Blog 29

Blog 29: 11/04/08-11/06/08

My rotations this week were awesome. The cirugia (surgery) department in ISSSTE has been consistently amazing. The orthopedic surgeons are great, and are really interesting in helping me understand what's going on. They really make an effort to help me learn the concepts and see the procedures during surgical intervention. I regularly rotate with Dr. Rene Velasquez de la Rosa (Traumatologo y Orthopedia) who's probably the coolest doctor I've met in Mexico... I'm EXTREMELY lucky. I've seen about 6 surgeries this week, which involved an ankle (tovillo), spine, and knee. I'll go through the cases, and reflect on my experiences with Dr. Claudio (another orthopedic surgeon) and Dr. Rene.

11/04/08

Today, I watched Dr. Claudio and Dr. Hector operate because Dr. Rene only operates on Thursday and Friday. Unfortunately, Dr. Rene thought that I wouldn't be interested, and directed me to Dr. Claudio. Looking back, I wish I sat through Dr. Rene's consults instead; I want to get a feel for the whole surgical process, from consult to recovery. I think it was kind of miscommunication on my part, mainly due to my limitations in Spanish. However, it wasn't a big deal because I still really enjoyed the ankle surgery. Next time, I'm going to request to sit in on more of Dr. Rene's consults which are awesome because he makes the experience really enjoyable for the patient. His consults reflect all the components of emotional intelligence that I've learned in class, which is what makes them so essential for me to see and learn from.

The few consults that I've done with Dr. Rene have been really awesome. It's VERY apparent that his patient's LOVE him. I think it's a result of his genuine interest in their well-being, and of course emotional intelligence. He's always talks to patients with respect, care, and empathy. His specific style of interaction is characterized by humor, friendship, and nonchalance; it works really well. He really jokes around with his patients, asks about their day, what they like to do etc...things that don't necessarily relate to their condition. He has more of a genuine interest in their life and their personality. The patient also asks about the Dr.'s life in return, and get to know about him also. Through his style of interaction, relationships he has with people turn into bonds of friendship. In essence, the consult room is really a place for him to socialize and build a meaningful relationship with his patient. My first consult was with a woman who was going to undergo a spinal operation in a few days. We met her in the hallway, and walked with her to the room. As soon as the she came in, Dr. Rene started joking around. she was laughing a lot, and was in a really good mood. She didn't seem particularly stressed or distraught about her impending surgery. I got the impression that she really trusted Dr. Rene. In sum, he knows how to change the traditionally stressful experience of surgery, in to one free of worry and fear. The secret to his success is his ability to form bonds of friendship with his patients. I hope to go on more of his consults and observe him in action.

Returning to today's rotation...I watched Dr. Claudio perform an open reduction surgery on a fractured ankle. He internally fixed the fracture by using torneos (screws) and plaqas (plates). The ankle fractured in 3 places, which required the use of a plate in one fracture site, and direct input of screws in the others. The most interesting part of the surgery, was how he drilled the plate in. He (with the help of Dr. Hector), lined up the 2 parts of bone and stuck a plate on it. The plate has spaces for screws to fit through, so Dr. Claudio drilled through the spaces in order to form grooves inside the bone for the screws fit into. Thereafter, he put in the torneos with a screwdriver. Seven torneos were put in total, in order to obtain a maximum amount of structural rigidity in the construct.

Dr. Claudio was really nice, and it really helped that he knew a bit of English. What made my rotation with Dr. Claudio priceless, was his inherent interest in trying to help me understand the concepts of the procedure. For example, I found out that screws and plates must be oriented on the bone to achieve maximum rigidity and tightness around the fracture in order for proper healing to occur. If they're are gaps or looseness, then the fracture fragments may slide around, therefore prolonging healing or resulting in improper healing. After the surgery, he asked about where I was from and what my schedule was like, and he really wanted me to come back and rotate with him. However, due to the fact that I'm rotating with Dr. Rene, it wouldn't be possible to do both. These rotations are simply incredible.

