By Alice Chung, OREXer ’08-09
Dr. Harken gave a very interesting lecture about vascular disease and studies recruiting people with different conditions into different therapies. I stayed in one operating room today and watched excisional breast biopsies and a lymph node biopsy. Although the procedures were basically the same for all three patients, the surgery for one patient really stood out to me because I was able to talk to the patient before the surgery. This thirty year old female patient was from another country and the only family with her was her husband. She was very scared and cried a little before the procedure and worried about not being able to see her family again. I held her hand and talked to her until the anesthesia started working and she fell asleep. Putting myself in her position, I would probably also be pretty scared to undergo a surgery that would verify the presence of cancer while in a foreign country miles away on the other side of the world from my family. But after watching this surgical team just perform two other similar procedures, I knew that the patient was in very good hands.
Once the patient was asleep, the anesthesiologist Dr. Reddy showed me how to ventilate the patient using a mask: first tilt the head back to open the airway, place the mask over the nose and mouth firmly to make a tight seal, and squeeze the blue balloon connected to the mask. You can see the chest rise and fall as the lungs fill with air and watch the changing CO2 levels, which signifies that gas exchange had occurred, on the monitor. Next, Dr. Reddy showed me how to insert an endotracheal tube. First tilt the head back and use a Mac blade with a light for better visualization. You will first see the epiglottis that prevents food from entering the trachea, and when you go behind the epiglottis you can see the white vocal cords in the trachea. Next, slide the tube into the trachea using the blade as a guide, remove the Mac blade, and tape the tube to the mouth to keep it in place. It was really interesting to look into the patient’s mouth and see the epiglottis, trachea, and vocal cords.
Dr. Liu used an ultrasound machine to look for the palpable mass in the breast. We saw an abnormal shape pushing against the chest wall in the left breast on the ultrasound screen as well as multiple large lymph nodes (looked like dark black blobs on the screen) in the axillary. Dr. Liu said that the patient definitely had cancer and we needed to take out biopsies of the tumor. Small amounts of a blue/green colored dye were then injected in various sites in the breast region near the tumor. This dye will go straight to the lymphatic system so is a very useful tool to locate lymphatic tissue.
After an incision was made in the left axilla, a large sentinel lymph node approximately 1.5 to 2 cm was removed and immediately sent to the pathology lab for analysis. Next, a left axillary tonsil that was almost 6 cm in length with 3 hard lumps inside was removed. Then the team moved to the breast and made a radial incision. In the two previous cases, a periareolar incision was made instead of a radial incision because only small samples of the tissue from an anterior margin were needed. With a periareolar incision the resulting scar would be inconspicuous and well hidden. It was interesting to learn how many different aspects are taken into consideration when making incisions. A large, multicolored mass about 4 or 5 cm in diameter was removed from the left breast. There was green/blue colored lymphatic tissue, yellow fat tissue, dark red/black tissue, and red tissue (more normal color) in the mass.
At the end of the surgery, a Jackson-Pratt drain with a flexible plastic tube connecting to an external plastic collection bulb (looks like a plastic grenade) was left in place to drain excess lymph fluid from the wound and the incisions were carefully sutured closed. The surgeons said that the patient will need to start chemotherapy. Unfortunately I did not get a chance to talk to the patient after the surgery, but the surgery went well and I hope that she will be able to spend time with her family once she recovers.