Written by Sonia Spindt (Class of 2012-2013)
As we all know, morning meetings with Dr. Harken can be somewhat hard to follow. He often lectures on topics that are both filled to the brim with acronyms and outside of our range of medical education. We frantically write down every word that is so easily uttered by Dr. Harken in hopes of being able to later put the pieces together when we attempt to write our journal entries. However, this morning meeting was not filled with the usual fragmented moments of comprehension. Instead, the topic was one that we all are familiar with as volunteers in a safety net hospital, health care for low SES populations.
My morning began when a lonely fourth year medical student, Allen, greeted me as I walked into the conference room. Not wanting to sit there in silence, I asked what was on the agenda for the meeting. Allen informed me that he was going to give a small talk on a project he started with some friends while in his first year of medical school. Being very intrigued, I asked about the project’s details and I eventually found out that the project was centered on ideas of media, social justice, and health care awareness. He and his friends videotaped individuals who lacked health care and were forced into unimaginable circumstances because of their low socioeconomic status (don’t worry, my mind also automatically jumped to Michael Moore’s documentary “Sicko”). Excited to actually be able to have a conversation that included more than just a “uh huh…?” mumble, I complimented Allen’s work and suggested that it could help tackle the issues created by the low national average reading level and the standards for health care literacy. Being somewhat impressed by my comment, he kindly invited me to participate in a survey on personal perceptions of health care that he would conduct after showing the room full of residents a clip. Dr. Harken briskly walked into the now full conference room, gave a short introduction, and let the medical student take the stage.
He began his talk with a two-minute clip of footage that contained the all too familiar stories of hard decisions brought on by a flawed health care system. For example, one woman was forced to choose what tooth to save because she didn’t have enough money to cover multiple procedures. (If you are interested in watching the clip or reading about the project please visit http://www.thevacuum.org/). After the clip, we all answered his survey that contained questions like “I agree with the idea of universal health” or “I am willing to pay more if it means everyone can be insured.” However, Allen was not prepared for the onslaught of critiques he would then receive from the residents who questioned the purpose behind such a study. Allen argumentatively stated that the project was used to try and influence public policy officials, a very lofty goal that often does not sit well with doctors who have been active in the field for a very long time and have witnessed very little change. Also, the residents were not moved by the footage that was deeply rooted in the rhetorical device of ethos. This reaction was not at all surprising to me considering the fact that every patient who walks into Highland has a story pulled from the same vein of bad luck. The doctors hear things like this on a daily basis, so the video was far from impactful.
Dr. Harken had prepared a lecture on the effects of giving patients fresh blood but was never able to make the transition into this topic because he was so enthralled by the public policy debate brought on by Allen’s research. Instead of flipping through the pages of a New England Journal of Medicine entry, Dr. Harken talked about the discontinuities found between the different sectors of the health care system. According to him, there are even discrepancies found between groups of doctors, (for example, those in the private sector versus those in the public sector), and that alone makes decisions hard because no one can every agree. I was amazed by the brevity of knowledge and the eloquence Dr. Harken possessed when discussing a topic like this on the fly. Soon the meeting was over and Dr. Harken could only tell Allen that he should figure out what his audience is and maybe add a question to the survey that asks when the surveyed individual last needed health care. I felt bad for Allen but it was definitely a nice change of pace for the morning meeting.
After grabbing some breakfast, I made my way up to the OR to watch my only surgery for the day, a simple lumpectomy. I targeted OR 5 because the surgeon and resident were just stepping out to start the process of scrubbing in. I don’t enjoy walking in on a surgery that has already started because I like to have a chance to introduce myself without feeling like I’m interrupting something. And this is important considering that befriending the surgeon can provide one with some amazing opportunities. Luckily this was just the case because as soon as I introduced myself, Dr. Godfrey invited me to scrub in with him…WHAT!?
Scrubbing in is quite the meticulous process, especially if it is your first scrub of the day. Being that this was my first scrub-in ever, Dr. Godfrey told me to take my time and count to 10 for each finger. Essentially, the entire process should take a little less then 10 minutes. To pass the time, he inquired about my background and where I was in the application process. He told me about his time in the Peace Corps and discouraged me from applying because the government doesn’t make the process all too enjoyable. We then talked about how he volunteers at a rose garden and we discussed the current events surrounding the Boston Marathon explosions, all of which just highlights the fact that Dr. Godfrey is a caring and very relaxed individual.
I clumsily made my way into the OR, making sure that my newly cleaned hands and arms remained isolated. The nurses giggled as I awkwardly attempted the proper suit-up procedure. There are ways to hold the towel as one dries each arm, applying a tricky flip maneuver to make sure one does not use the already contaminated side when drying the other arm. Surgical gloves come in specific sizes and I was said to be a size 7. One does not realize how difficult it is to put one’s fingers correctly into a glove when one is not given the chance to use the other hand! The nurses continued to giggle as they helped me sort out my fingers and finally, they tied my gown and told me to never lower my hands past my waist. And with that, my nose became suddenly very itchy and the surgery started.
Within seconds the resident started removing lymph nodes that were marked with a blue dye from the patient’s right auxiliary lymph nodes (the lymph nodes that are found right under one’s armpit. Dr. Godfrey asked me to come join him on the other side of the table so that I might better “see” the operation at hand. He took this as an opportunity to start “pimping” me, a term that is used to refer to the onslaught of questions asked by the attendee to the resident in an attempt to 1. teach and 2. restrain a large ego because we all know that medicine does incorporate some shame-based learning. Thankfully, he only asked me how many stages of breast cancer there are and being that my family is completely riddled with it, I easily told him, “four.” He smiled and started talking to me about the classification system used to describe each of the four levels of breast cancer. I swear that he used the term “Z11” when referring to the name of the national ranking system but after further research I can no longer definitively say this. Instead, it seems that I may have incorrectly heard “TMN.” Essentially, the patient was already classified as a level 2 because the mass in her right breast was already larger than 2 centimeters. This preliminary diagnosis would most likely be bumped up to a level 3 or 4 after the pathology confirmed that all of the lymph nodes harvested were positive for cancer cells. Dr. Godfrey took a break and let the resident tell me about closing a wound.
Due to the fact that they left a considerable amount of free space under the patient’s arm, the resident had to use 3 different types of stiches. The first was a deep tissue stich that essentially brought together the inner tissue of the lymph node, ensuring that no fluid would be able to build up in the wound. She only had to make 3 of these stiches before moving on to a dermal stich. Finally, she ended with a subcutaneous stitch. Dr. Godfrey then started on the lumpectomy and stressed using a blade because burning through the skin only prevents proper vascularization of the wound’s edges once it is sewn back together. When the surgeons got down to the tumor, they found that the cancer went much deeper than expected and this caused Dr. Godfrey to tell the resident that he wanted to really be a part of her recovery because the hospital was now at risk for litigation. Apparently, a test 2 years ago missed the cancer, allowing it to grow to a deadly size. Now she will most likely have to go through radiation, chemotherapy, and a complete mastectomy only to prolong her life and that was quite devastating to hear considering the fact that she was only 59. This cancer was completely avoidable if that original test was performed more carefully. They removed as much of the tumor as they could but they said they couldn’t clear the margins without performing a full mastectomy. Dr. Godfrey told the resident to only perform the dermal and subcutaneous stitch because they wanted the wound to fill with fluid. That way the breast would not have an awkward divot in it and the fluid would allow the breast to feel more natural. They then closed the wound and went to take a break. I thanked the team for their help and told them that it was an amazing experience to scrub in. I hope you all get the chance to suit up and I can not wait until my next day up in the OR.