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!

Blog 28

Blog 28: 04/11/08

I learned something extremely key today. However, due to its intuitive nature It is extremely hard to regurgitate it; but, it is too important for me not to try. It was an great epiphany, the magnitude of which I cannot describe. It was amazing because I was speaking from the heart, and realizations were flowing out of me like an endless, gushing river. It was knowledge which, up until know, hadn't presented itself in the forefront of my consciousness. The experience was an amazing high of energy, motivation, and gratitude. The final product was the realization of an essential personal truth, which I'm sure will let me spread my wings and soar through this amazing journey called life. First, I will introduce the context of the situation which lead up to this realization.

The morning was pretty relaxed. I ate breakfast at 9, and took a nap till 10:30. Around 10:35 I left the house to get my laptop charger fixed because the chord was hyper-extended, and it wouldn't charge my laptop anymore. After I dropped the chord off to Adonai(an apple certified store), I went to Cafe Los Cuiles with Justin and surfed the internet for a bit. At 2:00 p.m., I went home and had comida. I met some old homestays of my familia who were from Portland, Oregon; they were going to tour Sierras. After they left, I went to Cafe Italiano, and studied a bit with Jennifer. We ended up talking about our backgrounds, which was really interesting because they contrasted so much from each other. I'll have to make a completely separate post about that experience. I had Spanish class from 5-7p.m., which was fun because I learned how to give commands. After class, I went to Cafe Brujula to do research for my paper and read assigned articles. At this Cafe, at 8 p.m.,
is where my epiphany began!

In Cafe Brujula, I decided to call my friend Shuja through my Skype VoIP. Our conversation was about medical school. I think I called him because was thinking about medical school earlier that day, and was getting a little nervous and anxious. He asked me how the Oaxaca program was so far, and I told him that I was getting a little bored with the program, and my blog; I told Jennifer the same thing before. Although I was enamored with my surgical rotations, I was beginning to have problems extracting relevant lessons from my experience. Don't get me wrong though, orthopedic surgeries are still AMAZING, and I'm as giddy as ever watching them. But writing about cases and specific pathological details of certain conditions is something I'll learn in medical school. I feel like there's a greater lesson I need to learn before I can really appreciate the specifics of medicine. The realization came through the development of my blog. The blog posts of my rotations started to become regurgitation of case facts, instead of something more important. I stopped paying attention to the real lesson...How has this experience changed me? What have I gained from this experience? Has it matured me? Can I think on a new level? How does this effect the quality of life of the patient? Did I pay attention to how the doctor interacted with the patient? Why was the doctor interested in being a surgeon? Can I apply what I've learned through this experience to other situations in the future? The pathology and treatment of conditions is extremely interesting, but I know I'll learn all this stuff in medical school. I'm young, and at this point in my life it's essential to learn lessons that would allow me to mature, develop wisdom, and and force me to think in new ways. Lessons that present-day doctors have already learned before entering medical school. I realized that current doctors have skills to think on an abstract plane, and can use their minds in creative and new ways. Technical skills are only one aspect of medicine. I think I'm getting the idea of what it means to be a doctor now; it requires abstract critical thinking skills, wisdom, insight, which are learned through tough but deep life experiences; life experiences that force one to look for a deeper meaning than what's present in the obvious details.

However, I'm not downplaying the significance of my rotations. They've matured me in great ways. They've exposed me to medicine in a way I've never experienced before. It's served it's purpose in showing me that I wanted to be a doctor, and that I would love to be a surgeon for the rest of my life. Watching surgeries, excites me so much, and I get rushes every time I watch them. I would spend all day if I could in the O.R. However, I want to stop watching, and start contributing and getting involved. I think I need to approach my surgical rotations in a very analytical way. A approach that would allow me to understand what surgery is all about as an overall field. Also, I need to supplement my rotational experiences, with experiences that have nothing to do with surgery or medicine, in order to gain new insight and perspectives.

I also realized that, you don't want to be stuck in your comfort zone, because prevents you learning, changing, and gaining new perspectives. When things become boring and comfortable it's because learning has ceased. In fact, I realized the more random and interesting situations I throw myself into, the more I can learn different skills and lessons. If I'm in the same environment, it becomes a comfort zone because you gain familiarity with everything, and the rate of learning decreases substantially. Whether I intern at a construction site or at NASA, there are essential life lessons in each scenario. Doctors are able to extract the deeper meanings behind situations, which ultimately allows them to use more skills and improve their ability to give care to their patients. I feel as though medical schools look for people who are able to learn something beneficial from everything they do. Extracting meaning from experiences results in the development of critical thinking, analysis, and increased reasoning abilities; it forces one to understand the situation or context in more dimensions. It's an essential skill, and I'm going to practice thinking this way, by chancing the way I observe everything. I'm going to ask myself what did I learn from this experience? Why did I feel a particular way? How can I use what I've learned in the future? By thinking this way, development as a better person and physician is endless; it has no limits.

