OREX has been really amazing. But honestly, on many days, I didn't feel like waking up at 5am to bus to The Hospital in darkness--my safety feels threatened as it is in the daylight. I didn't feel like standing stiffly for 3, 4, 5, 6 hours in refrigerator-like operating rooms and smelling my own breath under my surgical mask. I didn't feel like hiding invisibly in the corner for fear of disrupting that magical surgical flow....or touching anything sterile that will potentially have serious consequences. But man. What a great opportunity. I will admit that even before I started volunteering at The Hospital, I had my sights set on being one of those 15 people who get to stand bedside in that operating room floor. I tried my best to not squander that privilege, or let my hunger, impatience, or desire to sleep in dilute my experience.
I read through a lot of my old OREX forum submissions in preparation for said interview, and wanted to share a couple with you. I've changed the names, but everything else I left in gory detail. Read on if you're into that kind of stuff! :)
FESS-- “Functional Endoscopic Sinus Surgery”
Dr. McDonald was performing a FESS procedure on a middle-aged male patient with polyps in his sinus cavity and a deviated septum. The procedure is done with a probe camera, and so it was very clear and easy to see on screen, just as Dr. McDonald had promised. He started with inserting the camera into the nose, past the nose hair forest, and it revealed many grayish blobs in the nasal cavity. These are polyps, or abnormal growths in the mucous membrane. They were simple to remove: a long device was simply inserted and clamped around the base of the polyp to pull it out of the nose. The motion was really as simple as clamping and yanking. Some bleeding ensued, but the blood was staunched later with packing of gauze after all polyps were removed. I’m normally not squeamish, but when Dr. McDonald dangled an especially large 2-inch blob of mucous-dripping tissue near my face, I had to turn away for just a minute. A microdebrider called "the hummer" was used to cut away excess tissue around the sinuses to further open the airway. I marveled at how clear the sinuses looked after removing about a dozen polyps from the man’s sinus cavities, and how in the world he managed to breathe before the procedure.
Laparoscopic superovarian cystectomy and partial hysterectomy
The patient was a 44-year old woman who had a right ovarian cyst that measured 7cm in diameter, heavy menstrual bleeding, and uterine fibroids. Dr. Do explained that the woman would need to have her uterus, cervix, and fallopian tubes removed, but ovaries intact. She said that they didn’t want to induce early menopause in the woman and have to resort to estrogen therapy sooner than necessary. With patient in stirrups on the table, an incision was made in the belly button and widened by wedging metal prongs. The special camera was then inserted and just as images of adipose tissue and underlying tissues were showing up on the screen, everything was shut down abruptly. I asked Dr. Do what was going on, and she said that the nature of the cyst made laparoscopic surgery too risky, and an open cystectomy had to be performed. It turns out that the cyst was an endometrioma, or “chocolate cyst.” This occurs when the endometrial lining that is normally in the uterine wall and sloughs off during menses forms an outpocketing elsewhere, and thus the blood pools within in a membrane without being drained. The result is a dark brown-colored fluid-filled cyst.
A longincision was made in above the pubic line, and a circular metal retractor was used to hold open a space of about six inches in diameter. The plan was to drain and excise the cyst without touching the ovaries. Eventually 300 mL of brownish fluid was drained and its jellylike membrane was removed. Occasionally, Dr. Do would ask the anesthesiologist if the urine was clear or not--this was because the area of interest is very close to the bladder and ureters, and if it were disrupted, blood would appear in the urine. Luckily, there were no complications at this point. Two hours later, the uterus had been carefully sutured around and removed as well. It came out in three pieces--the apple-sized fundus (body), the smaller neck, and the cervix, a coin-sized, whitish donut of a specimen. The left fallopian tube was also removed, as were many little cysts that looked like clear yellow vitamin E tablets. Dr. Do later had me put on gloves to palpate the pieces in formaldehyde solution before they got sent to pathology lab, and it was neat.
