Elective Course at Osaka Medical College

Taipei Medical University, Taiwan

Medicine, 7th grade student

HSU, Chen Heng (Steven) 徐振恆

11/02/15

The first day of school was quite interesting for me. Feeling nervous but also

curious about everything makes the chillness November more refreshing. Following

the psychiatrist professor’s ward visiting is the start of the very first course in OMC.

Though I can’t understand Japanese, but through the focused eyes and serious face, I

can feel the academic atmosphere around the ward. After the ward visiting, Dr.

Kanazawa taught us about the basic knowledge about psychiatry. I really learned a lot

from the teacher. One impressive moment is that the teacher brought us to do the

NIRS, which is a new technology to detect schizophrenia and bipolar disorder. Later

on, Professor Toshiaki Hanafusa took as to visit the whole campus. The museum, the

luxury ward, the anatomy lab etc, clean and neat is seen everywhere even in the

most detailed places. We also met the president of OMC, who is very friendly.

After, an exhausted day, the welcome party, most anticipated schedule, finally

started with those friendly OMC students. We discussed many difference about

medical school between OMC and TMU. We also talked about the places we have

been to before. It’s quite a wonderful experience chatting with them. Thanks to

Kaneaki Inoue, I enjoyed my first time with the right way to taste green tea, which is

very tasty also. After getting back to my dorm, my mind is full of all the excellent

memories I had today. I am look forward to making more great memories in OMC.

11/04/15

This morning, doctor Futaki explained her experiment and research to us. To be

honest, I didn’t remember much about basic science since that I haven’t been

reviewing them for several years, but I know they are very important. Without those

experiments, doctors wouldn’t be able to treat, or even cure patients. The

knowledge, every treatment and every medication are all based on experiments.

After the lecture, we visited the professor’s laboratory. She demonstrated her results

to us, showing us the genomic changed mouse with fluorescent showed under

special equipment. We also see the dissected part of the mouse under a microscope,

which was pretty interesting because they remind me of the days I spent in the lab

back at TMU when I was in my second year. In the afternoon, Dr Li not only told us

about his researches but also shared his life experience with us. Due to the fact that

all of us are not Japanese, it’s obvious that we would encounter same problems

studying abroad. Beside the knowledge doctor Li gave us, I think the life experience

the doctor shared us are also valuable, which is to find my interest and stick to it. As

long as you find out what you like, you can persist on it even if obstacles are on your

way. Thanks to doctor Li, I now learned more about the current Japanese medical

issues, also the pros and cons. Hope one day in the future I’ll find out what I want.

11/05/15

Today we met professor Miyatake, who introduced BNCT technology to us. BNCT,

a Boron neutron capture therapy is a whole new concept to me. Neutron capture

therapy (NCT) is a noninvasive therapeutic modality for treating locally invasive

malignant tumors such as primary brain tumors and recurrent head and neck cancer.

It is a two step procedure: first, the patient is injected with a tumor localizing drug

containing a non-radioactive isotope that has a high propensity or cross section to

capture slow neutrons. The cross section of the capture agent is many times greater

than that of the other elements present in tissues such as hydrogen, oxygen, and

nitrogen. In the second step, the patient is radiated with epithermal neutrons, which

after losing energy as they penetrate tissue, are absorbed by the capture agent which

subsequently emits high-energy charged particles, thereby resulting in a biologically

destructive nuclear reaction. It is also surprising that professor is cooperating with

Taiwan’s hospital and university for further development of BNCT. After the

professor’s astonishing presentation, he demonstrated the prosperous future and

incredible treatment of BNCT to us. I think this technology will be giving those

patients whom suffering from malignant cancer such as GBM a powerful solution.

After the introduction, we also had some discussion about the recent development

of BNCT which really broadened my views. I am sure that BNCT will be a promising

treatment in the future.

11/06/15

Time flies so fast that I didn’t realize it was Friday already until we were having

lunch together after watching professor Hanafusa dealing with patients with Type

1DM and the ward round with so many Japanese students. One thing that’s new for

me is that in Taiwan, most of the diabetic patients are type 2. I merely know anything

about it. Thanks to Ms. Matsumoto’s help, I read about the paper published on NEJM

by professor Hanafusa. He is the pioneer and prestige in the field of type 1 DM.

Inside the OPD, I saw how gentle and polite the professor dealt with the patient. No

matter what the question the patient asked, professor always replied him with kind

and patient. After the OPD, we followed the diabetology ward round. Thanks to

doctor Tachibana for translating all the stuff they discussed, or else I wouldn’t be able

to understand what the doctor’s are talking. What was interesting is that we

compared some medication between Japan and Taiwan, and surprisingly, at least to

me, many of the drugs are the same. The doctor also taught us some treatments for

type 1 DM since that I knew almost nothing about it.

