Posts tagged: surgery

Weeks 31-32: Surgery Sective – Fresh Frozen Virtual Living Pigs?

By , April 14, 2008 at 12:01 pm

I guess I really need to be less meticulous when it come to life, take blog writing as an example. The current date is September 30, 2008 and this article is pre-dated back to April, that’s a good 5 months behind, but I guess this call-it-what-you-may “attentions for detail” helps me out in at least considering surgery as an option.

We spent a week this selective learning and practicing some basic skills on tissue, on simulation, and then I real live pigs! It was pretty interesting as we learned some of the ins and outs of suturing, knot-tying, making incisions as we worked on day one on some fresh frozen tissues next to some ENT residents who were also working on their skills on dismembered heads. Despite being acclimated to this type of environment I still find it very surreal and disturbing that yes indeed there is much ‘practice’ in medicine, and sometimes in the most morbid of circumstances to say the least. I mean no disrespect in saying so though as I am extremely grateful for the donors who are willing to help in medical education — it just seems so primative though for how far along we’ve come, I would’ve thought that an entire anatomy dissection would have been in full 3D high definition tacticle reproduction right now – I guess I’m realizing that I just don’t have the greatest stomach for gross (in all of meanings) anatomy and perhaps that I’m lowering pathology and radiology from my list of possible career choices.

Strangely enough I find surgery fascinating though and I guess the ‘gross’ factor dissipates a little more in ‘real life.’ I shadowed an orthopod doing hand and shoulder surgery this week and saw a rotator cuff repair as well as a procedure that removed some bones in the hand. We also had a session in Mayo’s Sim Center where we did virtual colonoscopies, endoscopies, knot tying and sutures with instruments, and even a gallbladder removal that we ended up performing on a living though anesthetized pig! The good news? We got the gallbladder out without the pig crashing. The bad news? Wilbur’s prognosis despite the fact was still terminal as they don’t wake him up from that sleep again. I guess you can think of it as a better cause than $14.99 in your butcher’s case though. Poor pig.

Well that was a taste of surgery for me, another step into a confusing realm of seemingly endless prospects to my intial urge to “want to help people.” Now I just need to figure out how.

Week 19: A Surgeon’s Bane

By , December 9, 2007 at 9:14 pm

The surgery work week continued Monday back in clinic from 7am-5:30pm, surgery Tuesday from 7am-5:30pm, and Wednesday and Thursday followed suit in clinic and surgery respectively. Each of the surgery days I left before the last case of the day was even over as the chief resident Dr. Shridarani stayed often to 10-11pm each night and was back at it 6:00 am the next morning. Don’t get me wrong, I found from the experiences I had watching multiple surgeries scrubbed in and patient side holding retractors, pretending to review my anatomy in situ, very rewarding and very interesting, but after this week a new realization of the surgeon’s lifestyle really hit me. A surgeon’s schedule stinks!

Not only was I physically and mentally drained at the end of every day, but with 4-6 hour spine surgeries under hot lights, sweating, and standing on one foot watching the time go by one surgery at a time is unrelenting as well. I mean you could pay me $700 and hour, but at the end of the day, and the end of the week, and the end of my life I probably wouldn’t even have the time or energy to spend it all! It is amazing what Dr. Huddleston does in the time he has each day – and that he manages to be so involved in everything on top of it all, from being the president of the bone bank, sitting on various Mayo committees including education, and also being a lieutenant colonel in the U.S. Army as well.

Friday I took off just to recover as our leadership block started up on Monday. At the end of this selective I really reflected a bit on the fact that despite surgery being very interesting, it is also a lifestyle hardship making me question whether radiology or anesthesiology might fare better to allowing me to actually see Mikey grow up which I missed this week.

For now my doors are still open – but in my two weeks to attempt self-discovery in orthopedics I think I found myself with more questions than I have answers for in choosing a specialty.

Week 18: Thanksgiving Touring Orthopedics

By , December 9, 2007 at 9:14 pm

For my selective this time I went back with my mentor Dr. Huddleston in orthopedics and followed him. Being the week of Thanksgiving I took Thursday and Friday off to be with Carolyn and Michael as we hosted dinner this year with some friends. Carolyn has the details in the family blog.