I asked Imran Khan, who's a really close friends with one of my best friend's Shuja, about what activities I should do in order to get admission to medical school being that he was recently admitted into medical school himself. So he went on to tell me his personal experiences. He was a student defender in the student judicial committee at his undergraduate school. The experience wasn't a clinical or research experience, however, he was able to gain useful skills and lessons that he could apply in being doctor. In his experience, many times he had to defend students that he knew were cheating, but it was his duty to defend them. It also applies to taking care of patient because doctors have to offer health care to patients, even if the doctor perceives the patient to have moral corruption. It made him an applicant with a diverse skill set, who able to bring his diverse experiences and use them in ways others couldn't. I feel that's why he was able to get into medical school. He told me about this before I started the program, and I only really understood what he was talking after going through experiences in this program. It's important to have diverse experiences, in order to have unique skills that will allow you to approach situations and problems differently and more effectively.

I think it takes a lot of maturity to know why one want's to become doctor. Through my rotational experiences, I'm slowly getting a handle on the reason I want to become a doctor. The more rotations I go through, the more it strengthens my resolve and reason to pursue the medical path. Hopefully, i'll come to a point where I can easily express that reason, and it doesn't exist just as a feeling.

The main point of this program is to give the premedical student a new perspective in their approach to medicine because medicine isn't just grounded in technical skills, human physiology, and problem solving. There's a human aspect to it, and it requires diversified life experiences that can provide the motivation for true empathy and awareness of those in need. The program is meant to mature the premed student, and prepare him/her for the journey through medical school, residency, and practice.

Blog 27

Blog 27: 10/27/08

My third day at Hospital ISSSTE was amazing because I was finally transferred to surgery. Also, I was lucky enough to see a spinal surgery. To get the transfer, I went to talk to the administration, which was an interesting experience in itself.

At 8 a.m., I went to the administrative teaching office, which assigns students to various rotations around the hospital. At ISSSTE, the system is very regulated and permission is needed for students to change departments, and must be assigned specific doctors to rotate with; unlike Civil, where students can pretty much show up anywhere, as long as they have a proper identification. At the office, I wasn't able to speak a word of Spanish, I think it was just one of those morning where my brain wouldn't function. The only thing I could communicate was that I wanted to rotate in cirugia (surgery). After a lot of talking (none of which I understood), the secretary assigned a lady for me to follow. I followed the lady to a department that said Cirugia and Medica Interno (you can guess what those mean). She told me to ask for Dr. Eric Martinez, when I reached the department. So I asked for Dr. Eric Martinez, and he wasn't there today, so I was told to ask Dr. Victor Cruz about what I should do. Dr. Victor Cruz was a really nice guy, unfortunately I couldn't understand a word he was saying, and vice-versa. He took me to this room with two other doctors. This is where it gets funny. Dr. Cruz said something to do the doctors, and left. So, I was in an office with these two doctors, and I had no idea where I was, who I was supposed to follow, or where I was supposed to go. The lady doctor started talking to me, and I through she told me to enter one of the rooms in the hallway. So, I went outside and entered a room with a patient in it. The patient was confused and had no idea what I was doing in the room. What made things worse was that I couldn't understand a word the patient was saying. So I was waiting in his room for 10 minutes, and the patient's son told me to go outside to get a face mask. When, I went outside the male doctor who was in the office told me to follow him, and we ended up going to his consult room, which was two floors down. So as it turned out, I wasn't supposed to go into any of the rooms in Medica Interno, instead they just wanted me to wait for one of them to finish their paper work. So...not knowing good Spanish can make for interesting experiences and funny stories! I feel kind of bad because the patient, probably had no idea what was going on.

I'm starting to like ISSSTE more than Civil because my rotation is more personalized. It's just me and one doctor, and I follow him through his surgeries. The doctor is an orthopedic surgeon (title in mexico: Traumatologo); his name is Dr. Rene Velazquez. I'm really lucky to be shadowing him because he's a really nice guy, who's able to get along with everyone. His people skills are amazing. He also, really goes out of his way to make sure that I'm having fun and get to see really interesting stuff.

Today's case was really cool. Dr. Velazquez operated on a 33 year old woman, who had a "black disc" (deteriorating disc?) which was causing her problems (my guess a lot of pain). The surgery was especially interesting. Dr. Velazquez was learning how to do a new procedure from another orthopedic surgeon named Dr. Pepe. Dr. Pepe owned or worked for a company (www.lixus-spine.com) that developed special plastic spacers (and other orthopedic equipment), which would tie together and rigidify the vertebra that had the black disc in between. Dr. Velazquez entered the woman's back with a cauderizer. He kept going deeper, until we saw the vertebral arches. Dr. Velazquez used a special X-shaped tool to separate the vertebral arches of the two different vertebrae. Thereafter, there was an x-shaped space between the vertebral arches, where the x-shaped plastic spacer was placed. The plastic spacer was secured between the vertebra using this special rope that tied around the vertebral arches. The lady was then resealed. The deteriorating black disc could no longer act as a proper spacer, causing the spinal vertebra to start touching. It was a pretty simple procedure, meant to separate the vertebra that were touching and causing pain.

