November 23, 2016
Written by Viet Le (class of 2016-2017)
My first day of OREX started off nerve wrecking, as with most experiences that are new. I recall packing my food the night before and making sure I had plenty of rest. Surely, I will not go down in the history of OREX as one of the students fainting on their first day, not that there is anything wrong with that…it’s that it just isn’t my style. Hah, I kid. The goal for the day is to just get comfortable around the OR and not get too ambitious with trying to see too much in too little time. Above all else, bring minimum attention to yourself and if all fails, use the magical words, “I’m one of Dr. Harken’s students through the OREX program.” The plan worked and I felt the entire day was smooth sailing…except at one point which I will go over later.
So I arrived in OA2 at 6:40am just so I can find my cozy spot in the corner. In retrospect, I would advise to come at 6:55 since there was plenty of space. The other residents filed in and hung out in their little groups, going over cases that they are managing. Dr. Harken made his appearance shortly thereafter and gave a presentation on an article about the success rates of old vs fresh blood. The data was presented in a scientific and statistical fashion, breaking things down into quantifiable subcategories that we can use to judge for ourselves. Throughout the presentation, I never felt that he was trying to push an agenda but rather allowed us to take the information in and interpret it for ourselves. An example was how he would ask us, “Why, why why? What does intuition tell you?” I guess my medical intuition wasn’t up to par because a lot of the material didn’t make me automatically jump to any conclusion. I felt inspired though, and hope that one day this information will come second nature. After the meeting was done, I introduced myself to him and he paired me up with a resident name Eric to go upstairs.
We went up and I changed into my scrubs, put on my cap, mask, and booties. Eric showed me to the board and we looked at the upcoming surgeries. I saw one that starts at 8 and it was a Right Hip Arthroplasty. He told me that it might be a cool surgery to check out but wasn’t one that he was going to do…so he took off, leaving me to my own demise. I walked into OR1 and knocked on the door, asking them if it was OK if I can stand in the room. The two nurses looked more confused than me and asked me who I was. I felt now was the appropriate time to use the magical words, “I’m one of Dr. Harken’s students through the OREX program.” One of them nodded and said it would be great to have me. I went over to the board and wrote my name down under medical student. Onto the juicy details of the surgery itself.
The patient was sitting up on the operating table and getting some medicine through the spine by the nurse anesthetist. Her name was Kay and she was showing a first timer resident what she was doing, such as intubating the patient with her laryngoscope. The circulating nurse, Marisal, was running around the room and prepping everything before the doctors started. At first, they didn’t engage with me much, which is understandable. I definitely wanted to be that invisible fly on the wall. I think that after I expressed some curiosity with the things they were doing, their lack of engagement went 180 degrees and they became my saviors in the room! Marisal basically took me around throughout the day and showed me everything she was doing and answered any questions I had. For example, she put a Foley catheter on the patient and explained that it’s advisable to place this on patients if the procedure may go beyond 3 hours. I didn’t get to do it myself but I am sure that if asked, I can do this for future patients. You never know when this skill may come handy.
The preparation took a lot longer than I thought (about an hour) and finally, the doctors came in to begin the procedure. Surprise surprise surprise, one of the residents popped his music on and we were listening to hip hop music in the backround. I guess they got to stick with the theme of being hood since it is Oakland after all. Dr Shah was the attending physician, supervising over Dr Nguyen and Dr. Jerald as they took the reins on the actual procedure. They called the operation at 9:00am and made the first incision, slicing into the right hip of the patient. Marisal got me a stool and allowed me to stand literally at the foot of the patient. I made sure I was able to get a good view as Dr. Shah was 2 feet to my left and the operating residents were 4 feet in front of me. As Dr. Nguyen cut into the fascia and muscle, Dr. Jerald assisted and held the tissue open so that the field of operation can be easier to work with. Throughout the procedure, Dr. Shah gave advice to help Dr. Nguyen so that her operation can go easier. He was very chill and has an easy going demeanor. When he saw that Dr. Nguyen did not need help, he engaged with me and asked about my educational goals. I felt comfortable conversing with him and even went into depth about the procedure, such as why certain cuts are used with a scalpel and some are used with a Bovie (an instrument that cauterizes the flesh to prevent bleeding). This was interesting because in the background, Dr. Nguyen was sawing off the head of the femur and hammering in new instruments. I even had to get a face shield because I was afraid of having some bits of flesh or bones hit my eye (luckily nothing did).
Two hours into the operation and the finishing touches are done. The final sutures are made on the patient and it’s astounding how just a few minutes earlier, his femur was jutting out in the open. I noticed that my questions were going off at a much higher frequency at this point. Perhaps it’s because I was comfortable and the doctors were fine with answering any questions I have. There is always a fine line between being curious and being an added burden to the operation and I made sure to stay within the confines of what is appropriate. I do have to admit though, that I thought it was totally awesome that Dr. Nguyen methodically answered my questions even DURING her live procedure so more brownie points to her. One cool fact that I learned was how after they sutured up the hip, they placed this “glue” material called dermapin or something which seals up the wound. Apparently that small seal costs $500 bucks, which killed me a little inside. After the procedure, I was able to catch up to Dr. Nguyen a little bit and we chatted in further detail about her experience in medicine. She asked me if I was going to sit in on her next operation which was an ankle surgery but I was starving. I felt that this was a good time to head out and so I excused myself. I went to find Marisal and Kay to thank them for holding my hand throughout the day.
As I left the OR1, I felt a sense of inspiration overcome me recounting on what I just saw. I am sure that when the time comes for me to do anything close to this caliber, it would be absolutely terrifying. In that regard, being in OREX and increasing my exposure to the unknown diminishes my fear of what I don’t know. I took off my cap and mask and tossed it into the trash and began walking back to the changing room…
It was at this point that a small Asian nurse walking in the hallway (I didn’t get her name) stopped me in my tracks and asked me where my mask and cap was. I told her that I tossed it in the trash and was heading to the changing room. She must have sensed my weakness and closed in for the kill, asking, “Wait…who are you?” I felt it was appropriate to respond with, “I’m one of Dr. Harken’s students through the OREX program.” She sighed and lectured me about the rule of wearing a mask past the red line. I apologized and said I wasn’t going to do it again. I guess you can’t win it all. It was at this point that I decided to end the day and head to grab some grub since I didn’t eat anything since 7.