11/05/08-11/06/08

In the past 2 days, I've seen 2 spine surgeries and a protesis of the rodilla (prosthetic knee transplant).
The spine surgeries are quicker. They generally involve the input of a styrofoam-like synthetic disc, in the place of the original disc. Most of the spinal conditions are characterized by the deterioration of the discs between lumbar vertebrae, which usually results from "Black" disc disease or a disc "hernia". First, Dr. Rene always enters from lower back with a cauderizer or knife, and stops when he finds the disc. He then proceeds to use a unique clipping tool to remove peices of the deteriorating disc tissue. Once all the disc tissue is removed, he puts a synthetic disc in its place. Lastly, the patient is resealed with stitches and the surgery is done. It's simple and quick.

The protesis of the knee was definitely one of the coolest surgeries I've seen. It's much more complicated and requires more time and resources. A 69 year old female had a knee condition that required the input of a prosthetic knee. There were MANY parts to this surgery, so it's going to be hard for me to go through every detail, but I will go over the major parts. The bones in the knee were shaped by the usage of many unique tools, mainly saws and adapters to the saw. The shaping was done to accommodate the placement of the prosthetic knee parts to fit on the original bone, kind of like legos. First, the adapters that were drilled into the knee. These adapters had spaces that exposed the part of the knee that needed to be sawed off. The saw was put through the space and it shaved off bone at different angles. Once shaped, certain parts of the knee had grooved holes drilled into them. The purpose of these grooved holes were to help accommodate the prosthetic pieces to fit in their respective areas. There was a smooth Prosthetic bit made for the femoral part of the joint; it was a contoured piece of metal. For the tibial part of the joint, there was a flat metal platform that would accommodate a plastic spacer meant to slide along the metal femoral peice during motion. All the bits were cemented to the joint by a unique compound (it smelled like paint remover!). The compound was fluid at first so that it could be shaped and applied to the synthetic bits and the bone before bonding occurred. During bonding, it hardened quickly through an exothermic reaction (i held some extra cement in my hand and it was really really hot!). The application of the cement had to be precise because you don't want the synthetic bits to move from their intended positions. It was an amazing surgery, characterized by a lot of hammering, drilling, and sawing. I never thought that it was possible to shave parts of the knee and add prosthetic pieces to restore joint movement... It's really mind blowing how far we've come. This surgery is definitely an example of how technology in health is improving people's lives.

I really love rotating with Dr. Rene Velasquez. It's a very personal experience, and I'm able to really benefit from the amount of attention he's able to give. By following him around, I'm able to see all the aspects of a surgeon's profession. I've learned that it's not just about going into the O.R. and performing a procedure. It's much more than that. It's about gaining the trust and respect of your patients so that you can give them the best care possible. The only way to give the best care is to build a meaningful relationship with your patient, otherwise it's hard to empathize and look at them as a human being. Dr. Rene has an amazing quality, where he can form bonds fast and I'm 100 percent sure it's through his practice and usage of emotional intelligence. I don't think it's something he learned in a class, like me; I think it came from the years of experience and his love for what he does.

Another thing that I really admire about Dr. Rene is that he makes sure the patients family is happy and content with his care as well. For example, after a spinal surgery on a woman, the first thing we did was to go to the waiting room and meet with her family. He made sure her husband wasn't worried, and assured him that everything was fine. In another case, we waited for a patient's husband for 15 minutes in the waiting room, instead of just leaving or assuming he'll find out the post-operative status, one way or another. He treats everyone with a sense of humor, respect, and empathy that builds an environment of trust and security around him. People trust him and are really satisfied with his care. When random patient's in the hospital ask him questions, he makes sure they're directed to the right department or people. Many people are concerned, he can see that and behave accordingly. He's definitely a great representation of how doctor's should be. I hope to be a lot like him!