In the afternoon, I watched how the senior students presenting thyroid gland

ultrasound. This was also less encountered by me back in Taiwan. After watching

several cases such as thyroid nodules, Hashimoto thyroiditis, and follicular carcinoma,

the senior helped us examined the thyroid gland with each other. This was very

fascinating because I have never done this before. Later on, we listened to Dr Ali’s

lecture about his neuronal research with zebra fish. Though I couldn’t catch

everything he said, but I am confirmed that it will be very useful for the future

development of neuronal disease.

11/09/15

Today we learned about immunohistochemistry stain. This reminded me of the

days I spent in laboratory preparing H&E stain but not knowing what I was doing.

Professor Jin explained the protocols step by step thoroughly. The research professor

Jin is proceeding right now is about the growth of intima on the inner layer of

artificial vessels implanted in dogs. Associated to clinical uses, the development of

drugs or special shunts that prevent the growth of inner layer will give benefit to

those undergoing heart surgeries such as CABGs, due to the reason that many

patients with those kind of surgeries are under the risk of stent restenosis caused by

the growing of inner layer on the stent. After all of the sophisticated steps can

waiting, we finally see some part of the results done by the professor. At the end, the

professor showed us the stains under the microscope, which is compared to what

the professor said in the morning. In conclusion, I think the basic science and studies

are really important, without these experiments, we won’t be able to have progress

in our clinical manifestations. Thus, I think I really need to consider going to the labs

when I get back to Taiwan.

11/10/15

Today we learned about cardiology. In the morning, we learned about heart

sounds and heart murmurs. We discussed about the formation and abnormalities.

Honestly speaking, I took so lectures back at Taiwan when I was at the department of

internal medicine. However, some of the concepts I thought I understood were

proven wrong today. The teacher spent some time explaining to us about what I

thought was right, and after some brain storming I finally got it right. After learning

about the heart sounds and hear murmurs, it was the time to make it practical. The

teacher introduced as the “Ichiro”, the simulation instrument used to help medical

students practice diagnosing heart problems with audible heart murmurs, palpable

heart motions. However, I still had trouble identifying which kinds of heart murmurs

were showed. In my opinion, only lots of practices will I eventually get the point of

differentiating those heart problems. Time flies until I realized it was time to end the

lecture after watching the doctor showing us many typical cases of heart problems

under sonograph. Though I had practiced some cardiac echo back at Taiwan, but

most of them are without any heart disease. Today, the most impressive case is the

takatsubo disease. I had been taught many times about the disease but never had a

chance to see it under the cardiac echo. Today was a really nice learning day.

11/11/15

Today’s lecture is pathology, a department I have never visited before. My

memories about pathology only stopped at third and fourth grade when I had to be

tested of the specimens. After starting working in the hospital, I sometimes heard

about sending frozen specimens in the operation room. However, I never had a

chance to understand the steps to make a frozen specimen. Thanks to the doctor, I

finally figured out how the frozen specimens are made. The doctor also reviewed

many metastatic changes of carcinomas with us to help us learn more about how

pathologists’ work. To be honest, after a whole day of watching those slides, my eyes

and body were so tired that I can’t really pay 100% attention. But what I learned

most from the doctor is his enthusiasm. He loves his work and is proud of it, too. It

will be soon that I have to decide which department I will go in two more years, I’ll

have to figure out what I want and live with it for the rest of my life. Seeing the

doctor so enjoying his work make me realize that, no matter what others think, listen

to your heart, follow it, and you will find happiness.

11/12/15

Today we visited the department of emergency. After a brief introduction of the

Japan’s current emergency system, we visited the fire department in the Takatsuki

city. I never had a chance to visit a fire department back in Taiwan so I was pretty

excited when I saw the monitor of the whole Takatsuki city’s firefighter

communication system. After that, we were brought to get a close look at the

ambulance. Though I had rotated the emergency department at Taiwan already, but I

haven’t had a chance to see what it look like inside an ambulance. They

demonstrated every equipment to us and explained those every detail. I was quite

astonished by the design of the ambulance which they use every inch of the space to

make the most effort. After the eye-popping fire department tour in the morning, we

went to the institution we had been longing to visit for such a long time, “the

department of traumatology and acute critical medicine at Osaka University”. This is

the place where the Japanese drama “Code Blue” took place. Actually back in Taiwan

at our hospital, we also have a helicopter that can help transfer patients from rural

areas to medical centers for more advanced treatment. But I think the doctor Heli

system is more widely use in Japan. Maybe I can bring some experience back to

Taiwan and help our hospital improve out system. After learning the system of

“Doctor Heli” and visited the real helicopter, we waved goodbye to the director of

the center with the beautiful sunset lost in the horizon.

