Blog 24

Blog 24: 10/24/08

he surgeries I saw today have topped all of the other surgeries I have seen on this trip so far. God was looking out for me because the line up today was ALL orthopedic; as opposed to the last two days where I didn't have any. I was pumped on adrenaline all day. I'm pretty sure found my calling. I've never been so excited about watching anything in my life. I HAVE to be!!....no, I'm GOING to be an orthopedic surgeon!

In the operating room, my obsession must have been apparent because the residents where taking extra measures to let me see what was going on. They moved me near the surgical table and let me look over their shoulders while they hammered away. I'm sure they could see my enthusiasm by my constant facial expression of astonishment (I would've screamed if I could). In that room, I felt, what I like to call, a "surgical high" (I'm a dork I know). I was in a complete state of euphoria, and I could've stayed in that room for another 9 hours. Alexa and I, asked the attending surgeon (Dr.Zapien) questions after the first surgery and he invited us to other his surgeries of the day. We were really lucky. A lot of props go to Alexa because she really helped me understand what was going on in the first two surgeries.

The first operation was on a 7 month old girl. The tendons and ligaments in her feet were congenitally abnormal, causing her feet to be tilted to their sides and pointed downwards. To correct this, they had to cut her tendons and ligaments, and re-stitch them in a way which reoriented her feet into their proper orientations. The surgeon was going to specifically cut the tendon from the posterior tibia. They also removed the extra membrane which was around her tendons and ligaments (not sure why?)This was probably the most focus intensive surgery of the day. I could tell the surgeons were under great pressure because children are extremely hard to operate on because their tissues are small and look different compared to adults. Operations requires more precise cutting, time-constraints are different, and vitals are more essential. Complications can have negative developmental effects on the child, and even death.

The second surgery, which was a much simpler procedure, was a fractured elbow. The patient was a 10-12 year old boy, who probably fractured his elbow through some physical activity. The surgeon made a cavity into his elbow, and reoriented his bones into their proper positions. Thereafter, the surgeon (which was actually a resident) drilled two screws through the elbow (my guess is to keep the bones in their proper positions while they heal). Lastly, he re-stitched the elbow, and the surgery was done. It was really simple.
I don't think there was an attending present for that surgery. It seemed like one resident was teaching another. They kept taking out the clavias(screws) and re-drilling them into the same part of the arm. My guess was the resident's first time doing the operation, and he was having a bit of trouble getting the screws into the right spots. In fact, they kept calling a senior resident as a reference. But, I suppose that's how you learn to do surgery!

The last, and most EPIC, AMAZING, and INGENIOUS surgery to EVER take place (at least for me), was a femoral reconstruction surgery. A 22 year old girl had a motorcycle accident that resulted in a major fracture of her femur; her bone was broken into 2 main pieces and the area of trauma was shattered like glass They hung her leg up to a pole, and at the fracture site it bended 45 degrees, when normally that area of the leg shouldn't bend at all...crazy stuff.
The surgeon started by entering the site of her fracture, using cauterizer (similar to in radical surgeries, but on her leg). It was weird to see a huge bone like the femur to exist in pieces within the leg. The surgeon, separated the pieces of bone to reveal the interior of the femur. He took a unique hand-drill, and started removing the interior of the bone. Another incision was made at the top of the hip where they drilled another hole through the femur. Eventually, there was a hole that ran from the fracture site all the way to top of the hip. The surgeon inserted a long metal tube that ran through the tunnel made through the medulla of the femur (there was a lot of hammering for this part). Thereafter, the metal tube was visible at the end of the femur where the fracture was, as well as the end where the hip incision was made. The surgeons then took the pieces of fractured bone and pieced them together around the visible part of the metal tube (located at the trauma site), and used a metal tie-rod to hold the pieces together. After that, they drilled screws through the surface of her femur longitudinally so it permeated the metal tube and exited on the other-side of the bone. The longitudinal screws were meant to hold the metal-bone construct together. The surgery was indescribably amazing
She reminded me of a super-hero named Wolverine from the comic book series X-Men because this character had a metal skeleton.

I had a really amazing experience. It was my favorite rotation in Oaxaca thus far, and it's hard for me to believe I'll see anything cooler. However, I have yet to see an open heart surgery and a neurosurgery, so I'll keep my mind open. I have a feeling that neurosurgeries are also an amazing experience. One thing I know for sure though, is that surgery is definitely my path.

I still can't believe that I saw three orthopedic surgeries in one day, I could not have lucked out more. A real benefit was that I was able to watch two of the surgeries, with the same set of surgeons, and due to the fact that they've seen me before (yesterday, and the day before) they're pretty relaxed about letting me get close. They also gave me their e-mails, so I could e-mail them pictures of the surgeries and ask questions about anything I didn't understand. I talked to the attending surgeon at the end of the surgery, Dr. Zapien, he was really friendly and willing to answer my questions. Definitely a great experience. When I get back to the bay area, I'm interested in finding research that exposes me to surgical methods and techniques, and other aspects of the process also.