Capstone Project

Academic year 2019-2020

Internship at
The Faculty of Medicine Ramathibodi Hospital

Reflection paper

Ms. Lalitphan Thaidej (Gene)

Grade 11 Section 1101
 Capstone Internship Project
Daily Reflection

At
The Faculty of Medicine Ramathibodi Hospital
(โรงพยาบาลรามาธิบดี)

During
September 30th,
October 2nd, 9th, 21st, 22nd, 24th, 25th, 26th
(Total 8 days or 56 hours)

By
Ms. Lalitphan Thaidej (Gene)
6161001
 Table of Contents

Internship Schedule/ Worklog

Explanation of work in each day

Work Reflection

Intern Evaluation form

Hours Verification form

Internship Schedule / Worklog: Issued by The Faculty of Medicine Ramathibodi
Hospital

Date 07.00-12.00 a.m. 01.00 - 03.30 p.m.

Monday, Conference room OPD
30 September 2019 OPD
Wednesday, Neurosurgery (OR3) Neurosurgery (OR3)
2 October 2019
Wednesday, Ward Round Neurosurgery (OR3)
9 October 2019 Neurosurgery (OR3)
Monday, Ward Round at ER OPD
21 October 2019
Tuesday, ICU OPD
22 October 2019 (หออภิบาลหญิงประสาทศัลยกรรม)
Thursday, ICU Neurosurgery (OR3)
24 October 2019 Neurosurgery (OR3)
Friday, Neurosurgery (OR5) Neurosurgery (OR5)
25 October 2019
Saturday, Gross Anatomy Laboratory Gross Anatomy
26 October 2019 Laboratory
Day 1
September 30th, 2019

07.00 - 12.00 a.m.

Conference Room & OPD

What is it?
Conference Room is a meeting place where the Resident from one to six have to gather as they have
to present their patients’ medical history with their medical teacher. For OPD (Out-Patient Department), also
stands for Out-Patient Clinic, is the part of the hospital designed for the treatment of people with health
problems who visit the hospital for diagnosis or treatment, but do not require to be admitted for overnight
care.

Experience
This is my first day doing an internship in Ramathibodi hospital. I am very nervous yet excited. After
I have met Asst.Prof. Cdr.Sorayouth Chumnanvej, M.D. From Neurosurgeon, Neurosurgery Division, Surgery
Department of Faculty of Medicine Ramathibodi Hospital Mahidol University, we have to discuss about what
I have to do when being an internship. When we finish the discussion, I have to go to the Conference Room
first in order to learn how the residents study and present their presentation. Residents in medicine means a
physician who has finished medical school and is receiving training in a specialized area, such as surgery,
internal medicine, pathology, or radiology. In this room, there is a screen that show many MRI and CPR scan.
MRI scan stands for Magnetic resonance imaging. It is a test that uses powerful magnets, radio waves, and a
computer to make detailed pictures inside our body. The doctors can use this test to diagnose or to see how well
we have responded to treatment. For CPR scan, it stands for Cerebroplacental ratio. It can be used to predict the
adverse of pregnancy outcome and also our brain. I feel like watching a movie because everything in the room
is the same as in the medical movies or series. I have learned that the residents are very stress when they have
to present and discuss their patient’s case with their teacher. In my perspective, the residents are a person who
have a lot of knowledge and they also have a lot of experience. However, when I see their teacher blame them
about the mistake that they make when they diagnosed their patient, I suddenly realized that although
becoming a resident, they are still having a lot of things to learn. When the discussion finished, I have to go
to the OPD or Out-Patient Department to observe how the residents work. I noticed that being a doctor must
have a good personality such as being polite. Although there are some patients who are quite unpolite, the
doctors still have to take care of them and speak to them in a calm manner. I really respect these people
because they sacrifice themselves to take care of other people. They hardly have their free time. The resident
that I observe today names Taohu. She is a third-year resident. She is very polite and kind. I have talked many
things with her, and I have known that becoming a doctor you will spend time with your family less. Moreover,
you won’t have a time to travel too.