On Monday I started off observing Dr. Huddleston’s chief resident working in the cadaver lab as he exposed iliac crest for bone graft harvesting. Tuesday started off early at 6:30 am for spine conference in which I learned about how MRI’s were not great diagnostic indicators of a patient’s recovery. By 8:00 am I was in the operating room as I scrubbed into surgery and got a first hand view of three surgeries, the first being a Anterior Lumbar Interbody Fusion (ALIF) L5-S1 in which I even got to hold retractors. In the second procedure I watched an irrigation and debridement of a case in which the person had developed staff infection following back surgery so they needed to clean out his wound. Finally to end the day, I watched another decompression and even got to suture a bit at the end of surgery closing up the incision. Wednesday I spent the entire day in clinic as we met with pre-op and post-op patients. Dr. Huddleston even had me take a patient history of a lady. Needless to say Thursday and Friday were much welcomed days for rest and relaxation.

Week 11: Emotions Revealed – Anatomy Begins

By , December 2, 2007 at 3:36 pm

I scrubbed in on Monday morning to end my four day weekend a little earlier to observe another spinal surgery. I had a chance this time to watch the L5-S1 fusion from start to finish as the case went about 4 hours from first incision to last suture. They went in anteriorly through the abdomen and exposed the vertebral bodies, scraping the out the herniated vertebral disc, added a bone graft, a titanium plate, and six screws before closing the patient back up. I got a front row seat scrubbed in and got to play around with the mushy vertebral disc when it was taken out. By the end of the week with the start of gross anatomy I would learn that I was mashing up nucleus pulposus and annulus fibrosus of the vertebral disc.

Anatomy started early on Wednesday, skipped Thursday, and continued Friday as we substituted two days out of this selective for Friends and Family weekend over the weekend of October 11-12. With anatomy beginning the fun began as we were introduced to our cadavers on Wednesday and the same day began dissection on the back – with that the fun of learning muscles, nerves, insertions, origins, etc. began [in retrospect: what we thought was nigh impossible to learn in these first two days of anatomy would prove at the end of six weeks leaps and bounds easier than our final week and a half of anatomy trying to learn head and neck and lower limb in seven days]. Being sensitive to the nature of our dissections, the donors privacy and also confidentiality I will not divulge in any details or specifics regarding our cadaver or procedures, but for those of you who are truly interested in what we are doing, you can take a look at the University of Wisconsin anatomy site for anatomical dissection videos that will give you a first person perspective of what we did in the anatomy lab.

We ended the week with a training workshop by the Ekman Group that was paid for by the medical school. The Ekman Group is a team of specialists trained in facial recognition that works with security agencies worldwide and trains personnel in the technique of facial expression recognition and micro expressions. Purported to be more accurate than polygraph, facial expressions are hard to unlearn and retrain – especially micro expressions that only last fractions of a second – but when picked up by experts can be far more revealing that any other means. We looked at footage from the O.J. Simpson trial, various CEO TV interviews before secret corporate corruption was exposed and saw how micro expressions of contempt and disgust were long in existence despite their cheerful faces. It was an interesting seminar and as we trained, it hopefully helped us learn to analyze our patient contact better in hopes of better ascertaining hidden concerns. I thought it was some pretty hi-tech stuff that I sure didn’t anticipate learning in medical school to say the least.

Week 2: Scrubbed, Gloved, & Inside an Abdomen

By , August 5, 2007 at 2:24 pm

The title says it all for this week as we had a nice four hour orientation for scrubbing, gowning, and gloving – I’m all for the dry scrub 3M Avagard (Chlorhexidine Gluconate 1% Solution and Ethyl Alcohol 61% w/w) method that’s five times faster than the traditional wet scrubbing. I got to use our training the next day when I shadowed my mentor who was operating in the morning on a lower back fusion case. Apparently the patient got into the hospital at 6:00 am in the morning, and when I arrived at 8:00 am he had finally been sedated, and was just beginning to get prepped and draped. The first incision occurred shortly thereafter but by 11:55 am when I had to go, the orthopedic surgeons still hadn’t had a chance to go in yet as the general surgeons were still trying to prep a window to the patient’s spine – untangling a lot of anatomy that was in the way of the vertebrae. Some impressions and lessons learned from this experience observing first hand surgery for the first time include:

