Day 6

Blog Entry 6: 9/25/08

Today, was pretty sweet! I had my first surgery observation, and I couldn't wait for it to begin! Me and my housemate ate a banana and ran over to Hospital Carmen in order to get there before 7 A.M., which was when the surgery was scheduled to begin. We got to the clinic before any of the doctors arrived, and were kind of worried that the surgery wouldn't happen while we were there. We were informed that doctors can come in, up to an hour or two late, and it's not really a big deal in the local culture. But, I guess we got lucky today because they were on time. The first doctor we met, Dr.Hector Rodriguez, was this really cool guy, he came in with a motorcycle helmet, and was talking to us in some of the best english I've herd around Oaxaca. He was really relaxed, and wasn't really surprised by us coming to observe, even though he had no clue who we were; my guess is that he's had many international students come and observe before. He really got me good, by telling me that I wasn't allowed to watch the surgery; I almost went into cardiac arrest, luckily he was joking. Looking back it's a really good joke to play on premeds because it's a perfect way to mess with their feelings... It was my first time wearing an operating room head cap and shoe covers, and reflecting back that's a big deal because that's the first time I've ever gotten ready for a surgery, it felt good.
I'll give you what little background information I was able to extract on the surgery, from the limited interaction I had that morning. The surgery, a knee arthroscopy, was taking place on a girl who was around the age of 10-12. She had an inflamed synovial cavity. It was Dr. Tenorio's brother who operated, while the Dr.Rodriguez assisted him. They had to remove inflamed tissue from her knee and drain synovial fluid to reduce inflammation, and to find the cause of her knee problems.
They started off by giving the girl anesthesia through pain killer shots and nitrous oxide (i think that's the gas they use, not sure). They inserted a line into her spinal cord through this metal device, I still need to find out what it was, but the procedure looked painful because the girl was trying to pull it out, even through she had the anesthesia mask on. They also inserted, what I think were painkillers directly into her spinal cord, which also looked super painful. With scissor type tools (I've never seen any of these before), they cut two holes into her knee, one for the optical camera and the other for a surgical tool that looked like a drill. The optical camera functioned to show the location of inflamed tissue within the synovial cavity. The inflamed tissue was red and looked like puffs balls, while normal tissue was white and was relatively flat and layered. The unique surgical drill, actually had a spinning knife inside that would cut and suck the inflamed tissue from the cavity through a tube on the other end of the drill, to the outside of the body. The doctors would then collect and send the tissue to a pathologist for analysis. When the procedure was over, and all the inflamed tissue was removed, they washed out any residual floating tissue in the cavity by passing IV through it, thereafter the surgeon stitched the incisions, and wrapped her leg in a cast. It was an efficient and quick surgery, I loved every minute of the 2 hours I spend in the operating room. I didn't have too much time afterwards to ask questions because the doctors were in a hurry, which is why I didn't understand the function of a few of the procedures, but I'm going to find for sure. What I did find out is that the current hypothesis is that the girl suffers from arthritis, which was weird because she was so young (also something I need to ask about).
What I noticed throughout the experience, is that these doctors operate with SO much ease, it seems like they could do these procedures in their sleep. The surgeon used his tools as if they were extensions of his hands, being extremely fast and precise when cutting and moving his tools inside of the cavity. In fact, the reason the whole surgery took maybe 2 hours was because of how fast he was able to go. I noticed that surgeons need a lot of dexterity with their hands, and I was really impressed with Dr. Tenorio's brother, he didn't break a sweat. This surgery went really well for me, and I really am reaffirmed that I want to be a surgeon. The experience really appealed to me in a deep way, I was excited on so many levels. Surgery seems to be an art-form, and I feel as though I'm meant to be its artist. But I'm still keeping an open mind, I have yet to do my primary care rotations, so I'll see what appeals to my heart more.