Fun Fact
When I have a break, there are many doctors come and speak to me. They ask me if I am interested to
become a doctor. When I said yes, they all said that I should run away. They laugh about their joke, but
seriously, they said that becoming a doctor is very tired. I should choose other careers. They said that I should
become a dentist instead if I want to work in the medical field because they do not have to be on the duty at
the hospital. Furthermore, they gain more money than a general doctor. However, I still want to become a
doctor, so I tell they them that I will never change my dream. They said that I am a good kid and cheer me up
that I can past the exam and become the doctor as I want.
 This is the picture of me, my friend,
and Asst. Prof. Cdr. Sorayouth Chumnanvej

01.00 - 03.30 p.m.

OPD

Experience
In the afternoon, there is nothing much to do because most people usually visit the hospital in the
morning. So, one of the nurses show me the application that Dr. Sorayouth did. It is a game for testing the
level of consciousness in a person if they can respond well or not after they have a surgery. The game is
very easy for me when they let me test the game. They said that my brain is normal. Nothing has to be
worry. I kind of confused at first that how this easy game can measure people consciousness. However,
when I saw an old people play this game, they cannot do it very well. The nurse said that their brain work
slower than people who did not do the surgery. Moreover, they’re already old so their brain are not that
fresh when compare with the adults or the teenagers. The game has four level to play. When playing the
game, the time and correctness will be record. If they use too much time or click the wrong answer, it
means that their brain are still not recovery. There is color testing, memorizing number, matching pictures,
and order the number that are shown. The nurse said that the game is still developing and she believes
that it will get better and better in the future.
Glasgow coma scale (GCS)
The Glasgow coma scale is the most common scoring system used to describe the level
of consciousness in a person following a traumatic brain injury. Essentially, it is used to help measuring
the severity of an acute brain injury. The test is simple, reliable, and correlates well with outcome
following severe brain injury. GCS is a reliable way of recording the initial level of consciousness in a
person after a brain injury or after being surgery. The Glasgow coma scale provides a score in the range 3-
15. They usually say that 3-8 are the patient that are in coma. The GCS measures eyes opening (E), verbal
response (V), and motor response (M).

This is the picture of me and the nurse who shows me the game that
they create.
Day 2
October 2nd, 2019

07.00 - 12.00 a.m.

Neurosurgery (OR3)

What is it?
Operating Room (OR), also called surgery center is the unit of hospital. In other word, it is a special
room where surgical procedures are performed. When performing a surgery, the doctors can do it with any
part of the human body. Neurosurgery is a type of surgery that involve with the human brain, or you can say
that it is a surgery of the nervous system. Neurosurgery is the medical specialty concerned with the diagnosis
and treatment of patients with injury, or diseases/disorders of the brain, spinal cord and spinal column, and
peripheral nerves within all parts of the body.

Experience
This is my first time visiting the operating room, and I am very excited. There are total two cases for
today. The first case, the doctor and his team will remove the tumor which located inside of the patient’s brain.
For the second case, the doctors’ team will remove the tumor inside of the rib cage. Yet before the first case
start, there is one patient that needs to do the CT scan first because the doctors need to look for the tumor
inside the patient’s body. CT scan, also known as a computed tomography, it allows the doctors to see inside
our body. It uses a combination of X-rays and a computer to create pictures of the organs, bones, and other
tissues. Furthermore, CT scan also display more details than a regular X-ray. CT scan does not take very long
time and it is painless. Although the doctors have found the tumor, luckily it is still small. While scanning,
every people in the room need to wear the lead apron in order to protect our body from the scattered x rays.
We also need to wear it around our neck too. The lead apron is quite heavy and when you wear it for a long
time, your shoulder will feel very weak. After the scanning process had finished, the doctors will send their
patient to her room and discuss with her about the date that she will have to take a surgery. Now, the doctors
can finally begin their work. As it is written above, the first case that the doctors will have to work with is
removing the tumor in the patient’s brain. Before they can do the surgery, they need to let the anesthetists
work first. The anesthetists are specialist doctors who are responsible for providing anesthesia to patients for
operations and procedures. In brief, anesthetists have a range of practice which extends beyond anesthesia for
surgery to include pain management and intensive care. When they finish their work, the rest of the works is
neurosurgeries’ job. They use many instruments when performing the surgery, which includes Hudson brace,
Skull ronguer, Gigli saw, Craniotome, and High-speed drill. The surgery takes four hours before it ends. I am
tired because I have to stand for four hours. I have seen a real brain and it makes me feel more interested in
this job. The process of the wok is very fun for me, but I don’t know if the others like it or not. The reason is
because before they can remove the tumor, they need to use the boring machine to bore the patient’s head. It
makes me feels like I am watching a horror movie at that time. It doesn’t look scary at all, but the smell is
unpleased. The patient is a male and looks approximately 60 years old or older than that. The doctor says that
he is very lucky because the tumor is not very big and can be cure very fast.
 In this picture, I was in the OR (3). It was very cold in there.

