University of Illinois at Chicago
On our last week of Ophthalmology Dr. Sugar gave myself and my partner Mike a surprise. We went to the simulation laboratory on the first floor next to the general eye clinic not knowing what to expect. To our surprise we enter a room filled with practice equipment for medical students, residents, fellows, and whoever wants to improve their skills. The room itself was large and spacious and not to mention dimly lit (mainly cause no one turned the lights on).
Dr Sugar gave us a quick tour of the place. There are rows microscopes that are used in the actual surgeries at each station as well as a platform for the doctors to have a place to practice on. We were informed that the students could practice on research tissues or a model.
One very amazing piece of simulation technology was a virtual simulation machine. This device allows the user to practice most surgeries that will be performed on the eye in this hospital. The system breaks up each surgery into smaller portions that helps the user practice individual skills in addition to the entire surgery. Each time you practice you are tested based on how well you handle the microscope, surgical instruments, tissue handling, efficiency, and if you completed the objective of the particular practice simulation or not. At the very end a score is tallied up and lets you know how well you did.
Myself and Mike were able to try our own skills out. The test we had was to put red block around the edge of the cornea into a wire basket they had in the middle of the eye. This was to simulate the first part of a cataract surgery. Our first couple of attempts were bad…. After the first try we realized that while we are performing the surgery there is a comment line at the bottom of the screen that lets the user know what they are doing wrong in real time. For instance we got a lot of the “do not hit the lens” reminders as well as “close the instrument when leaving the eye”.
We treated this exercise as a bit of a competition and I would like to say that I caught on a little faster then Mike did. My advantage was being right handed while Mike is a lefty. For me it was easier to hold the instruments and operate the simulation. For our last try I did amazing. I was able to finish in a rapid 22 seconds with what I thought was a good score. Before Mike’s last try Dr. Sugar came in and help Mike out with the instrument positioning and gave him some pointers to go along with it. Since Mike is left handed, Dr. Sugar made it a rule that he gets doubled the time I was able to complete the surgery in as a handicap. Sadly Mike beat me badly. He did take longer but his tissue handling skill was much more gentler then mine. I for one was shocked.
Although we were not in the clinic or the OR I gained a lot of valuable information and experience from this. I realized that surgery is more intricate then I could have imagined. The small incisions that they make do not leave much room for mobility in the eye. Also we were lucky enough to have a stable eye opposed to someone moving theirs in the operating room because they are uncomfortable. Most importantly I learned that eye surgery is not meant for me. It was fun and exciting but I do not think I am gentile enough for this.
Pediatric Ophthalmology focuses on children’s (newborn to 18 years old) eye health. They see a variety of cases from glaucoma to strabismus to regular eye tests for school. Due to this most of the technology they use can be seen in the other specialties as well in addition to some special technology just for kids. For instance, when a kid is uncooperative and unable to allow the ophthalmologist to use the slit lamp to examine their cornea and retina they will use a portable slit lamp. This allows the ophthalmologist to have more mobility when the kid is being extra fidgety. Although it does not solve the problem if they are not keeping their eyes open this technology does allow a greater chance of cooperation.
Strabismus, a misalignment of the eyes, is a big portion of pediatrics at this hospital. In order to test for this the physicians use different prism block thicknesses. What they do with these prisms is hold it up against one eye in order to distort their vision in that eye and not the other. Then the ophthalmologist looks to see if the eye moves and focuses. If the eye does move and focus then they do not have strabismus. This is because the eye is refocusing to adjust to the distorted image. If the eye does not move it is because the brain is already used to an unfocused image. Although this is a good way to measure the misalignment it is not the best. Since there is not quantitative way to measure strabismus, the physician is only able to diagnose based on what they see. When I asked a fellow about this they said that these movements are very hard to see which can make it difficult to determine in the cases that the strabismus is fairly minor.
The hardest part of observing pediatrics was observing the kids that were scared. Some were scared of the doctors themselves, others were scared of the instruments, but most of them were scared of anything that came close to their eyes (mainly the drops). It seemed that about 85% of the kids did not want their eyes dilated. When this happened they would scream and cry, some even kicked their legs in retaliation. Since they did not make it easy for the physician to put the drops in it resulted in the kids being restrained by their parents and/or other medical professionals. This was so hard to see. I felt so bad for the kids whenever this happened. All I wanted to do was to help them but this wasn’t possible because they needed the eye exam in order to make sure everything was ok. This usually happened in little kids (about 6 and younger). I think it was because they really do not understand what was going on like the older kids do.
