April 2012 (Part 1)
By Jimmy Lam, OREXer ’11-12
Alarm went off at 6:30am and by 6:38am I was already out the door eager to embark on my seventh day at OREX. As usual, I arrived at the A2 wing just a few minutes early. Unusual today, Dr. Harken was not here yet. Medical students and medical residents begin to trickle in and the room began to fill with medical conversations about patients and new surgical techniques. We waited for Dr. Harken and to my dismay, he was absent today. I guess even doctor’s need a break here and there and can get sick. Despite Dr. Harken’s absence, I did happen to learn something new. I learned that the medical residences are quite nice to each other and try to help one another finish their rounds if they happen to finish their’s early. How nice of them I thought. As I was bummed out that we had no lecture today, I was quickly picked up by realization that would get the pleasure of observing surgery an extra hour. How can you be down from that?
Being more experienced now at OREX encounters, I know better now to grab breakfast first before entering the operating room. As I was checking out the scrub card, I had the pleasure of meeting Mark, one of the new administrative assistants. He was very nice and smiley and liked to crack a lot of jokes. My acquaintance with Mark reminded me how much fun and exciting it can be to meet new people. Within minutes I was all scrubbed down and geared up to enter the operating room. My highlight surgery of the day goes to an endoscopic sinus surgery with Dr. McDonald. The patient has developed some over grown sinus in his nose that now occluding his airway and made it very difficult to breathe. After talking to Dr. McDonald, I unraveled that the doctors tried to treat his sinuses with steroids first to stunt and reduce the sinus growth, however that did not work which prompted the necessity for surgery today. I was in for a treat today because the nasal camera feed live video to a screen overhead that would allow me to see every step done in this procedure today. Super awesome!
Light projected out of the ends of some fiber optic cable endoscopic camera permitted us to see into the nasal cavity. Fine and slender instruments were used to probe around the nasal cavity. Looking at the video feed, I would never have guessed I was looking through the nasal cavity as it looked very foreign. This ignorance I feel is naturally common as our daily encounters with the nose consist primarily on the outside (well at least for me). As I watch Dr. McDonald navigate through the nasal airway, I am astound at how dexterous he is. One hand held a suction tube and the other the fiber optic video instrument, all the while managing to probe about the nasal cavity which was a very small opening. It is incredible how these surgeons are highly specialized. I can’t even know what tissue is supposed to be there or not. I guess I need trained eyes of a nasal surgeon to distinguish that. As Dr. McDonald ventures deeper and deeper into nasal cavity, he maneuvers both instruments concertedly, being very gentle not to cause damage to the surrounding tissue. He uses one of the suction instruments and begins to suck what appears to be mucus and tissues that are preventing him from entering deeper into the nasal cavity. An hour of this goes by, slowly inching through the nasal cavity, cleaning and sucking what appeared to be stray tissue and drainage. I was beginning to think that this surgery was like a chimney cleaning just a very fine and miniature version with much more at stake.
Eventually Dr. McDonald reached deeper into the nasal cavity and there hung an abnormally large nasal turbinate. The best way to describe how the nasal turbinate looks like is to imagine an oversized uvula that was large at the base. Now the nasal cavity itself was made of very smooth tissue while the nasal turbinate looked quite tumorous from the growth. Dr. McDonald then switched to a different instrument that had, I thought, little chompers at the tip. I wish had asked what it was called but I am going to refer to it as the chomper. Dr. McDonald inserted the chomper into the cavity and directed it at the base of the nasal turbinate. Now describing it as nibble is most likely an understatement because man, can this make quick of the nasal turbinate. Sure enough, after a few minutes that nasal turbinate was gone and was replaced with a large pool of blood. In came the suction tube again to drain out the blood. The issue was more blood came out and still more came out. Dr. McDonald then inserted long strips of cotton into the nasal cavity in hopes of, for lack of better descriptive wording, plugging the nose bleed. I thought to myself, how is that going to work? There is so much blood coming out there is no way that is going to work! And indeed it wouldn’t work. But Dr. McDonald didn’t tell me that these cotton strips were soaked with epinephrine. Now I remembered from my course work at Cal that cocaine can be and is used as a topical vasoconstrictor to prevent bleeding. I am certain that epinephrine must work in a similar fashion. But in any case, it worked beautifully. You learn something everyday.
Once the cotton strips where removed, and we all got a better view of the nasal cavity, it was hard to believe how much different the nasal cavity looked. The nasal cavity appeared three times more spacious. All the blood was gone. It was as if a plumber came in and fixed a running clogged sink and now I can see the bottom again. This is just going great I thought. The patient is definitely going to enjoy being able to breathe through his nose again. As Dr. McDonald was wrapping up the surgery, I asked if any nasal function was compromised due to the removal of the nasal turbinate or just from the procedure alone. Luckily no glands or major tissue was removed so there would be no loss of functionality at all. Now I did not mention that throughout the surgery, Dr. McDonald was addressing both nasal cavities and performing the nasal turbinate removal in both nasal cavities of the nose; switching back and forth between the two nasal cavities. I explained it as such because it didn’t occur to me that he was doing that until I saw the other nasal turbinate. I thought it would be interesting to have you, the reader, experience that jump in realization as I did that day. I am certain that Dr. McDonald has been specializing in this for a very long time because he executed the surgery magnificently. I felt like I was watching a well-orchestrated performance and the punch line was, “and then there were two.”
In the end I had, as expected, an amazing time at OREX. Other surgeries I had the pleasure of seeing was tibula and fibula ankle clamping with a special wire technique, an anal fistula, and a broken ankle hardware removal. As usual, I am always disheartened at how much space I get to describe my amazing experiences here at OREX. Not to mention how I didn’t get to stay till my usual 7pm because all the surgeries were done. There is never enough time in the OR. However, I can always manage time to give a shout out to Mark who is super friendly, Dr. McDonald for a job expertly done, Dr. Farrell who has been very helpful, and easily one of my most favorite surgeons, Dr. Krosin, who I always wonder how he can be so rockin’ yet down to earth. These surgeons, two words: top notch. It has only been 24 hours since I left the OR and already am I excited for my next OREX encounter. Until next time, Jimmy out.