01.00 - 03.30 p.m.

Neurosurgery (OR3)

Experience
In this afternoon after I had taken a lunch, I take a break about ten minutes before heading back to the
OR (3) to continue the observation. The doctors need to remove the tumor that located inside the patient’s
body (around the rib cage area). This case the patient is a woman and her age is around 30. The first step
before the surgery is the same as the first case. Before the surgery, the anesthetists need to do their job in every
case because the patient needs to be unconscious. If they have conscious, they will feel a lot of pain. Moreover,
they might die because of the pain. This case also took a long time. There is also one thing that I did not
mention on the first case yet. When they remove the tumor, they need to use a very hot machine to cut of the
tumor. At first, I always thought that the way to remove the tumor is by using the scissors. I was wrong. This
experience makes me gain a new knowledge that I will never forget. After the tumor have been cut out of the
body. The doctors who are in charge of the cleaning stuff will bring the tumor and put it in a small bottle.
Inside the bottle contains alcohol and it is used to clean the tumor. One of the residents that works inside this
room told me that the reason why they keep the tumor is because it can be used to study about the cause.
 Bonus Picture

• This is the picture of tumor.

It’s located near the patient ribcages.

• This is the picture of human brain.

Day 3
October 9th, 2019

07.00 - 12.00 a.m.

Ward Round & Neurosurgery (OR3)

What is it?
Ward round, in medicine means a regular visit to patients in the hospital by medical staffs and doctors
for the purpose of making decisions concerning patients care. On ward round, the doctors will review each
patient under the care of his/her consultant with the rest of the team. A nurse may join too, so that she can
updated on the clinical plan. Each medical staffs and doctors will have a different timetable. They will visit
their patient in the different time because if they have to work at the same time, it will be overcrowded.

Experience
On this day, I had visited many patients during the morning. Most patients are old but there are also
people around 30 to 40, too. When I visited many patients, I feels sad because some of them have a very
harmful disease, which is very hard to cure. Some patients have faced with a horrible accident, which is very
dangerous. For instance, some have a car crash, some have fallen from their stairs, and many more. I feel very
sorry for them. At the moment, I always hope that I can help them somehow because I do not want to see
other people suffer from their pain. I have noticed that most people usually visit the public hospitals more than
the private ones. It is very common as the public hospitals have a lower cost. The private hospitals are more
expensive when we go there to diagnose the disease. However, both types have both benefit and non-beneficial
things. The benefit of the public hospital is that every people can come and visit. People who have a low
income will not have a lot of effect because the cost is not too expensive for them. On the other hand, we have
to wait for a long time to meet the doctors. The reason is that there are more patients than the medical staffs.
The process needs to take time because it has very long queue. For the private hospital even though it costs a
lot of money, they can provide good services to their patients more than the public sector.

01.00 - 03.30 p.m.

