November 17, 2016

Written by Lisa Jo (class of 2016-2017)

My first OREX day was Thursday, November 17. It was awesome! I saw a craniotomy, cataract removal, ankle draining, and a laparoscopic gallbladder removal.

I got to Kaiser Oakland for Grand Rounds, enjoyed a free breakfast burrito, and listened to a few residents give their presentations. The first presentation was “Does Surgery Stimulate Inflammation?” (apparently it does); he summarized the immune and endocrine response to surgery. One new term I learned is “third-spacing”, which is fluid shifting into interstitial spaces; surgery typically involves blood volume loss, so (as I will discover later) the amounts of IV going into the patient and the urine produced after are recorded to monitor fluids.

The next resident briefly talked about Ella Wheeler Wilcox, a poet who outlived her children and husband, and read her poem “Solitude”.

The final two presentations were the pros and cons of using statin and aspirin during surgery. Both presentations cited the Jupiter trial and Poise-2 paper, and mentioned Dr. Poldermans (a doctor that fabricated data for many papers). Overall, it seems that statins do not significantly harm patients during or after procedures, while aspirin marginally does.

Grand Rounds was over around 8 am.

At Highland, the first surgery I observed was a craniotomy! I walked in to see the patient already unconscious, on her side, and head in a clamp. It was unexpectedly fast; the surgeon, Dr. Patel, dictated the patient information before starting and predicted that it would take about an hour and a half (and it did). The patient had meningioma. He has able to pinpoint the tumor location by using a reflective tool to create a 3D model of the current head and compared it a recent MRI. He sliced through the iodined scalp, drilled and picked a small (~3 inch diameter) circle in the skull, removed it into a bucket, and used an ultrasound tool to cut through the brain matter. The white tumor he removed was about the size of a grape and probably benign. Dr. Patel filled with a white material then a blue liquid plug that mimics the cerebrospinal fluid. The skull flap was polished and had metal brackets attached to it so that the piece can be screwed to the rest of the skull. Then the scalp was sewn, stapled, and wrapped.

The patient’s urine was collected to measure the patient’s fluid loss during the procedure.

The cataract removal was performed by a resident. The patient was responsive and draped throughout the procedure and put under a microscope. The surgeon dropped in a liquid onto the eyeball to keep the eye dilated and injected anesthesia under the eye. He cut a few slits around the iris and injected a blue dye into the eye to stain the capsule surrounding the cloudy lens. He removed a part of the blue capsule, and the lens surfaced. He used an ultrasonic tool that also acts as a vacuum to break up the lens and suck it out; he also used another tool that filled the area with water. After he made sure the area was clean of cloudiness, the resident injected the lens implant and stitched slits in the cornea with the smallest thread and needle I’ve ever seen. The eye was covered with gauze and a hard patch. The procedure took about 2 hours.

An orthopedic surgeon and a resident did the ankle drain. The patient had a previous injury and had sutures. The resident cut the sutures, and the doctor stuck his finger into the open wound! He felt around the tissue, lifted the foot over a bucket, and washed the wound with saline solution. He injected and vacuumed the solution multiple times. He pointed out a visible nerve in the foot; it looked like an off-white, thin cord. The wound was closed with sutures and the whole leg was wrapped. The procedure took about 15 minutes.

I visited Dr. Krosin on the 7th floor. The orthopedic back office was really cramped and full of computers displaying x-rays. I shadowed him while he met and followed up with two patients, one who had hip replacement surgery a month prior and another with back pain. He was really amicable with the patients and their family, but also efficient. He addressed their concerns on the spot and explained away any confusion. The patients were visibly glad to be in his care. (Afterwards, I got another even bigger and better free burrito in their office!)

The laparoscopic gallbladder removal was performed by three doctors. They inverted the belly button and cut it into quadrants. The reason of going through the belly button is the skin there is relatively thin for all patients. This is where the camera went through. They filled the cavity with air so they had more room to see and work; with the light of the camera inside, the body looked like a red, glowing balloon. They made two other entry points near the gallbladder with their scalpels for their tools. The gallbladder was white-ish green and really distended. They cut and burned near the base of the organ to look for the cystic duct and blood vessel; the gall bladder popped during this process and black bile leaked out. They used the vacuum to suck out the bile. Once they found the vessel and duct, they clamped and cut them. After the gallbladder was free, they cut to detach it from the surrounding area, tossed it into net that passed through the belly button, and removed it from the body. The entry points were stitched. The procedure took about 2 hours.

At about 4pm, my feet were a bit sore and decided to get going. After all the excitement, I was glad I didn’t get kicked out once! Everyone was helpful and willing to answer my questions.

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Posted on January 13, 2017, in Uncategorized and tagged , , , , . Bookmark the permalink. Leave a comment.

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