Furthermore, the younger kids could not perform all of the eye tests easily. The main test they could not perform well was the typical eye chart test. When they are really young they do not know all of their letters or are to shy to communicate what they see very well. Due to this the doctor do not always get the most accurate prescription for their glasses. there is a test they do before hand that allows them to get a general idea on what the prescription should be but it does not mean that this test is the most accurate. Often after they do the preliminary test they fine tune the reading in order to get the correct prescription, if the kid does not know the letters they do not do well. In some cases the family is sent for with some worksheets with the letters on them in order to practice. This works better when the child actually sticks to practicing everyday with the letters and helps the exam go much smoother.
Although pediatric ophthalmology is hard sometimes it is still a very interesting field of ophthalmology. It’s even a great experience when the kids cooperate and have fun with the doctors.
During my time in Ophthalmology I had the pleasure of seeing a lot of different specialties within the field. So far I have been in Cornea, Retina, Glaucoma, Contact Lenses, Pediatrics, Plastics, Cataract surgery, Vitrectomy (Retina surgery), Glaucoma Surgery, and an Enucleation. While I was here there were some problems that I noticed. Some of which I already talked about with the contact lenses. Two of the problems that I talked with some of the physicians about are a double barrel needle and electronic charting system.
When I was in Retina with Dr. Lim we discussed a few different improvements that she would like to see. The one that caught my attention was the double barrel needle. It is important to keep eye pressure in mind when injecting antibiotics into the jelly-like fluid filled space in the eye. In order to reduce an increase in pressure in the eye some fluid needs to be removed before injecting the antibiotic. This way approximately the same amount of fluid is within the eye therefore keeping the same amount of pressure. Unfortuently in order to do this the eye needs to be stuck with a needle twice: once for the fluid removal and another time for the antibiotic injection. This results in an increase in chance of infection (even though this is still small it is still an increase) and healing time. In order to remove these concerns Dr. Lim mentioned that a double barrel needle would be ideal. One part of the needle would be used for fluid uptake and the other for injection. Her concerns were that she did not want any cross contamination and it had to be able to use a small needle size because the eye is so sensitive and small.
While I was in Pediatrics with Dr. Abbasian we talked about the current charting system and she’s not the only one. The charting system at the hospital is very outdated and according to Dr. Sugar it would take $3,000,000 in order to update it. Even with this update the charting system would not be made any easier. Right now all of the patients charts are hand written and then scanned in order to be put into the system. This takes time away from the receptionists as well as the physicians when it comes to reading other physicians handwriting and after seeing some of their handwriting it’s surprising that anything can be deciphered at all! Dr. Abbasian said that it would be ideal to have a system that could be written on, typed on, and have spaces for their drawings of their patients eyes (which they do a lot). In addition it would be convenient if this could all be done on a tablet. That way it is portable and have the ability to switch between stylus writing and keyboard typing. In addition since it would already be electronic it would be even easier to send to outside physicians, cut down on the time it takes for scanning, and can potentially reduce the amount of paper that is used in the hospital.
**Note the image above was taken from https://upload.wikimedia.org/wikipedia/commons/a/af/Specrx-prescription2.jpg and is used as an example for the written charting system. **
As we go further into the week we start to see more of the different specialties. Dr. Sugar decides to break us up for the better part of the week so we can see what different specialties have to offer on our own. In addition to some additional time in cornea and retina, I spent some time in glaucoma and contact lenses.
Glaucoma is a disease of the eye that is caused through an increase of eye pressure and can lead to blindness. Once glaucoma develops there is no way to retrieve any of the loss vision but it is possible to try and maintain the disease so that no more vision is lost. During my time in glaucoma there were a couple of things that got my attention. The main one had to be the amount of patients that asked about marijuana as a prescription. Dr. Aref (the attending I was following around for my time here) informed each and everyone that although marijuana does lower eye pressure it only does so for a couple of hours and is not a good solution. Upon hearing this one patient put it “so you would have to be lit up around the clock,” which wasn’t the most medically correct way to put it, it was an accurate one. This was a big misconception to all the patients that asked about this form of treatment. After we left the room of the first patient that brought his up Dr. Aref told us that this has become a very popular topic among patients ever since the ruling to legalize marijuana in Colorado.