Neurosurgery (OR3)

Experience
In the afternoon, there is only one case that I have to observe. Today, the neurosurgeries need to remove
the tumor which located inside the patient’s brain. The patient is woman, which I assume that her age is around
50 or more. The process is different from the first case on October 2nd. The patient has been operated and
surgery for three times. Today is her forth times. Her skull had been removed because if the doctor did not get
rid of it, her brain will get injured. It does not take a long time compared with the first case as she did not have
a skull, which serves as a barrier to protect the brain. I already ask the doctor if it will cause any harm or not
when we do not have a skull. He told me that it will not affect us, we can live normally like nothing happen.
On the other hand, he said that the people who has no skull should be careful all the time because accident
can occur at any time.
Picture taken from the inside of OR3
Day 4
October 21st, 2019

07.00 - 12.00 a.m.

Ward Round at ER

What is it?
ER, also known as emergency room. ER in medical term, it stands for a hospital room or area staffed
and equipped for the reception and treatment of persons requiring immediate medical care. Most people who
come to these room have a bad accident such as a car accident, a fight, and many more.

Experience
Today I have a chance to go ward round at the emergency room (ER). In this room, I have seen many
beds in the room, and there are many patients too. It is very crowed. All the doctors and nurses are very busy
because they need to take care many people. I have to stay at the corner of the room because I do not want to
disturb their work. There is one thing that I really want to mention. There is one moment while I was observing
the doctors. On the left side where I am standing, there is an old woman sleeping uncomfortably because she
cannot breathe well. Her nose is very red because she has a lot of mucus. The nurse needs to help her by
inserting the Endotracheal Tube. However, the nurse inserts the tube very hardly and I can see the patient’s
tear. The old woman was crying but she could not tell that she is hurt. So she just makes a cracking noise. I
almost cry with her because I hate to see old people in pain. In my mind at that moment, I feel very abhor at
the nurse. I know that it is her job but she does not need to hurt her patient. Also, before the nurse inserts the
equipment, she had tired up the patient’s wrist to make sure that the patient cannot move. Or else, the nurse
cannot insert the Endotracheal Tube, and the patient will continue to suffer because she cannot breathe.

01.00 - 03.30 p.m.

Out-Patient Department (OPD)

Experience
Before visiting the OPD, Asst.Prof. Cdr.Sorayouth Chumnanvej had bring me to his laboratory
because he knew that I am interested to be an Anatomical Pathology Technician, which is also known as an
autopsy. Care lab is the name of his laboratory. His lab uses a robot to do the surgery. However, the robot
is used with the dead body only because he said that it is too dangerous to use with alive people. When I go
inside his laboratory, it is my first time that I have seen so many dead bodies. He told me that all of the
bodies come from a person who is willing to give their body to the doctor after they died. They let us use
their body for study. I feel very impressed for those who have a kind heart and brave enough to give their
body. There is nothing much to do after the tour at the laboratory because there are few people in the Out-
Patient Department. I am bored at that time because there is nothing to do. I just have to watch the residents
and the doctors talking with their patients. When there is nothing to do, the doctors allow me to go and take
a walk around the hospital. It is quite fun even though I already observe the hospital.
Asst. Prof. Cdr. Sorayouth Chumnanvej’s laboratory.
Day 5
October 22nd, 2019

07.00 - 12.00 a.m.

ICU (หออภิบาลหญิงประสาทศัลยกรรม)

What is it?
ICU, also known as Intensive care unit. ICU refers to the specialized treatment given to patients who
are acutely unwell and require critical medical care. An intensive care unit provides the critical care and life
support for acutely ill and injured patients. Except you are an emergency admission, you will need a referral
from your doctor or specialist to be admitted to ICU.

Experience
Today is a very busy day for me as I need to observe many doctors and residents. The reason why I
have to follow many different people is because there are lot of patients coming to the hospital today. The first
thing that every doctors and residents must think of is about their patients. Patients always come first no matter
what. I can learn many things from many medical staff because they are all working in different things. I can
only sit and watch them quietly as I might disturb them. I observe the tone of the voice that the medical staff
use with their patient. Look how they express their emotion and how they act. A few hours later, I have visited
the intensive care unit. There were many medical students and medical teachers. The medical students have
to take note and listen to their professor all the time because everything that their teachers teach can be on
their exam. They work very hard and I like how they concentrate very much. I honestly respect them from the
bottom of my heart.