11/13/15

Today’s schedule was dermatology, which I have never managed to understand

even the most basic knowledge. I started the morning in the outpatient clinic,

watching the doctor patiently reviewed the wounds, taking the histories, and

prescribing the most suitable medicine. Unlike Taiwan, where we often have more

than forty patients in every clinic that the doctor actually don’t have time to examine

every patient carefully, in Japan the number of the patient for each doctor is limited,

ensuring the quality of the examination. The seniors were also friendly that they

always tried to help the translations. After reviewing all of the twenty patients, I felt

pretty exhausted because the teacher taught me so much. In the afternoon, we had

ward round that many doctors and students review all inpatients and follow up their

situations and lab data. At the end of the day, we had a pathology conference.

Although I couldn’t understand much, but thanks to the doctor that translated to me

what they are talking about, at least I can go home and check them up in books. To

sum up, today was really a day full of learning.

11/16/15

Today was pretty exhausted. We went into the operation room early in the

morning right after the morning reading club ended. The operation room is quite like

our TMUH’s, but with more space. In the morning, we watched a patient whom is

bothered by hiatal hernia for a long time that undergone the surgery called

laparoscopic Nissen. I did learn about hiatal hernia, but I had never seen the

procedure of repairing hiatal hernia before. The procedure took just only an hour,

which really surprised me that the techniques of the doctors’ are so prestigious.

After the lunch, we switched to another operation room which was undergoing the

super lower anterior resection. Although the tumor around the cancer was so closed

to the anal part that normally should be treated by abdominal perianal resection, the

surgeon still gave it try for the very small chance to preserve the patient’s anal for a

better life quality. However, it still failed at the end so they switched back to

abdominal perianal resection. Later on , we changed to the operation room which

the pancreaticoduodenal resection was preparing. The patient suffered from ampulla

vater tumor which made him very sick. Though we did not finish watching the

procedure, I was still very interested in the procedure. To sum up, today was a tired

but full of learning day.

11/17/15

Today is all about physiology. We met professor Ono in the morning and had a

look at his experiments with the zebra fish. I was astonished with the equipment that

can control the temperature, the acid base number, and even feed the fish all by the

machine itself. After that we watched some experiments that professor was doing

with the high-tech microscope with a defibrillator with it. Because of the scale of the

baby zebra fish which is too small that a little bit of vibration will have a massive

effect under the microscope, thus there’s the technique that will prevent from

vibrating all the time. It is very cool because I had never thought of that situation,

and by the delicate design the problem is solved. Later on we moved to another

professor’s lab who studies about the potassium and sodium channel signal

transition. He told us about the research that he had done within an hour but he

worked for 2 years. For researches, I think it is difficult to think of a good topic,

what’s even more difficult is to prove the hypothesis. Through the lecture, we

understood how the professor find question, prove it with experiment. At the end of

the day, professor Ono gathered us and had a little chatting about the life style of

researchers. It was a memorable day which ended with the good memories of

professor Ono’s nice coffee.

11/18/15

In the morning, we visited the infection control center of OMC hospital. It was

different from Taiwan that there is no department of infection here. So the doctor,

pharmacist, nurse, technician gathered together to build this center for the

improvement of antibiotic use in OMC hospital. They checked the patients’ data and

combined the members experience and evidence-based-information to help doctors

prescribe a better medication. I was surprised to find out that many antibiotics used

here are similar to Taiwan, some of them even have the same brand name. In the

afternoon, we visited the blood transfusion center. The doctor told us that many

students who had come here stated that they did not understand why they needed

to visit this center. However, I think it is quite important because blood transfusion is

everywhere in the hospital and if you know it well, the patient is going to have

trouble. It was very interesting to understand the process that the doctor established

to make sure everything goes right when blood transfusing. The doctor was so

interesting that we often burst out into laughter when he told jokes. It was a really

fascinating experience today.

11/19/15

Today was a fulfilling day that I finished watching two surgeries till the end. The

first one was about a 30 years old female diagnosed of cervical cancer that would be

conducted a total hysterectomy. In Taiwan when I rotated to the department of

gynecology, the most seen cases were myomectomy. I didn’t really have chances to

see any other kinds of surgeries. But today, I watched with the use of laparoscopy.

Though it was time consuming when the doctor had to separate the tissues inch by

inch, the doctor still did it with patient and tried to explain what he was doing step

by step to me. After five hours had passed, the operation was finally done, then I

turned to another room to see the removal of the ovary due to a 12 centimeter huge

mass. I was also surprised to see such a large mass because I have never seen that

before. The surgery was quite fast because it was done by opening of abdomen.

