Universidad of Murcia

Emma Mao, Christ Church, Medicine, First Year Undergraduate, in-person

working

Work Projects

At the hospital, I was assigned a doctor or

researcher to shadow for the day. It

allowed me to eventually see the whole

hospital which was large; there were 10

floors with two underground layers that spanned greater than the building. I was given insight

into many aspects of cardiology. There was a day spent on treatment of patients with heart

failure; I could relate the theory we learnt in the year on the treatment plans of patients. I

discussed with the doctor the variables in treatment for each patient and how they were

specialised. Having not had any clinical contact in the first year, I also saw presentations of

symptoms in patients. There was a patient with severe heart failure where I could observe all

the features; liver enlargement, peripheral oedema, visible jugular vein, the vena cava not

collapsing on the echocardiogram showing congestion and vertical B lines on echocardiogram

showing interstitial lung fluid. The heart failure specialist showed me how to perform each

diagnostic test.

There was a day with a cardiomyopathy specialist which branched into genetics and applying

ECGs. With this doctor, I met a patient with Costello Syndrome, a rare condition that is

estimated to affect ~300 people worldwide and got to listen to their heart murmurs using a

stethoscope which was a unique experience. I also got to spend time in a congenital heart

disease clinic which allowed me to get an in-depth introduction to echocardiograms. I could

transfer the new skills I learnt and apply them in a research setting. I observed medical research

on mice on the topic of myocardial infarctions. Echocardiograms were done on mice and the

procedure and measurements were extremely similar.

In the research building, I was also shown the genomics lab which was linked to the hospital to

help do testing for the patients with cardiomyopathies. I also got to get a close-up view on

catheterisation procedures; there were both femoral and radial catheterisations. I observed in

the CATH lab, where they are replaced an aortic valve going through the femoral artery. We

were wearing lead aprons to protect from X-rays used to visualise the arteries. Accessing the

heart through an artery meant lower risk of infection and no broken bones.

I learnt how to ensure sterility for surgery when I was

allowed to stand next to the surgery table. The use of

intervascular echocardiography fascinated me as it

provided so much information on the 3D structure on

coronary vessels that would give the doctor a clear idea

of how to proceed with treatment. There were so many

different types of catheters for different uses; ones that were balloons that could be inflated to

dilate the artery, ones that were stents to maintain the artery, ones with micro knives on to

break the calcium plaque. In the arrythmia ward, I was shown the procedure of putting in a

pacemaker and ICDs and the testing required to qualify patients for a device. Lots of ideas

linked together after seeing so many wards, with arrythmia drug testing linking to genetics. For

example, a son was found to have Brugada syndrome which meant that his parents must be

induced to see if they also have this syndrome which then needed to be further confirmed

using genetic testing to figure out what the mutation is.

At the lab, I was assigned to proofread a protocol report that was in its final draft. I would

research science to help myself gain a deeper understanding of the hypothesis and correct the

grammar. It helped that I had read protocol reports from my day spent in the hospital’s clinical research office where I learnt about ongoing clinical trials that were in the recruitment phase. A

highlight of the experience was watching a heart transplant. It was a privilege to be able to

watch a heart being removed and have a donor one put in its place. Samples of the original

ischaemic heart were taken for genetic testing as a control in a cardiomyopathy study. I felt the

stents inside the removed heart that were previously placed to prevent further ischaemia and

got to see the ischaemic part of the heart that was previously visualised on an echocardiogram.

Daily Life

In the morning, I would get up usually around 7am and get

ready for the day before heading down for breakfast. I

learned to have a big breakfast as Spanish people have a

late lunch. I would catch the bus to the hospital to arrive

around 8am. There was a meeting every morning to discuss

interesting cases of the day before and to get more

perspectives on each patient. I would then meet with the

internship organiser who would assign me a person to shadow for the day; I would follow them

on their day whether it was seeing patients or performing experiments. It was a bit hard to

understand what was going on sometimes due to the language barrier, but I soon settled in as

everyone at the hospital was very welcoming and accommodating. I got into a schedule of

things to do which made each part of the day make more sense. I would end my day at the

hospital at 3pm when I would get the bus back to my hotel. I would then have free time to grab

something to eat.

I usually went to Mercadona (Spanish supermarket) and visited the bakery section and tried

Spanish pastries e.g. empanadas and ensaimadas. I explored different regions of the city where

I picked up the hobby of sketching buildings; the cathedral and old town are a must see in

Murcia. There was a gym in the hotel where I could exercise out of the heat. In the evenings, I

would have dinner in the hotel’s restaurant across the street which served Spanish dishes that

were interesting, particularly ajo blanco – garlic soup with watermelon and salted fish. At the

hospital, I met some ERASMUS medical students who I could socialise with as they could also

speak English. I had discovered very soon that most people in Murcia did not speak English as it

is not a tourist location. All the people at the hospital were very friendly. In their breaks, snacks

would be brought in to share and one thing I discovered from this was horchata, a cold frozen

drink that was very refreshing.

At the weekends, I would travel to the nearby beaches by train or bus. I visited Alicante,

Torrevieja and Cartagena which had the Mediterranean Sea where I swam and did other

tourist-y things. I also visited the outskirts of Murcia which included Carrascoy and the Valley,

which is a mountainous regional park where I did some hiking and got the tram to the

university campus and IKEA etc. to explore.

Lasting Impressions

This was an amazing experience. I got such an

in-depth view into life in a hospital as well as a

laboratory which was facilitated by the doctors

and researchers showing me their work. I gained

so much insight that would not be possible

without experiencing everything first-hand. This

internship has also taught me life skills of independence and many others. Not being able to

speak Spanish, I managed to figure out the public transport system, navigate daily life and

travel on my own in a foreign country. I am much more confident in my organisational and

decision-making skills. I got to experience Spanish culture, people and sun which have formed

fun memories of this summer. I found application in the topics we had learned in first year in

treatment and new research and this has consolidated these ideas for me. This experience has

shown the wide range of routes available to take and made me want to explore more areas.