01.00 - 03.30 p.m.

Out-Patient Department (OPD)

Experience
In the afternoon, there is nothing much to do. So I decide to talk with some of the residents that look
very friendly. I ask them about the patient who cannot afford the care. Moreover, I also ask how can poor
people get a care and treatment from the hospital. The resident whose name is P’Taohu told me that they can
borrow money from the hospital. They can give the money back to the hospital after they collect the money
to pay the hospital back. P’Taohu said that there won’t be any debt. It is a very good thing in my opinion that
the patient can borrow money. Furthermore, I ask P’Taohu about her experience when she was still being a
medical student. She said that the first year we have to learn all of the basic that we have learnt since high
school. If we did not learn and skip the lesson, it will cause a lot of trouble for the rest of the years that we
have to learn. Medical student needs to plan very well because they have a lot of works to do, and there are
many exams that they have to prepare for. I can tell that she is very tired by looking at her eyes. She also tells
me that becoming a doctor is not easy, there is no free time like other careers. She can travel aboard once a
year because she needs to take care of many patients. She also does not have much time with her family too.
I feel sad when I hear that.
Day 6
October 24th, 2019

07.00 - 12.00 a.m.

ICU & Neurosurgery (OR3)

Experience
Today I start my day by walking around the ICU to check each patient in the room with many residents
and doctors. The doctors need to tell the patients to follow the things that they order. For example, when the
doctors tell their patients to lift up their left hand, the patients need to follow the order. It is very easy things
to do. However, some patients cannot follow the instructions. The doctors had said to me that there will be
some effects after they had taken the operation. They might not be able to respond as fast as normal people
do. Today I observed three doctors and I really like how they organize their work together. One of them have
to take note and the rest have to talk plus check their patients’ consciousness. Sometimes the doctors need to
shout to their patients because they cannot hear. Even though the voice is very loud, some patients still cannot
hear. In ICU, there will be one special room for the patients that might have a disease that other people can
get infected by touching or staying near them. Moreover, the temperature in that room is very cold. There is
one strict rule that every doctor needs to follow. The doctors must wash their hands before and after touching
their patients. I have noticed that nurses that stay in the ICU have to wear a pink outfit, and I think that other
hospital might wear a different color. Other sections have to wear a different color and they usually wear
green. After visiting the ICU, I need to change my cloth before entering the operating room. The atmosphere
inside the room is not very stressful like in the movie or in the series. They can listen to their music while
working.

Fun Fact
Different location of the tumor causes a different side effect to the patients. For instance, if the tumor
located in the front of the brain, the patients will usually have a bad mood. If the tumor located in the middle
of the brain, the patients will feel very sleepy and weak. The ability to memorize things will not be effective
like in the past. If the tumor located at the back of the brain, their eyes sight won’t be as good as in the past
too. The worst case found in the patients is that they did not wake up. However, they still feel pain because
the receptor still working.

01.00 - 03.30 p.m.

Neurosurgery (OR3)

Experience
In the afternoon, I feel very depressed and sad because today case is very hard to handle. Naturally,
most tumor will be located inside the brain. However, in this case, there is a very big tumor outside of the
patient’s skull. One of the doctors said that she is only 30 years old and there is no chance that she can survive.
He speaks to me very straight that she will die soon because the tumor already grown big and it will continue
to grow and grow until she cannot handle the pain. She has taken an operation for seven times. This is the
eighth times for her. I am very shock and sad at the same time. She is younger than my mother but she will
die soon. I almost cry when I know that she cannot stay any longer. It is very painful to see that even though
many doctors have tried so hard to help her, there is still no hope. Her head looks terribly hurt because all I
can see is the tumor. I cannot see her face very clearly.
Picture taken during the operation (Tumor in brain)

In front of operating room

Day 7
October 25th, 2019

07.00 - 12.00 a.m.