I really thank God for my experiences today. I was assigned to a really friendly surgeon, who was happy to have me with him. It did wonders for my learning and observational experiences. Dr. Pepe spoke English, and he was super happy to explain the procedure he taught to Dr. Velazquez; he ended up giving me his e-mail and card, and told me that next time I was in Mexico City, I should call him to check out his orthopedic company. Both surgeons were really impressed with my videos and pictures, and wanted it on C.D.. During the surgery Dr. Pepe wanted me to take a bunch of pictures of his equipment and how it looked inside the body, so I have some really cool viewing angles on photo. I'm going to continue my rotation with Dr. Velazquez next week, so I should see some pretty cool stuff. What's really interesting is that he's going to let me view him interacting in the consult room, as well as in the operating room in order for me to get a full understanding of the surgical profession. He also told me, I could come into the O.R. anytime I wanted, even if he wasn't there, and introduced me to Dr. Venacio Rodriguez, the head Anesthesiologist. Now I have full surgery observation access at ISSSTE! Kudos to the Oaxaca Program!

One more thing: ISSSTE's operating facilities are better funded than Civil. There is more surgical equipment available, and more resources are used during surgery (such as more sheets and coverings on the patient). There are less people in the O.R. which makes the viewing experience more personalized. It's better maintained, and the rooms are much cleaner. It was easy to see how good insurance, can get the patient better resources for care. The difference between ISSSTE and Seguro Popular is pretty big in terms of quality of care.

Blog 26

Blog 26: 10/30/08

My second day at Hospital ISSSTE was tough. In the ICU, being aggressive takes a lot of energy, and after a while I couldn't keep asking the doctors and med school students to explain every little thing. To really learn in that environment, you need to have the requisite knowledge they teach you in medical school. So I decided I'm going to switch to cirugia(surgery) tomorrow, or at least gynecology. Overall, it was a pretty relaxed day. One thing that I don't like about ISSSTE is how hard it is to move from one department to the other. I have to go to the administrative department and get permission (which is contingent on if the lady is even there that day) in order to move from ICU to surgery.

On a side note, one thing I noticed about Hospital ISSSTE is that it's pretty well funded. They have pretty good landscaping, and the hospital is relatively well taken care of, especially in comparison to Hospital Civil.

So far, my favorite rotation has been through the surgery department of Hospital Civil. It's very easy to switch rooms or departments to find what I wanted to see. And most days there were tons of interesting surgeries going on. I'm trying to get Hospital Civil to be my last rotation on this trip, but it's extremely sought after by the other students, so the only thing I can really do is pray. I'll definitely start going on the weekends to see surgeries, being that I don't have many more chances to be there, before and after Puerto Escondido. Also, there's a ton of work to do before this quarter ends. I have a 10 page individual research paper, a 10 page group research paper, and a final paper....YIKES. I've got to jump on that horse quick or else it's not going to get done.

Comida was good today. At Becari, many home-stays made tamales, and luckily there was manteca-free tamales for me to eat. It was really good, and I was pretty satisfied. Dia de los muertos (Day of the Dead) is coming up, and there were little kids dressed up as skeletons and zombies. They performed a dance for our group, which was pretty cute. Dia de los muertos are actually two days in Mexican culture. The two days are dedicated to honoring dead children and adult family members once a year, by making them altars. In Mexico, they actually celebrate the dead instead of mourning them, which is really interesting. The rituals and customs are derived from pre-Spanish cultures, and combined with Catholicism. It's going to be on Friday and Saturday, so I'll definitely take pictures and keep everyone posted. I'll also keep everyone posted about my surgery experiences tomorrow. Salamz.

Blog 25

Blog 25: 10/29/08

It was my first day at Hospital ISSSTE, which is a hospital dedicated to serving government employees such as public school teachers, administrators, etc. It's a very nice hospital, located only a few blocks away from Hospital Civil (General Hospital of Oaxaca). My first rotation was in the emergency department/Intensive care.
Unfortunately, by the time we got there, all the patients were stabilized and referred to their relative departments. There wasn't much to do. Rotating through the ER is very different than through the O.R. or primary care units.

ER has a lot more stress associated with it. A lot of patients come in with unknown problems, and need to be stabilized immediately. Because today wasn't such a busy day, the residents were using it to really relax; they looked really worn out, probably because most of them were on a 36 hour rotation. It was a really interesting and valuable rotation for me because I learned a lot about myself, and how I would need to change in order to take what I wanted from the experience.