  • How long surgery actually is, especially when you’re scrubbed in with your arms against your chest for four hours under bajillion candlelight inferno lamps with no way to touch your face or wipe the beading sweat off your brow.
  • How less blood there really is in surgery (if you’re not severing arteries and viens), I guess that’s why they call it an abdominal cavity.
  • How unique and different an individual’s anatomy is, ie. making a routine procedure a lot more complicated.
  • How un-surgical surgery can be as this procedure resembled more cut and clamp, pull and shove, slash and sew (don’t get me wrong though the surgeons still have to be extremely careful especially to the spinal cord, nerves, arteries, and veins coming off the spine.
  • How anesthesiologists seem to have a boring role: four hours of watching a monitor on the other sides of the drapes, reading a book, and being a more or less passive to the team and the procedure.
  • How few knives there really are, in buckets of sterile equipment I counted 2 scalpels, 1 pair of scissors, and a snippet thingy – a lot of the cutting was done with electro-cauterization using a bi-polar and another doohickey (I’ll get these names down in the future)
  • How dissimilar cadavers are from live patients, cadaver::cooked turkey as live patients::meat aisle displays – as gross as that may sound, I was surprised how familiar I was to gore just from my exposure of being comfortable handling, cutting, and cooking red meats.

So my first exposure to surgery thus far has been a good one. At the end of my observation, to
“get some blood on my hands,” I got to reach inside the patient’s abdomen, feel his aorta and vertebrae, and even got to stick a marker in the disc between L4 & L5 to see on the CT scan. Definitely a novel experience. For now I’ll definitely have to continue considering some sort of surgery as a possibility, especially to compliment my type A personality.

We actually started some team based presentations and studies this week as we have already been assigned a team service project that we need to design and perform to the community by mid-December. We also studied the assigned topic of “Self-Directed Learning” or autodidacticism and presented a 40 minute presentation Friday along with the other team focuses of “Communication,” “Time Management,” and “Negotiation.”

A highlight on the week perhaps was Mayo CEO Dr. Cortese’s visit to our class to present Mayo’s proposal to a solution on the health care crisis. Part of his commentary is available online, but of his ideas many are quite practical that I’d readily agree with. Some of these ideas include implementing a pay for value system, which amazingly enough – a shout out to those Utahns out there, is exemplified best in Intermountian Health Care (IHC)’s system of practice offering both system and also its own insurance. Also of note is IHC’s handling of patient care, employing 5 endocrinologists to oversee 25,000 diabetic patient needs but not by seeing a single patient, but rather being in charge of allied health teams to direct individualized care for each of the 25,000 patients in a home care setting.

Dr. Cortese also listed many other facets of a true health care system that can be developed for the first time, one thing of note to have parallel private and public life-long insurance programs with no exclusions and the option to switch in and out of either plan at any time. An interesting argument to this end is right now the policies designed – including Medicare – offer no incentive for insurance agencies to invest in the long-term health of patients as they see no benefits after 65, passing on all early healthcare investments to saving Medicare dollars in later life. If insurances were required to insure for life, they would likely invest more for long term health and for prevention as they would likely see a return in lower end-of-life health care costs.

Finally the creation of a universal electronic patient record that could be shared and transferred to all is another factor that he mentioned in his system. As health care becomes a larger political issue you can be sure to see Dr. Cortese in front of Congress and on the news promoting Mayo’s official perspective on the solution to health care. The amazing thing to all of this is that Mayo doesn’t just talk the talk, they also walk the walk, and are currently implementing all these changes as far as they are able into the Mayo Clinic as an example of a working model. So if anything Dr. Cortese did raise my interest in health care policy – something that will definitely be a hot button issue in the next few decades as baby-boomers strain the system to collapse.

To wrap the week up on a fun note, we had lunch at Charles Mayo’s historic mansion at Mayowood, lunch with our third-year advisers in the Kahler Hotel, and started a new class: Dynamic Physician Skills which has us working already on a project for December studying emotions which my group has been assigned fear. We’re also reading Paul Ekman’s book Emotions Revealed: Recognizing Faces and Feelings to Improve Communication and Emotional Life

Finally as an ode to last week’s title, a little snippet of our team purple’s photo scavenger hunt product is here below. Week 3 starts tomorrow with Basic Life Support training, and ends in the hospital for a night’s stay!

Copyright 2004-2013 Dan & Carolyn Chan