Neurosurgery (OR5)

Experience
There are two cases for today and it consume lots of time more than any case that I have seen before.
I also met the resident from Russia today. She told me that she came to Thailand to observe the work for two
weeks. I am very curious about why she chooses to come to Thailand because when becoming the resident,
they can choose one country that they want to go to observe other doctors from different countries. She told
me that the reason why she chooses Thailand is that Thailand have good quality of equipment. Many people
respect doctors. At first when I hear that, I was confused because people usually respect doctors and medical
staffs. She said that in Russia, people usually look down the doctors and they did not respect the doctor at all.
She also states that doctors in Thailand gain a lot of profits. She told me that she is very jealous. Moreover,
doctors in Thailand care their patients very much. They treat every patient very kindly and talk very smoothly.
There is no type of this doctors in Russia.

Behind me is the machine that can scan human brain

01.00 - 03.30 p.m.
Neurosurgery (OR5)

Experience
I just need to watch / observe the doctors working as a teamwork to remove the tumor again. The first
case takes a lot of time. I have late lunch at 1.00 p.m. And they are still working when I come back. They
haven’t had their lunch yet. After this case ends, they need to continue working with other cases. I think they
might have their lunch at four o’clock or later than that.

Fun Fact
During the operation, we can check if the patients are already unconscious or not by looking at their
eyelids. If there is some movement, it means that the patients are not unconscious yet. Moreover, when it’s an
operation time, the percentage of the patients waking up are very low and hard to see. There are many ways
to check if the patients will wake up or not. First, we can look at the BIS (Bispectral index), which will be
attached on the patient’s head. It is used for checking the brain wave. The second thing that we will look at is
the heart rate. We also need to look at the machine that help the patients to breathe. Usually when the patients
are unconscious, they will not have the ability to breathe by themselves. If the patients are going to wake up,
they will breathe against the machine.

This is a group picture with Thai residents

and Russian resident.
Day 8
October 26th, 2019

07.00 - 12.00 a.m.

Gross Anatomy Laboratory

What is it?
Gross Anatomy Laboratory is a place where the traditional study of human anatomy by dissection will
be demonstrated. The word “Gross” comes from German word for large, which referring to anatomy that does
not need a microscope to be seen. Students will have an opportunity to learn anatomy from the best teachers
possible, which is the altruistic individuals who donate their bodies for education.

Experience
First, I changed into a surgical room proper uniform which is commonly known as “Scrubs”. The full
outfit includes green dress shirt for ladies, a green paper mask, a single-use paper cap, and a pair of rubber
shoes. The outfit will be prepared by the medical teacher who is responsible for teaching the student in the
Gross Anatomy Lab. When finish using the outfit, the dress must be put away in order to get clean. For the
paper mask and a cap, it can be thrown away because it can be use only once. After I got change, I have to
wait inside of the Gross Anatomy Lab in order to learn together with the residents. I have learnt that when we
enter the medical university, we can learn with the dead body when we are in second year. However, we can
only observe just a little because we are not the expert yet. We can only operate on the dead body deeply when
we graduate the six year in the university and we become the resident. Resident in medicine means a physician
who has finished medical school and is receiving training in a specialized area, such as surgery, internal
medicine, pathology, or radiology. The temperature in the lab was very freezing because it must be cold all
the time in order to keep the dead body fresh. Although it’s very freezing, I really like it. When all the residents
and the medical teachers (the experts) come into the lab, they have to discuss together about the things that
they are going to operate today. There are two sections and are divided into the morning and the afternoon. In
the morning, the plastic surgery will take place. The residents have to learn the anatomy of human face,
especially the nose so that they can do the plastic surgery. When I see them cut the nose, in my opinion it
looks like a mushroom. Moreover, when they do the face lift, I can see many yellow pigments underneath the
face’s skin. It is an adipose (a fat). I am sure that many people might be afraid of the corpse, but it does not
look scary at all. I think that it is a good thing to learn because if we learn from the living people and there is
some error occur, it may cause the patient to death.