Unlike in the other departments, it was much harder to learn in emergency care. Everything is fast-paced and people don't have the time or energy to stop and teach. It was really frustrating because I was having a hard time getting what I wanted out of the situation. I was used to having doctors taking the time to really explain the patient's problems, and answer questions that I asked. Many times In surgeries, doctors explained to me what was going on, many times without me even asking questions. Due to time and attention constraints present in the ER, I really had to change my strategy to learn. In order to learn, I realized I would have to be more proactive and persistent. The residents weren't just going to wait for me follow them around and ask questions. I would have to be more aggressive. So, I changed my approach and tagged along with any residents I could find. I didn't wait around for them to notice that I had questions, instead I asked questions as they were working and walking around. Any free time they had, I would swoop in with questions that I needed answered. The residents didn't mind my approach at all, and were really willing to explain things when I took the initiative to ask. Many times they didn't fully answer my questions, so I would just ask the person later, or ask someone else.

I learned a lot from the experience because it forced me to learn adaption skills for that environment. In this particular environment, where there's no time and a lot of stress, the only way to benefit is to be proactive and go after what you want. No one has the time to notice what you want or need. Hopefully, I step it up a notch tommorrow and get even more out of the ER. I want to practice my new found skills. However, I also realize that being this aggressive may not fair well in other contexts, such as in the O.R.; instead it might be interpreted as something else, and serve as a great annoyance to surgeons and surgical residents. The lesson I took away from this experience is that it's important to adapt one's approach to learning, based on the context of their environment. Being proactive takes energy, but I'm really looking foreword to my rotation tomorrow!

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.

Blog 23 - Competition

Blog Entry 23: 10/23/08

I learned a really important lesson today. I've defined what competition means to me, and how I can use it to my advantage. I think it really improved my opinion of certain people I used to look down on, and me realize goals through their perspective. By integrating my morals, what I want, and how other's perceive competition, I've created my own definition, which I think will serve me extremely well on my way medical school, and throughout the rest of my life.
Competition was a concept that I've only recently come to address. And until now, I've never consciously identified what it means to me. What I found was that I subconsciously defined it as process of defeating everyone else by any means necessary to achieve a goal. Motivation to compete would come from hopes and efforts in the failure of others; it also meant having hatred and jealousy when witnessing the success of others. This internal definition kept me away from competing in many things because it went against my values and morals. However, I changed my perspective by observing some students on this program.
Initially, I saw some other students spending disproportionate amounts of time with the professor, as well as going on some really awesome rotations. I framed their actions in the context of my old definition of competition, which built resentment in my heart. I felt that their intentions were to step on others to get what they want. I viewed them as my cold, heartless, and selfish; people that I have to beat. However, I was able to identify the condition of my heart, and I didn't like what I saw.
Our perceptions are colored by our beliefs and principles (Thank you emotional intelligence lectures!). It turned out my perceptions of these students were a result of my flawed belief of competition. I found that a little part of me wanted to have all the cool rotations to myself, and that others shouldn't benefit as much I should. I really didn't like thinking that at all, and it wasn't something I wanted to exist as a part of my personality. So, I thought about it in a different way, in other words I reframed it so that I could understand the perspective of these proactive students.
By reframing and putting myself in their shoes (Thanks again emotional intelligence lectures!!), I began to understand and respect them. In fact, I ended up respecting them a lot. I noticed that these are students who were motivated enough to take the initiative to try obtain what they were interested and passionate about. They weren't going to wait around for something amazing to fall into their lap. That's also something I've come to realize about life in general, things aren't going to come to you, you have to go proactively find it. I think I trace my old perspective to the way I was raised. Everything was pretty much handed to me, and I never had to proactively seek much of anything. When I didn't see amazing stuff falling into my lap as usual, I became stressed out. I saw other students benefitting, by being proactive... something I didn't understand at first. This program actually taught me otherwise, which is what makes the experience priceless. It's an essential life skill for anything one wants to accomplish.
I realized that it wasn't the intent of these students to take something away from me, instead it was to seek out something they wanted. My new definition of competition incorporates that. If everyone benefits that's great, but the reality of life is that there are goals that many people may have, but only a few people can obtain them. These goals are obtained by people who take the initiative to go seek it out. Their intent isn't to prevent others from getting to the goal, in fact, they're unconcerned with that. It's more of an internal struggle with yourself to go and get what you want because you realize it's not going to just be given to you. And people who proactively seek things out, deserve the rewards of that. I respect people like that, and they've really motivated me to do the same. By this definition, the success of others should inspire one to strive and learn from the success of others. It should build respect for those you see succeed and obtain a certain goal. At least, that's what it has done for me.