Another interesting condition of glaucoma is that it can affect the drainage system of the eye. If there is an extra build up of fluid in the eye from improper drainage or an increase of fluid production, can lead to an increase in the pressure within the eye. When this happens there are two different options. The first one is to to create a tiny hole in the eye in the filtration angle (where the cornea meets the iris). This hole is generally not noticeable to other people. The other option that we saw was to insert the tip of a tube in between the cornea and iris. This tube is attached to an implant that allows for the fluid to drain properly. This device can only be seen under the microscope and even then it was hard to do so! I thought that this device was amazing at how it was able to drain fluid without creating a larger hole like with the other technique.
When I went to contact lenses I wasn’t sure what I would gain from it. According to Dr. Sugar there isn’t a lot of technology that is used there, hinting that it may not be interesting or valuable. In contrast to what Dr. Sugar said, I found contact lenses to be very enjoyable! The atmosphere was generally very happy and welcoming and the patients for the most part seemed to be in a good mood during their visit. Although there wasn’t a lot of technology present, there was some things I find rather interesting.
In order to fit the contact lens properly a corneal topography test (photokeratoscopy) is done to measure the eye. It uses a lighted bowl with a concentric ring pattern that projects data onto the eye in order to map it (pictured above). Although this generally works for those who have “normal” eyes there are multiple artifacts that can alter the reading. These artifacts include: eye lashes and people who have poor topography. The last one was especially surprising to me. This machine is being used to measure topography yet, according to Dr. Joselin, it can have poor result with patients who have poor topography. Due to this inaccurate reading, there can be an extended amount of time needed to fit someone for a hard contact lens. There was one case I was were the person was getting fitted and based on the readings the left eye was easy to fit while the right eye took a much longer time. This was because the reading in his right eye was very off.
In addition to this Dr. Joselin talked about an interesting technique called “piggy backing”. This is were the user wears a soft contact lens underneath a hard contact lens. The purpose of this is to help the hard contact lens adhere better to the eye so that it will not fall off during regular use. The soft lens acts as saran wrap and shapes itself to whatever topography they eye already has. Oppositely, hard lenses will have a smooth outer surface no matter what and is rigid in place. This makes fitting a hard lens user more difficult because the steepness of the eye place a large role as to how well the lens will fit. The reason why more physicians do not prescribe this kind of treatment is because taking care of four different lenses is a lot of work. In addition, the soft lenses are not oxygen permeable like the hard lenses are. This makes the care and use of each lens more challenging since there are different protocols for each type.
I hope to spend more time in glaucoma and contact lenses during my time in opthalmology. I feel like there is a lot of potential for improvement in each of these and it is really exciting to think about!
It’s the beginning of week 4 and I am starting my new rotation in ophthalmology with my new partner Mike. When we arrive to the eye clinic it’s definitely something that I was not used to in anesthesiology. We meet our mentor for the next three weeks, Dr. Sugar, in the cornea clinic where he is an attending. After our introductions he takes us on a tour of the other specialties that are at the University Hospital.
In the cornea clinic we were able to see how the patients were assessed and the quality of care they receive. I’ve noticed that Dr. Sugar’s care varies with the amount of time he has had with a patient. For instance, one patient he’s had for over twenty years and they were in the room joking around and giving each other a hard time like old friends. In contrast, another patient he hasn’t had for quite as long, Dr. Sugar is more formal about what is going on.We also had the opportunity to visit the retina clinic with Dr. Meiler. Compared with the cornea clinic, the retina clinic was much busier. Within an hour and forty-five minutes we were able to see a total of twelve patients and kept this pace the entire time I was there.
