real education for me," she said.

In a span of 10 minutes, veteran emergency physician Dr. John Mills went from providing the interns a tour of his work space to treating a male patient with abdominal distress to caring for another patient with a sunburn.

"It's never dull," Hokama said after his internship in the Emergency Department.

Like Lennon, Ching was fascinated by the technological advances in medicine, particularly in the operating rooms, where high-tech instruments allowed for noninvasive surgical procedures and provided doctors with more detailed information than ever before.

Ching likened herself to former intern Luna, who had explained Thursday his trepidation about being exposed to blood in a hospital.

"I was a little squeamish about this myself," Ching said. "But actually with the technology, I saw very little blood."

Both Ching and Willie K stood quietly as they watched two separate surgical procedures conducted by ear, nose and throat specialist Dr. David Crow. Narrating for the interns was 68-year-old Dr. Andrew Don, a senior hospital physician, who talked about the advances that have come about in the last 20 years.

At the onset of the day, Don recalled interpreting X-rays that provided an idea of the issues surrounding a patient's problems. But today's CAT scans give more detailed information and provide doctors more confidence in their diagnosis and treatment of patients.

Crow cleaned out the blocked sinuses of a sedated patient with instruments that were guided through the patient's nose and monitored over a computer screen that provided pictures of every step taken by the doctor.

"He should be able to breathe better," Crow said as he completed the procedure on his patient. The man, according to Crow, would also have a decrease in sinus infections and would be able to walk out of the hospital on the same day.

Sinus surgeries are fairly common; Crow estimated that he performs two to four a day.

After a 15-minute break, Crow went to work on another patient who he suspected had tumors around his vocal chords. Again, the patient was examined under anesthesia. Crow lifted a sample of tissue about the size of a cookie crumb within a few minutes of his patient's falling asleep and seven minutes later received a call from the laboratory confirming his suspicions – it was malignant.

Crow said he planned to talk with his patient later in the day about the prognosis and possible treatments. For Crow, the biopsy procedure was the easy part of this case.

"It's always harder to tell someone they have cancer. It's definitely easier to do a biopsy," he said.

Emergency Department physician Dr. Ben Massenburg said he found it valuable to have an intern follow him for a few hours.

"It gave us an appreciation for what we can do for the patient," he said.

Don said that after meeting Hokama, he was no longer intimidated by the idea of providing public testimony before the County Council.

"I have a sense of community now," he said after meeting all the interns.

Dr. Dwight Lyons, a surgeon who conducted an emergency appendectomy Friday morning, said some medical personnel have questioned the benefits of the annual internship program, but he doesn't.

In fact, Lyons said, he was involved in legislative budgeting for the hospital this year and found it to be the "smoothest ever" in part because of the help provided by former interns like state Sens. J. Kalani English and Shan Tsutsui.

The hospital's Chief Executive Officer Wesley Lo shared his and his staff's dream Thursday night of turning Maui Memorial into a health hub for all of Maui County and the Big Island. He said support from individuals like the interns is necessary to carry out any master plans proposed for the facility.

"The community has to be with us," Lo said. "Everybody has to want to do this."

He said he had hoped that the interns would see: "We're not in the hospital business. We're in the health care business."

"I just want to look at us going forward and not going backwards," Lo said.

Claudine San Nicolas can be reached at claudine@mauinews.com.

Copyright © 2005 The Maui News

Original article URL: http://www.mauinews.com/print_version.aspx?id=9005

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