Plastic surgery
Plastic surgery is a surgical specialty involved with both the improvement in a person’s appearance
and the reconstruction of facial and the body tissue defects due to illness, trauma, or birth disorder. Plastic
surgery restores and improves function, as well as appearance. It can involve surgery on any part of the
anatomy, except the central nervous system. Furthermore, Plastic surgery includes both reconstructive and
aesthetic (cosmetic) procedures. In this morning, there are three bodies that the resident can use in order to
study before doing the real work with a living people. Today, they only concentrated with the face part, which
is the aesthetic (cosmetic) plastic surgery. Cosmetic surgery is done to repair or reshape otherwise normal
structures of the body, generally, to improve appearance.

Fun fact
I have talked with one of the medical teachers about doctors who do plastic surgery. He said that almost
every people want to do this surgical specialty because they can gain a lot of money. There are many patients
who are willing to do the surgery because they want to look beautiful and handsome.

01.00 - 03.30 p.m.

Gross Anatomy Laboratory

Experience
After I finished lunch that the maid prepares for everybody, I have to go inside the lab again. However,
this time I have to sit with other residents so that I can watch the presentation slide and listen to the medical
teachers. The information on the slides demonstrated the definition of the liver, its function, its location, and
its shape. In the slide, it is also mentions that there are eight segments for the liver. After we have learned all
the basic things that we have to know about the liver, the teacher opens a new presentation slide so that we
can move on to our next topic. We have to learn how to operate the liver. There are totally eight steps to do
the surgery. It starts with the exploration, then follow by mobilization, inflow control, outflow control,
parenchymal transection, post resection, and pancreaticoduodenectomy. There are six bodies that is available
for us to use for the study in the afternoon. The new resident group replaces the previous group because they
study in different section.

Anatomy of liver
Liver shaped is like a cone, it has a dark reddish-brown organ that weighs approximately 3 pounds. It
is located in the upper right-hand portion of the abdominal cavity, beneath the diaphragm, and on top of the
stomach, right kidney, and intestines. The blood is very important for the liver, and there are 2 sources that
supply blood to the liver includes Oxygenated blood flows in from the hepatic artery, and Nutrient-rich
blood flows in from the hepatic portal vein. Our liver holds about one pint (13%) of the body's blood supply
at any given moment. The liver consists of 2 main lobes. Both are made up of 8 segments that consist of
1,000 lobules (small lobes). These lobules are connected to small ducts (tubes), which connect with larger
ducts to form the common hepatic duct. The common hepatic duct transports the bile create by the liver cells
to the gallbladder and duodenum (the first part of the small intestine) via the common bile duct.

Fun Fact
I think that the corpse smell like a pickled fish, it makes me feel a little dizzy. However, I can get used
to it after a while. Furthermore, I have noticed that one dead body can be used to study for many times. It can
be used for a year. I really respect the people who are willing to donated their body after they died. They are
very brave in my opinion.
Work Reflection
First of all, I would like to explain the reason why I choose to do an internship at the
hospital. The main reason I prefer to work in the hospital is that I want to study and become
a good doctor in the future. If I can work in the hospital, then I can know if I suited to be a
doctor or not. I want to work in the hospital and become a doctor since I was in grade 6
because I want to help other people. I don’t want to see other people pass away like my
grandmother. I have to deal with depression and sadness for a long time. I don’t want other
people to suffer like me when people who they love passed away. Furthermore, I
specifically choose Ramathibodi Hospital because it is the place that I want to work. The
atmosphere in this hospital is very heart-warming and clean. The facilities are very effective
and high-technology.