One device that is common between the cornea and retina clinic is the use of the indirect ophthalmoscope. The indirect ophthalmoscope allows the doctor to see the retina in the back of the eye. In addition, this is a headset device that shines a light on the eye of the patient through a handheld lens. The actual headset is bulky and hard to control for those who haven’t had a significant amount of training with it. When I asked a medical student what made it so difficult he told me that a lot has to do with alignment. You first have to align the headset on yourself, then make sure you can see the light through the lenses on the headset as well as the hand held lens, finally it all needs to be aligned with the specific spot on the eye that the retina needs to be seen. To make things more difficult for those who are new to using this device, the lenses are inverted. The medical student I talked to expressed how this takes a while to get used to.
Although I spent most of the time in a clinical setting it wasn’t as boring as I would have imagined. There are a lot of opportunities for improvement on the devices that are used daily, such as the inverted ophthalmoscope. In addition, I think it is a good change for me to be in a more clinical setting opposed to an OR. During these next three weeks I will be able to see how these medical devices affect patients who are awake opposed to those anesthetized during surgery.
Looking back on my past three weeks in the Anesthesiology Department, I cant’ help but feel sad about leaving such an amazing experience. I was exposed to multiple interesting procedures both in and out of the operating room. Some of my favorites included a spinal fusion, a craniotomy done to help someone with moyamoya, the local anesthesia nerve blocks, a quadrupedal bypass, witnessing the Da Vinci robot during a kidney transplant, and the mandibular resection/reconstruction. Each of these surgeries, as well as the many others we were fortunate enough to see, provided me so much insight into the clinical world and how surgeons are able to help their patients out in ways that surprised me at some points.
Form these surgeries I realized that more then just memorization is necessary to be a good medical practitioner. For instance, they need to be able to think quickly when things go wrong and know what each little sign or physiology change means to their patients health and well being. Besides that what I have noticed is that the anesthesiologist and surgeons are a master of their technology. By using the equipment every day they know exactly how it works and what needs to be improved upon it. In more cases then I thought they even knew about the circuitry or mechanics behind the device they were using. In addition before complicated surgeries the operating team would get together and plan the surgery out with great detail. They would know each step of the procedure as well as who would be performing what at approximately what time that would happen and what technology they would be using. This was all incredible to see in person.
Besides seeing all of the different surgeries and the technology that was used in there we were able to be taken aside and go in-depth into what the technology actually did. Sometimes we would be taken into a hallway or the storage room were we would get this explanation while other time we were able to try it out for ourselves. We would be set up in a room and practice the same techniques for anesthesiology that are used in the OR with the technology the anesthesiologist would use too. Doing these simulations was one of my favorite things to do. We were able to practice using an ultrasound, spinal epidurals, nerve stimulation, putting in a subclavian vein and an interior jugular vein central line, and ultrasound guided epidurals. By doing this I was able to see first hand what the shortcomings of either the technology that was used or the methods themselves were.
After having all of these amazing experiences I will miss my time in the Anesthesiology department very much. I would not have been able to do any of this without the help and guidance of Dr. Edelman. He was an amazing and knowledgeable person to shadow and observe. I would like to thank him for all of his time and effort during these past three weeks because they have been one of the best experiences I could have hoped for.
Going in for the usual morning lecture on Wednesday I was exhausted and ready to fall asleep, especially knowing ahead of time that this lecture was going to last an hour and a half long. Coffee in hand I went in with the mind set that I was going to have to try really hard to stay awake. To my surprise it was much easier then I thought. What help is that the presenter kept cracking jokes throughout the entire time. I mean when you compare spinal anesthesia to “the cats meow, the bees knees, for you younger generation the older ones of you would say it’s ‘da boom’ and for you even younger ones it’s ‘the shit'”. After that I knew this day was going to be one to remember.
Once the lecture was over we went straight to the OR as usual. Unlike most days we stayed in the same room the entire time. The surgery being performed was a mandibular resection/reconstruction for a patient with a jaw and neck tumor. A quick summary of what they were going to do is remove some surrounding tissue of the jaw as well of part of the jaw bone itself. The jaw would then be replaced by the patients right fibula.
Since the surgery was concentrated with the neck and jaw it was decided to sedate the patient with an awake tracheotomy. The patient had additional surgeries in the same area before with tracheotomies as the form of sedation, this lead to a difficult tracheotomy. After the tracheotomy there was still a good amount of prep that needed to be done before the main procedure could begin. This included placing multiple IV’s and arterial lines as well as a gastrostomy tube (G-tube) to provide the abdomen with fluids.
