February 25, 2015
Written by Andrew Sondag (class of 2014-2015)
I arrived at Highland at 7am and was promptly greeted by a lecture on proper surgical techniques when dealing with neck wounds. The physicians discussed the pros and cons of different evaluative procedures for about 45 minutes, and then wrapped up the meeting. During the chaos, I managed to fall in with the surgical trauma team, led by Dr. Sadeghi and Chief Resident Dr. Parmar, who had an unusual amount of scheduled surgery that day (or so I was told!).
Our first stop was a resident break room, where Dr. Parmar updated me and the two trauma NPs on the status of his patients. I was surprised to learn that he was currently working with around 20 patients. All I could think was “where does he find the time?” After finishing the review, we began rounding. The first patient we saw was an older man who had fallen while seeing a movie with his girlfriend. Upon further prodding it turned out that the movie was 50 Shades of Grey, which got a good laugh out of the team. We then rounded to another patient that was scheduled for surgery later in the day. Most of the tissue in his butt had become necrotic and needed to be removed.
The team and I then went to another break room where Dr. Parmar and one of the NPs looked at CT scans of another patient. They showed me what they were looking for in the images, and constantly asked me if I had any questions. It was inspiring that the team had the energy and personalities to be so welcoming to me, even though I knew that I was essentially just a mild inconvenience to them. After reading the CTs, Dr. Parmar sent to me to assist one of the NPs in pulling a chest tube from a patient who had suffered from a collapsed lung earlier in the day. The NP first showed me the initial x-ray of the collapsed lung, followed by the healed lung, and then we were off. We chatted with the patient briefly before the NP explained to me the correct technique to remove the tube, which is to yank it out as fast as you can!
Once the NP and I met back up with Dr. Parmar, it was time for surgery. They were to be performing a colostomy reversal on a patient that had been a shooting victim months prior. A colostomy is a procedure where the intestines are cut, and both ends are fed to the outside of the belly. This allows bowel movements to be routed away from an injury in the intestines that are further down in the system. In this procedure, Dr. Sadeghi and Dr. Parmar were to reattach the two ends of the intestines. I watched the team scrub up and then we all entered the room.
As the patient went under there was a slight hiccup. The machines were reading a double pulse, and the anesthesiologist was frantically trying to remedy the situation before it became clear what the problem was. Finally, a new EKG was brought in that read normal rhythms and pulse was brought in, and the procedure continued.
First Dr. Parmar sewed up the two stomas, and then the cutting began. The intestines are normally held behind layers of skin, fat, muscle, and a layer of connective tissue called the fascia. Since the two ends of the intestines had been routed through these layers for months, the tissue had healed in place. This meant that the team had to cut the two ends of the intestines away from all the layers before they could be safely reattached and then placed behind the fascia. For around two hours the doctors and NPs slowly cut through the surrounding tissue, making sure not to nick either the intestine or the tissue that delivered blood to the intestine.
The last hour was dedicated to reattaching the two ends of the intestines and then placing them back in the fascia. I couldn’t exactly tell how they were reattaching the ends, but it was done through multiple rounds of stapling. The closure of the wound was quite interesting. They had removed a fair amount of skin during the procedure, so I was wondering how they would close up the wound. It turns out they didn’t! Dr. Parmar just ran surgical thread through the circumference of the wound and then tightened it like the cinching of a small coin purse. Even after this, there was an open wound left that was about 2 inches in diameter. Dr. Sadeghi noted that this technique heals extremely quickly.
After surgery wrapped up, Dr. Parmar and I went to the trauma bay in the ED where a patient had been brought in for severe head trauma. We looked at the CT scan together and Dr. Parmar again walked me through what we were looking for, and what we would see if things were bad. The patient was in good shape, so we headed back to the resident break room. I soon learned that the necrotic tissue removal that I had looked forward to had been put off until the next day, so I thanked the team for an amazing day and I went home after an amazing 10-hour shift!