Written by Stephanie Nguyen (class of 2014-2015)
OREX, Oct. 24th 7AM-1PMupper extremity arteriovenous
Today was my first day of OREX. The morning meeting was a complete blur; not in the way that it wasn’t memorable, but in the way that I understood less than 10% of the lesson. Dr. Harken went over the respiratory system, offering notable facts and proposing hypothetical scenarios for the residents and medical students to solve. I was surprised by how entertaining Dr. Harken was, and in turn, how at ease his students were—it felt like the kind of open and inclusive learning environment that any student would hope to be a part of. I quickly learned that Dr. Harken was the extraordinary man that Lucy spoke so highly of: warm, caring, and extremely committed.
Dr. Harken took me under his wing right as I entered his Right IJ permcath, Left Upper ext., AV procedure. I really didn’t know what any of that meant, but I watched as the resident, Dr. Markham, dilated and inserted a catheter into the jugular vein of a 59-year old woman. It was surprisingly forceful and unexpectedly superficial. For that matter, the bulky end of the catheter stuck out even by the close of the surgery. Dr. Harken made sure that the X-rays were set for me to see the placement of the line and the beating heart within the thoracic cavity. The next part of the procedure involved identifying and connecting together separate vessels in the arm. This section of the procedure took approximately an hour and a half, which Dr. Harken later admitted was way over schedule. Because the patient was so small and thin (he later joked that that would be me in around 40 years), everything including her blood vessels was just as small. With the guidance of Dr. Harken, Dr. Markham pulled out a large artery in the patient’s wrist and worked to tie off branches that came off of it. After countless ties and cutting farther up on the patient’s arm, she was able to work on another vessel to later tie together with the previous artery. It was a grueling process that I imagine only an experienced surgeon could endure and with such precision. She then meticulously sutured together the two vessels, again with painstaking precision, making small ties over and over again. The procedure in total took around 2 hours. Everyone in the room was extremely welcoming from beginning to end and seemed genuinely happy to have me in the room—it was a great feeling.
Once this procedure was over, I followed both Dr. Harken and Sean into another room, where a patient was finally getting a fatty cyst removed from his scalp after four years. One of the PAs, Ingrid, was in charge of the procedure, guiding Sean and also addressing me as she demonstrated how to anesthetize his scalp and carefully work around the fatty lump in the patient’s head. They worked on putting in anesthesia for as long as they worked on the extraction, and yet the blood flowed profusely from his scalp. The patient didn’t feel anything, though. After about an hour, they finally were able to take out a fatty lump the size of half a golf ball, and sew up the patient’s scalp, even with the missing chunk from his head. I was amazed that his scalp could do without so much of a chunk missing. At the end of the procedure, Dr. Harken insisted that “all the surgeons” (including me and the MA) take a picture with the patient and his cyst.
I left at 1:00PM invigorated despite my sleep deprivation and the fact that my feet were killing me from standing up for six straight hours. I was touched by the graciousness of all those I met that day, and especially of Dr. Harken who so willingly brought me along to all his procedures. His energy and warm personality inspires me to be like him, even at more than half his age. And as for surgery, I realize how much it resonates with my idea of direct and hands-on treatment for patients that physicians can provide. Today, I fell in love with surgery. I cannot wait to attend my next shift.
Posted on January 6, 2015, in Uncategorized and tagged catheters, cysts, fatty cyst, permcath insertion, removal of tumors, right internal jugular permcath, upper extremity arteriovenous procedure. Bookmark the permalink. Leave a comment.