The main procedure had two different surgeries going at the same time. Simultaneously, one set of surgeons were working on removing the jaw and tumor while another set of surgeons worked on extracting the fibula. We were unable to see the entire surgery since it was projected to go until 8:00 pm. The rest of the procedure included microvascularization of the vessels in the jaw to the reconstructed jaw, taking flow measurements, and closing the patient up.
On the wall of the OR was something that caught our attention. Before entering the OR the surgeons gathered and discussed a plan of action they saw fit for the surgery as well as modeled what was necessary for the reconstruction. This part was what is really interesting. By using VSP Reconstruction (Virtual Surgery Planning), they were able to plan exactly how much of the fibula was needed, how to cut it in order to get the proper structure and function of the jaw, and what the dimensions of the metal brackets to hold the bone in place. These diagrams can be seen below.
These models really resonated with me. I enjoy modeling (even if it is not exactly this type of modeling) but more importantly it got me to thinking. The only type of modeling we have in the curriculum so far is in BIOE 101 with SolidWorks. After seeing this in the OR I feel like it would be very beneficial if we had more of a modeling class, even if it was only an elective, that would incorporate real world applications such as this. In addition, it could include how to test a medical prosthetic with static and dynamic aspects.
Besides being able to watch what Anesthesiologist do and their technology we were able to be exposed to intraoperative neuromonitoring during a STA-MCA bypass surgery. Before seeing the technology being used we were lucky enough to talk with two specialists, Ashley Selner and Faisal Waseem, about how the devices they use work and what it is they do. Intraoperative neuromonitoring utilizes sensors that are inserted next to a set of nerves cortically, subcortically, and a peripheral point of interest. These senors detect potentials from the nerves that they are next to (pictured above).
In order to get waveforms that can are easier to understand the signal is amplified, put though a low pass filter, and averaged. This allows the small potential (uV) to be read more easily. The main job for the intraoperative neuromonitoring specialist during surgery is to monitor these waveforms and alert the surgeon when there is unusual or abnormal activity that is seen.
The STA-MCA bypass surgery that used the intraoperative neuromonitoring was done a a nine-year-old kid. Before the day began Dr. Edelman warned us that this would be a tough one because of their size and age. At nine, the vessels are small and frail making it very difficult to operate on.
In the operating room there was a lot of tension due to this, which could also explain why they prep time took much longer then usual. Approximately three hours were used to place in all of the necessary tubing, IV’s, and intraoperative neuromonitoring sensors. Although it was heartbreaking to see them loose a lot of blood because of the difficult placements, the hardest thing to watch was shaving their head. That’s when the whole experience became very real since this was the youngest patient we have seen undergo surgery and not to mention it was a very serious surgery too.
Once everything was set up and the surgery was underway the overwhelmed feeling of what was happening became much more manageable. Seeing how the monitoring was going about was very interesting to me because of the signal processing and waveform interpretation is something I enjoy learning about. After seeing the sensors in action and talking with the specialist this is something I am planning to continue to look into as a possible career choice.
Since we started this internship there have been moments when people come to use and say this is what is wrong or this is what we need about a product or technique. One such instance not only effects anesthesiologist but trauma surgeons as well as those who are in the ER.
A suction device is used in most surgeries, especially those that require the patient to be opened up. The device takes excess fluid and small particles out of where a surgeon is operating on the table and places it into a sealed container. For the suction device pictured above when anything is added to the container it will display the amount in mL on the screen. As seen in the picture, there are two containers where the suctioned substance can be collected and that is determined through the initial set up, for this case the bottom container was the only one utilized.
I should also point out how the bottom container is much larger then the one on top, this is because the suction machine is used throughout the day without draining the liquid until the very end of the day. Although this is convenient in the sense that there is less clean up required throughout the day and between surgeries I couldn’t help but find this method wasteful. As strange as that may sound I kept thinking that there could be some way to reuse the blood that is entered into the container. Maybe so that it can go back into the patient similar to a bypass machine so that there is less of a blood volume and hemoglobin loss. The problem with this is that there would need to be a way to completely remove the blood from any irrigation that was used, tissue particles, and small bone fragments that could have been picked up from the suction. Although this might sound easy the fact is that some of the particles are so small they have the possibility to pass through a filter.
