INTERNSHIP JOURNAL

Name: Alyssa Abonitalla

Internship Site: Klein Dermatology & Associates
Dates: December 18, 2017; December 21. 2017; December 22, 2017
December 18, 2017:
Upon entering Klein Dermatology & Associates, I found myself at ease. The staff was
very welcoming since they knew I was an intern from Glencoe High School. I first met with
Karyn Gibbons, who is the office administrator and the one responsible for coordinating my
days and hours. Since my internship was in the medical field, I had to sign a confidentiality form
to protect the rights and identity of the patients. This also kept Klein Dermatology & Associates
from being sued. Unfortunately, because of HIPAA, I am not allowed to take photos of what
procedures occur. I then met with Dr. Klein who gave me a quick rundown of the requirements,
education wise, to become a MD in dermatology. She was very engaging which lifted some
weight off my shoulders. We quickly went into each patient’s room and Dr. Klein made sure to
gain consent with the patient(s) for me to be in the room, if they agreed, Dr. Klein informed me
of the patient’s previous appointment. If the patient declined, I sat with other staff and looked
over a couple of books they had set out for me.
Just within the first appointment, I learned a handful of things: types of benign skin
spots, types of procedures for check ups and more. The first patient was very comfortable with
me being in the room and often asked me questions to alleviate some nerves that was very
evident in my face, supposedly. The next patient I interacted with was very kind and also open,
however, I learned that insurance companies do not like it when two types of appointments, in
this case, general and cosmetic, happen in one appointment. Dr. Klein said one of the struggles
is when patients prolong appointments which will delay and put her behind schedule. Dr. Klein
exposed me to how liquid nitrogen comes in handy when freezing off precancerous cells to
prevent further maturing of the cancer cell. After doing so, Dr. Klein performed a biopsy on a
question area to test if it is a basal cell. When using liquid nitrogen, she counts in seconds,
usually between five to fifteen seconds. At that point, I felt more comfortable being an
observer.
Throughout the last two hours, I was thrown into a great amount of different surgical
procedures. The last hour and a half was dedicated to an ear surgery in which the earlobe was
split due to a past event. Erin, a medical assistant to Dr. Klein, prepped the patient’s ear by
numbing the area. In addition, Erin prepares the instruments and bandages, needles and
chemicals that will be used. Using a tongue stick to brace the knife against, Dr. Klein snipped
away the scarred tissue of the ear to seal the incision to prevent further bleeding. As Dr. Klein
began to stitch the two parts together, she ended up using seven stitches; she mentioned that
having prior knowledge of hand sewing is helpful because it is the same idea for with skin.
 “Skin is like fabric.” -Dr. Klein
Erin lathered on some Vaseline on the stitches and placed bandages over it. Injuries tend to
heal faster in moist places rather than drier areas.

December 21, 2017:

As soon as I opened the doors to the practice, Karyn was quick to greet me with a lab
coat in hand. She directed me to Erin, who I would be shadowing while Dr. Klein looks at some
slides of the previous patients. Erin informed me that as a medical assistant, she prepares all
the necessary documents and information to minimize the time of flipping through papers to
find what occurred in the previous appointment and the biopsy results for Dr. Klein. Also, Erin
writes the medication and family history of patients. Shadowing Erin has revealed to me that
the life of a medical assistant is super intriguing because it still provides an opportunity to work
closely with the doctor. This particular day, for the most part, I was stationed by Erin’s desk as
Dr. Klein’s patients wished for modesty, this allowed me time to ask Erin questions. She
mentioned that the most challenging encounters are when patients are very chatty or when
they have many problem areas in addition to the one primary area as the reason for the
appointment. Dr. Klein at one point told me that she has a block in her schedule to inform me
of some additional knowledge in that it is more favorable for new patients who are couples, to
be in separate rooms to make the appointment quick and easy. Often times she has to ask
parents of teenagers to leave the room to ask about personal questions, such as one’s sex life
to provide say, birth control.
One of the first patients I saw today was one with rough patches on the skin from
extended exposure to the sun. Sun damage usually becomes pre-cancerous so the best solution
is to prevent it from growing is with cream or photodynamic therapy- although the cream is
more efficient. Certain occupants like firefighters, farmers or pilots have higher risk of cancer
due to the heat/sun exposure. I had the opportunity to view a biopsy using a punch tool- similar
to a hole puncher. This was used on a mole.
Cosmetics in dermatology was a new concept for me. I saw the process of using Kybella,
an injectable liquid that essentially melts away fat for double chins. Dr. Klein mentioned that
over time, she is able to tell the difference between each layer of the skin, which is helpful for
cosmetic procedures using needles.
The last two hours consisted of viewing an extraction of a pilar cyst on the right parietal.
Before extraction, hair must be matted down with gel to view the cyst better. Trick to know:
use distraction to make the patient forget about the pain from the needle to numb. The
procedure itself was simple. Cutting open the scalp to loosen the cyst to come out. Luckily, the
cyst was still encapsulated.
December 22, 2017
Knowing that today was my last time interning for Dr. Klein made m both excited and
sad because I enjoyed the short days I had previously. I asked Erin what schooling was like to
become a medical assistant and she said it was similar to high school in the sense that there
was a lot of memorizing and many biology classes. Being a medical student was hard because
it’s tough finding the job itself. She explained one of her skin conditions that she calls her,
“super power.” That being keloid scarring, which is essentially when the body over heals itself.
Getting a wound near the heart will heal faster because of the white blood cells pumping faster
whereas areas below the knee would take much longer to heal. Those with keloid scarring often
have to massage the area to promote circulation.
When I walked in with Dr. Klein for the first patient, I noticed the young female had very
orange skin, carotenaemia. Skin tone differences are very subtle, so it is highly important for
doctors to be able to tell the difference between an orange and a yellow skin tone. Yellow
typically reveals there is some sort of problem with the liver. When it comes to patients with
tattoos, specifically black ink, makes the doctor’s life much more difficult due to the potential
problem of missing a cancerous area that is covered by the tattoo.
Dr. Klein performed a shave biopsy on a patient with what was assumed to be basal cell
carcinoma based on the physical appearance. To ensure Dr. Klein had gotten all of the basal
cells, she used a scraping tool along the shaved area. Normal skin does not scrape away unless
it has basal cells. She was able to scrape off an additional three millimeters of circumference. In
times where the basal cell is beneath the skin, Dr. Klein must use a tool to scoop out the cells.
In the last hour of my internship, I was able to watch a cosmetic procedure in which
Botox was used for hyperhydrosis. Botox makes a certain neurotransmitter put a block from
receiving messages of excess sweating. Botox is insanely high where one 100mL vile is worth
$610. A patient using this particular procedure must come in every month for treatment to
reduce their symptoms.
TOTAL HOURS AT KLEIN DERMATOLOGY: 15 HOURS
Internship site: Kaiser Permanente- ICU
Date: May 2, 2018
Today, I am shadowing Alphonsa, an RN in the ICU. She ran me through her
responsibilities, one of which being in charge of two to three patients since the ICU holds only
twenty maximum. The first thing she does upon entering a patient room is using sanitizer,
except for special cases. The ICU is the only unit in the hospital that has access to view patient’s
EKG on all levels of the building. She showed me which monitors correlate with the ICU- only
two. Alphonsa showed me the different heart rhythms and pretty much reviewed what I had
learned previously in health sciences last year. The ICU has a rule called, “NOWA,” no one walks
alone. This is for patients who wish to move up and around outside of their room. This is to
ensure that there are no additional injuries.
I was stationed at Alphonsa’s desk for maybe an hour or so. This gave me time to reflect.
I realized how quickly one must be able to retrieve the name of certain acronyms for certain
conditions because the hospital has spreadsheets of patient conditions using acronyms.
Alphonsa only has two patients that she is to check up on throughout the day. Her
responsibility is to check up on them at least every fifteen minutes. She asks patients how the
feel, provides medication and charts every since action (example: actions- getting up, sitting
down; medications- how much, what type; who comes in and out of the room, etc.).
Within the first half of my eight-hour shift, I can honestly see myself working as a nurse.
I do enjoy interaction, but with two to three patients, I am able to have less stress when
comparing it to my previous internship with Dr. Klein.
Alphonsa was a nominee for the DAISY Award, an award ceremony that recognizes
nurses who have a ton of compassion for their patients. I was able to attend this ceremony, the
tea party. The flowers were true to its ceremony name and everything one would think of for a
tea party, this ceremony had.
After the tea party, we returned to the ICU where one of the patients of Alphonsa was
transferred out and her other was discharged, leaving her with zero patients. Luckily this didn’t
last long as she had a new patient be assigned to her, this patient was essentially quarantined.
Those who enter the room must put on a gown, gloves and a mask to protect themselves from
what the patient carried, in this case, an infectious bacterium that causes diarrhea. Instead of
leaving the room to use hand sanitizer, all people who enter the room must wash their hands to
kill the bacteria.
TOTAL HOURS AT KAISER PERMANENTE- ICU: 8 HOURS
Internship site: Kaiser Permanente- Imaging
Date: May 9th, 2018
This internship was my shortest, being four hours. I was able to examine X-ray tests take
place. X-rays are different for each patient, depending on the problem areas. Generally, there
will only be two to four pictures taken of an X-ray. A red horizontal line is used to guide to
center. The rays will shoot to the center and diverge outward.
All technicians in this department must be cross trained for all scans. Techs aren’t
assigned patients, it’s more of a first come, first serve.
I was here for four hours and I felt that I had learned nothing.