When the ovary was removed from the body, I followed the resident doctor to the

pathology room to have a look at the ovary. I was astonished to see some hair and

some adipose tissue which proved the tumor to be a teratoma. Although teratoma

was always mentioned in the textbook, but I had never seen the real thing in my life

before, thus, when the tissue flowed out of the ovary, I was very surprised. At the

end, though I was tired, but I was full of joy that I have seen two totally new things

today.

11/20/15

Today we visited to department of rehabilitation, which is quite fascinating to

me. In Taiwan, there are hundreds of thousands of people whom suffered from

limited activities due to reasons like strokes or accidents. There is the need of

rehabilitation to help those people return to the daily life. In the morning, we met a

patient with cerebral palsy, whom has trouble walking, turn to the doctor for EMG

and Botox injection. After then, we watched the swallowing examination. The patient

suffered from tongue cancer and had half of his tongue removed. He had this

examination to see if he could normally swallow things. After the examination, the

doctor also let us tried the examination. We swallowed some liquid stuff under the x

ray machine. It was quite amazing when I saw myself under the x ray machine. In the

afternoon, we had a lecture about the EMG. I didn’t really understand EMG until this

lecture. The doctor explained ever detail to let us realize the principles of EMG. After

the lecture, we saw a patient who had problem raising up his left arm. We can easily

tell the problem after the doctor conducted the EMG. At the last, the doctors taught

us about the ultrasound of shoulder and let us practice about it. We end today with

finding out that we had no problem of our arms.

11/24/15

This morning we joined the morning meeting with the department of

orthopedics. Although they talked in Japanese, but I can still tell that they are

discussing about some interesting cases by the image they shown. After the meeting,

we rushed to the operation room for the surgery of a two years old child who has the

problem of club foot. There was also a doctor from Pakistan who taught us some

basic concepts of the orthopedics. After several hours of operation, finally the child’s

foot was back to its neutral position again. In the afternoon, we went to the

department of oral surgery. In Taiwan, I never had a chance to visit this department,

thus I was quite interested in it. Today’s case was about male patient with no

symptoms and was found a cyst inside his mandible. Although there was no

symptom at all, but the cyst must be removed to prevent its enlargement that will

eventually compress the nerve. The surgery was quite success and the teacher

explained every detail to us. After the surgery, the doctor brought us to the ward for

the visit of the special care about oral hygiene for those patients with the chances of

aspiration pneumonia. I think this kind of care is really important because there are

so many disabled patients who are under the danger of aspiration pneumonia. I

haven’t seen any hospital doing such kind of thing in Taiwan. Maybe in the future, I

can introduce this management to Taiwan.

11/25/15

Today we went to the Mishima critical care center to understand the special

department that Taiwan don’t have. We first joined the morning meeting with them.

Two cases were discussed, one was a cholangitis case and the other one is a car

accident and his second toe was nearly cut off from his foot. Then we visited the

intensive care unit, where they gather those severely ill patients. For example, the

first patient we saw is a ascending aorta aneurysm case caused by a traffic accident.

We saw the three dimensional image of the patient’s aorta on the screen, which I

think is a marvelous technique because it helps surgeon to identify the location of

the lesion more exactly. After that, we kept the ward routine, and unfortunately, we

saw an attack of ventricular fibrillation that the patient undergone the flow chart of

ACLS I have learned and was intubated. Next we visit the other part of the center.

Professor took us to see their operation room and emergency dorm. I was very

surprised to see the doctors, nurses and others cooperate so fluently. In the

afternoon, we took a lesson by the EMT of the ambulance system. I’m not sure if

Taiwan has the same dispatching system but I’m pretty sure this works well and

provides more time for the rescue team to help the patients. At the end, the

professor explained the BLS system and told us that it actually started from Japan.

We also talked about the neurological critical care system which I have never heard

of it before. It is a very fulfilling day today.

The last two days were also very interesting, but i can't fully concentrate due to

the fact that we were going to leave soon. Looking back to the point where we

started our journey, i didn't expect too much for this exchanging program because I

can't really understand Japanese. However, after those magnificent, eye-poppig

lessons, I totally found a whole new world. I have to be grateful to all of the crews

and students whom had helped us so much on everything in Japan. We wouldn't be

able to finish this journey without every one of them, and i need to give special

credits to Ms. Matsumoto, whom took care of us so well that i had started missing

her on the way to the Kansai airport at Ibaraki station. They say every journey comes

to an end, but sometimes the end feels just like the beginning. Even when you think

you've come a long way, you can suddenly find yourself right back where you started.

This November will be the most unique memories ever, in my life.