Dental Extraction
I
followed Jackson to the dental extraction performed by Dr.
Garvin and Dr.Wu. Dr. Garvin explained that on Tuesdays,
they perform surgeries for people with special needs. Having worked with
special needs students in college, I was touched by this fact. The patient needed to have teeth 1, 16, 29, 28, 27, 26, and 22--all of the rest of
his teeth!--extracted because they were decayed. Due to his history of
seizures and treatment history, this more challenging case was done in
Surgery and not in the Dental Clinic in the Old Building. The procedure
itself was reminiscent of going to the dentist office, with gum scraping
and forceful pliers rotation. Since the mouth is a small space to work
in, Dr. Garvin would tell me to come closer, and even moved out of
the way to show me the exposed jawbone! They needed to smooth the jaw
bone down, remove excess gum tissue, and suture up the gaping holes.
Special needs patients don’t do well with dentures, Dr. Wu told me.
Thus, the patient will probably have to chew with his gums from now on.
I followed my curiosity and went to OR 5, which the white board had listed simply as a “wound debridement,” which in my experience, wasn’t a particularly interesting procedure. But I peeked in, and was immediately intrigued by the sight of a young Asian girl was sedated on her side with her left leg up to her hip entirely eaten away by necrosis. The fat and muscle on her buttock was putrefied and left the area concave. There appeared to be no healthy skin left on her leg; only exposed muscle with blotches of black skin and pus. My immediate thought was, “How in the world does this happen?”
It turns out that this 18
year-old girl was hit by a bus two weeks ago, and was rushed as a Level 1
Trauma to The Hospital ED. She has been in and out of consciousness in the
ICU for the last two weeks, and doesn’t know the state of her leg, which
became infected from a hip fracture. The doctors said that they’ve
never seen anyone survive an injury of this magnitude.
The
worst part is, the doctors had wanted to amputate for some time now,
but the family had refused it. The only consent the
surgeons received was to clean the wound and debride it. Perhaps the
family still hoped that the leg could be saved. “If not amputated soon,
the girl will die of uncontrollable sepsis. The only reason her body is
holding on is because she’s young,” a nurse told me. It was all very sad
to see the nine doctors and nurses crowd the table, sullenly stripping
away some of the necrotic fat and tissues while murmuring about the
tragedy at hand. After some whirring of the microdebrider, the procedure
ended anticlimactically with bandaging up the bloody slab of a leg.
Since the infection had spread up her hip and lower back, her entire
pubic area was agape as well and her lower abdomen had to be packed with
several packages of acrylic gauze. Joan had said that because most of
the buttocks was gone, the anus may become a freestanding protrusion of
the intestine--if the girl survives.
It shocked me that a pelvic fracture is one of the most life-threatening fractures a person can sustain, because the pelvic region is so highly vascularized. It also shocked me that bacteria can eat away at an entire leg in a matter of days. I’ve read Atul Gawande’s book, Complications, in which a case of necrotizing fasciitis was destroying tissue before the surgeon’s eyes. (I highly recommend reading the book if you haven’t already, and also Better.) The images stay with you. But perhaps one of you OREX-ers in the next coming days will be able to witness the follow-up amputation surgery and share some good news.
It shocked me that a pelvic fracture is one of the most life-threatening fractures a person can sustain, because the pelvic region is so highly vascularized. It also shocked me that bacteria can eat away at an entire leg in a matter of days. I’ve read Atul Gawande’s book, Complications, in which a case of necrotizing fasciitis was destroying tissue before the surgeon’s eyes. (I highly recommend reading the book if you haven’t already, and also Better.) The images stay with you. But perhaps one of you OREX-ers in the next coming days will be able to witness the follow-up amputation surgery and share some good news.
..........
These were just a few of many things that I saw over a period of one year. I'm incredibly grateful that God has opened my eyes to this type of work, and for the restorative nature of surgery.
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