By Jimmy Dinh, OREXer ’11-12
I arrived to Highland Hospital around 8:30am after dealing with a bunch of traffic on the freeway. After I signed in, I went upstairs to the 7th floor to look for Dr. Krosin, the orthopedic surgeon. I had trouble finding which one was the orthopedic clinic, so I had to ask around. I went through the doors of the orthopedic clinic, but Dr. Krosin was no where to be found! Luckily, there were sound residents there who helped me: Dr. Molina, Dr. Enriquez, Dr. Rodriquez, and Dr. Kelly. Dr. Molina helped me page Dr. Krosin. Dr. Krosin told me to meet him in the surgical floor.
I met up with Dr. Krosin and he is very friendly and nice! Dr. Krosin and I walked to O.R. 1 and he asked me about myself. He then explained to me the patient’s situation. The patient, initials D.I, is a 20 year old female, had a broken ankle. Dr. Krosin explained to me that D.I and her friends were slightly intoxicated and drove to Jack in the Box for food, but got into a car accident. She had a broken femur, which was surgically treated earlier in the morning. However, they did not see the broken ankle and now Dr. Krosin was going to repair it. The patient was already put under anesthesia. Dr. Krosin elevated the foot first and the nurse cleaned the entire food area. He then marked about a 4 inch line with his marker.
The surgery started at 9:43 a.m and he used a 15 blade to make the incision. A little blood gushed out. He made the incision and exposed the broken ankle within a minute! He then showed me the broken ankle with the white bones. He used various tools to keep the broken ankle exposed as he started to drill screws into the ankle. There had to be a lot of suction because there was a good amount of blood. Dr. Krosin then took x-rays of the ankle to make sure the screws were placed carefully. At the end, he used two screws to repair the broken ankle. He made sure they were tight and placed correctly by using a screw driver to tighten the screws. I asked Dr. Krosin about what kind of stitch material he was using and he was using absorbable stitches. He then used a staple like tool to completely close the wound. He finished at 10:03 a.m! Dr. Krosin is so fast! He finished in about 20 minutes!
We left the O.R and went up back to the orthopedic clinic. Dr. Krosin told the residents to invite me with them when they see patients. Dr. Kelly invited me to help him speak Spanish with a patient. He knew a bit of Spanish, but he wanted me to see what the primary care setting was like. He first explained to me what the patient’s x-rays meant. The patient was around 50 year old and is female. She has a history of bad arthritis and needed a complete joint replacement in her right knee. The materials that were used were metal and plastic. Dr. Kelly and I entered into the exam room and he explained to the patient that I am a volunteer. Dr. Kelly examined her and said she was doing great after 6 weeks. Dr. Kelly prescribed her vicodin and antibiotics. I helped translate a lot and it felt good to be able to help out.
Next, Dr. Enriquez invited me to come see a gun shot wound patient with her. The patient was a 28 year old male. Two days ago, the patient was shot in his upper right arm (near the should area) and the bullet went through superficially to his scapula. The bullet did not exit. Dr. Enriquez examined the wound and tried to see his arms’ range of motions. We then went out to examine his x-ray. Dr. Enriquez said sometimes they do not need to surgically remove the bullet, unless it is compromising other organs. Sometimes, they even come to the surface of the skin where they can easily remove the bullet. We came back and Dr. Enriquez prescribed him vicodin and a referral to see a physical therapist. She explained to the patient and me that the nerves and tissues around the bullet wound were still repairing and that’s why he was still experiencing a lot of pain.
Lastly, Dr. Rodriquez invited me to see a 55 year old male patient. The patient was approved a knee surgery, but needed his primary care physician’s ‘okay’ to proceed with the surgery. The patient explained to Dr. Rodriquez that he wanted a knew surgery to help him with knee problems, which was preventing him from a lot of physical activities. The patient likes to hike, jog, play sports, and other things. Dr. Rodriquez told him to take the tests and paper work to his primary care physician to sign, because without it, the anesthesiologist would be uncomfortable with putting the patient to sleep given him health concerns. I thanked the doctors for allowing to be exposed to the primary care setting, as it was very exciting for me because I want to become a primary care physician.
I went back up to the surgery floor, observed a masectomy due to breast cancer, laparoscopic uterine fibroid removal, hysterectomy, and a permecath (performed by Dr. Harkin, a medical student, and two residents). I left at 5 p.m.
By Sean Cleymaet, OREXer ’11-12
Today’s OREX was outstanding and thought provoking on several levels. I saw Dr. Harken put in a pacemaker and Dr. Hoffman put in a titanium nail along the length of a patient’s broken femur. But it’s the third case that gave me pause.
The third patient was an elderly woman with stage 4 cancer. Stage 4 in broad strokes means that the cancer has metastasized from its origin into other areas of the body. In this patient’s case the cancer was so advanced that it was likely terminal. It was present in her liver, her lungs, and had even almost completely replaced one of her vertebrae. Why on earth was this woman in the operating room if there was essentially 100% chance that she would die from this disease?
I know many of us consider surgery something that one goes through in hopes of being better off afterwards, perhaps even regaining the quality of life we had before. There are risks in any medical treatment but rarely does someone elect to have surgery when they could be dead in a month. In this case, the surgeons operated not to eradicate the disease present throughout the woman’s body but to ease suffering in the last weeks or months of her life. It was palliative surgery; it’s primary goal was to provide some small measure of comfort. There was no hope of curing this woman.
This case gave me a chance to reflect on two paths, one where we search for a way to cure somebody of an ailment and the second where we maximize a patient’s quality of life. Oftentimes the two paths are aligned; normally when a patient no longer has a disease or condition, their quality of life improves as well. But at the end of life, our desire to pursue a cure fades and our focus shifts instead to being comfortable.
I deeply appreciate the opportunity I had this past Tuesday to reflect again on this issue. Thank you to the surgeons and staff that were present that day, and to all the rest who undoubtedly act with equal sensitivity in similar situations.