This was something that I couldn’t help but notice while Dr. Eldelman was explaining an enhancement to the machine that would quantitatively benefit those who monitor it. As previously mentioned there is more then just blood that enters the suction device therefore, the total volume that is displayed is not purely the blood loss the patient has experienced. This is a concern for anesthesiologist because they are worried about the patients blood volume as well as their hemoglobin levels. They do have ways to estimate these measurements but they are not exact. Even if the estimation is close there are still those cases where the anesthesiologist are wrong and the hemoglobin drops below 8 after drawing blood and checking the hemoglobin level (on average a normal hemoglobin level is 15 but 8 is still good especially during surgery).
What was proposed by Dr. Eldelman is a way that the hemoglobin level could be displayed on the screen with the blood loss as well as the total volume collected by the suction machine. This way would provide qualitative measurements so the anesthesiologist know exactly how much hemoglobin to give a patient. By doing this patient care becomes more efficient.
In order for something like this to work there would need to be a hemoglobin scanner and a red blood cell detection system. Although this might sound simple Dr. Eldelmen assured me that it is much more complicated then it seems.
No one should be a full functioning adult by 6:30 in the morning. It takes enough effort to function as is at a normal hour of the day let alone when your brain should be turned off and sleeping away. With that being said I was at the hospital on the Anesthesiology floor ready for the morning lecture by 6:15 like a crazy person.
The anesthesiologist we are following around, Dr. Eldelman enters the conference room about two minutes after me and probably noticed the half asleep gaze or maybe I hid that well enough with some enthusiasm to learn, since I was the only crazy person there, either way he knew the desperate need of coffee I was craving. He showed me to the glorious kitchen that they have for the department with the constant flow of coffee. Obviously the clouds prated and a beam of light shown over that coffee pot.
In the morning lecture Dr. Eldelman was the one who was presenting on the type of anesthetic drugs that are used for the practice of anesthesiology and made special note one those used at UIC. Here is where I realized how the bioengineering classes I have taken so far all connect with a medical specialty.
When the lecture ended we changed into our scrubs and got moving. It started off chaotic. We went downstairs to the radiology department. Dr. Eldelman’s cases were switched at the last minute so he was quickly reading over his knew case file and so multiple problems. The main one was that this patient had some serious health concerns yet did not go in for necessary testing before coming in for this new procedure.
Anesthesiologist need to take multiple factors into account before even letting the surgery take place. Some of them are as followed:
-the patients medical history
-previous operations and whether there were complications intubating
-a patients physical state
-anesthetic drugs (the amount necessary to put them under, how much is necessary to keep them under, how long they need to be sedated, after so much time will they need to be awoken, and any possible reactions that the patient might have with the medications)
-the type and duration of the surgery
Since this patient had Sickle cell and came to the hospital in regards to a brain aneurism with a possible hart complication, this made the process a bit more complicated. By choosing not to go to the medical tests that were required before the procedure Dr. Eldelman along with other professionals decided it was best to wait for testing before proceeding with any surgery.
We proceeded to another surgery were the patient came in because of an abnormal heart due to either its shape or size. We arrive just as they are getting ready to intubate the patient. The doctor was using a video camera laryngoscopy (VCL), which uses video assistance in order to intubate the patient. This seemed to take a little longer then usual so Dr. Eldelman began as he put it “mooshing” the neck to prevent the patient from vomiting. “Mooshing” is where someone massages a part of the neck. This did not help put in the entubation tube. They quickly switched to using a fiber optic cable to get a better view. This still did not allow the tube to pass the vocal cord. Things start to become a bit more panicked and the real chaos begins. Dr. Eldelman steps up on the stool that was already by the head of the operating table semi-tripping on the cords on the way up. Since the fiber optic assistance did not work they switched to an airway rescue (what they call when the patient is not getting any air into their body and the anesthesiologist needs to reestablish the airway). Dr. Eldelman decided it was best to bag the patient and start to manually ventilate with the goal being to awaken the patient and intubate them awake instead of under anesthesia.