After eight days of internship, I feel very relieve as my work is done. On the other
hand, I want to continue working as I like the job that I take in the hospital. I have so much
fun at that time and all the memories that I got is very wonderful. I had met many friendly
medical staffs who taught me many beneficial things during the internship. I wish I can still
be in touch with them because I still want to gain more experience and knowledge. The
internship is not hard at all in my opinion because I really enjoy it. Most of the jobs that I
need to do is to observe the patients with the residents, doctors, and nurses. I also need to
observe the routine of doctors and medical students. It’s more like I’m having a field trip
rather than doing an internship. I learn that doctors need to be very patient and calm because
every people that they met is totally different. Each person has their own personality and
level of manner. Sometimes doctors need to deal with the bad people. They cannot blame
them or argue with them as it is a bad action for doctors. Doctors have to be able to treat
other people equally even though some of them is not a good person. They must have very
good emotion control. I really respect all of the doctors, especially in this hospital. In
contrast, there are few problems that I have to deal with. I have to wake up very early every
day because the work starts at 7 o’clock in the morning and my home is quite far from the
hospital. Sometimes I feel tired and exhausted because I have to walk all day to check the
patients with my residents. Furthermore, when I am in the operating room or the surgery
center, I need to be very quiet and try not to make any problems. If I accidentally touch
something in the room, it might cause a very negative effect to every people in the room.
I also have to take note while my residents were teaching me and explaining some of the
information that I need to know. I cannot catch up with her sometimes because she speaks
very fast and she speak a lot, which makes me feel very dizzy. However, I still like my
work here. The solution that makes me feel fresh all the time is to sleep early and eat a lot
of foods in the morning in order to gain more energy. Sometimes I also do exercise about
30 minutes at home before going to the hospital so that I can be alert all day. Moreover, I
want to become a Forensic medicine in the future. This internship gives me the opportunity
to learn something new in the medical field and I also have the opportunity to learn the real
dead body (Gross Anatomy) which is very amazed. They do not look scary at all, they just
like an ordinary people but cannot breathe nor live. I think that I am very lucky because no
one ever have an opportunity to go near the death body unless you become a medical
student.

Nevertheless, one thing that I always think about while working in the hospital is that
I think this hospital still lack of medical staffs and I believe that other hospitals have to face
this problem too. In Thailand, we still lack of many medical staffs which lead to
overcrowded of patients per doctor. Doctors have to work very hard all the time and they
need to treat their patients equally. They don’t even have their time for themselves. I wish
that I can be like them (become a doctor) so that I can at least reduce their work. If the
medical school can create more doctors, that would be very lovely. In fact, if we have more
doctors then the patients won’t have to wait all day long. I had asked my resident who is in
charge of taking care of me about the problem in the hospital. She said about the lack of
medical staff and she also tell me that many people have complained about the slow process
of works.

There are many qualifications of a doctor. To become a doctor, the person must have
the following traits respectively. First of all, the most important thing to be a doctor is to
have a good manner. They also need to follow all of the rules and medical ethics. Doctors
must be good person who commit to help other people because doctors need to take care
of their patients all the time. If the person doesn’t have a commitment for helping other
people, then this person is lack of qualification. Second, doctors should interest in science
because science is the basic things that they need to use for this career. Third, they need to
have the ability to work under pressure. It is true that not every day of a doctor’s life is full
of stress, but it occurs frequently. The person who want to become a doctor have to be able
to handle the stress, work under pressure and make quick decisions. Also, doctors need to
have the ability to make other people feel at ease. In every single day, there are many
visitors in the hospital. For many people, visiting a doctor is a stressful experience. Doctors
need to be able to communicate clearly and explain their patient choices carefully. At the
same time, the doctors have to inspire the patient’s trust and confidence. If they inspire
trust and confidence from their patients, patients will be more likely to follow the
instructions but may also seek help earlier and provide the useful and more information.
Lastly, doctors need to have a leadership skill. As a doctor, he / she has to be able to lead
other people healthcare with the effective way

After the internship had ended, all of the work that I had done there proves me that I
have full qualification to become a doctor which makes me feel very proud. All in need to
do now is to study harder in order to take the exam to entrance to medical university. Deep
down in my heart, I know that becoming a doctor is very tough and tired. There are many
obstacles and many hard tasks to complete. Nonetheless, I still want to follow their path
and become a doctor in the future like them. If there are things that I cannot complete, I
will find the solution for it no matter what. Finding the solution might take a long time, but
it would be worth it.
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