When the patient became awake and responsive they were told the news and was in good spirits about the situation, maybe because this was their 13th surgery within the past year. The steps for an awake intubation are as followed: numb the throat and mouth, use a video guided scope in order to intubate, and then to finally intubate the patient while they are still awake and responsive. After this was completed the procedure of the surgery was as followed: the surgeon would stimulate the arrithmia, create a 3D rendition of the heart based on this data, find the defect based on the rendition, burn the defect, and test the heart once complete. We actually did not see this part but instead left after intubation. Honestly this was probably for the best because I was freaking out silently while the true chaos was going on.
Dr. Eldelman walked us out of the room and told us exactly what happened and why this became an emergency situation. I think he noticed that we were a bit caught off gaurd and let us have a coffee break while we did some research on anesthesiology (reading from the giant textbook he gave us). I for one was thankful because I needed the time to process and get everything straight again.
After our nice break we talked about some of the technology that we saw in the brain surgery yesterday. Pictured above is a nerve stimulator that is used to detect the amount of paralysis that a patient experiences throughout a surgery. As seen above the sensors are attached to a nerve in the forearm and allow a current to flow through. When checking for paralysis a button is pushed that allows what is called a “train of four” to pass. This is four stimuli that go to the nerve at equal intervals. This stimulus will be reflected by the amount of movement seen in the thumb. In order to see the full effect and what they patient would be experiencing we were able to test it out.
After this sun experiment we observed a neck dissection for thyroid cancer and a lumbar epidural that was used for a gun shot victim. By the end of this I was exhausted but thrilled to see so much and have all sorts of ideas running through my mind. Most of these will be explained later as I document the rest of the week and they become more pertinent then. Now I am just looking forward to the rest of my time here and hopping that it never ends!
My partner Tiana and I were assigned to the anesthesiology rotation of the clinical immersion internship. Needless to say we were excited about it. This was the one we really wanted and for good reason. With anesthesiology we came in thinking that there would be a multitude of different surgeries we would see as well as the vast amount of technology that is used during a surgical process the anesthesiologist uses.
The moment I entered the hospital I was a little bit anxious about what lies ahead. I wasn’t to sure what to expect but I had a feeling it wouldn’t be anything like what was on surgery based shows. As soon as we met our mentor for the next three weeks we hit the floor running (actually speed walking would be more accurate). Without hesitation we went to get scrubs to change into. To be honest putting scrubs on for the first time is an exhilarating experience! It was as if this program officially started and I was excited to get started (just look at the picture for proof!).
After a very quick tour of the maze-like surgical floor we took a trip into a near by OR that was performing a spinal surgery. While here we were informed about the rules and regulations of an OR. Something that surprised me was the fact the entire room was not sterile. They did in fact have a sterile field that had very strict rules about who can even go near the field. The sterile field consists of any open uncovered tray or anything that is facing the patient. Since the entire room is not a purely sterile environment only those who entered the sterile field needed to scrub in.
We went to another case right after this introduction to an OR setting and this case was eye-opening to me. Before we met the patient our mentor did prep us for how sensitive this case was going to be. This was the first time that I was exposed to an extremely emotional clinical setting and it was only day one. This patients family was visibly worried and nervous about them undergoing this procedure (brain surgery were there was a build up of CSF in the ventricles due to a cyst). Although they were worried they tried to be strong and supportive for the patient while at their bed. The patient themselves were another story. They were terrified and crying. This was very hard for me to see and I was very thankful to have my face mask on during this time.
Although this was a very difficult time for the family and patient my mentor surprised me even more then I could imagine. I had this preconceived notion that anesthesiologist were more behind the scenes and did not interact with the patients except to walk them through the anesthetizing process. I could not have been more wrong. He was there before going into the OR and talking with the family and patient about the procedure and was there to comfort them in such a difficult time.
Once in the OR with this patient they were still scared but the procedure continued as planned. Some interesting observations was that the room was very cold compared to everywhere else and the vast amount of wires seen throughout the room. These wires made moving the patients table very difficult.
Although we did not stay for the entire operation there was some valuable information that was gained about the preparation and thought process of anesthetic treatment that goes into each patient. After observing a good amount of the surgery we retired the scrubs for the day only leaving eager to return in the morning… at 6:30 AM.