May 22, 2017

Written by Jenny Luong (class of 2016-2017)

OREX always surprises me. It’s something new, something a little different each and every time.

Before the conference started, Dr. Harken was telling me about how many hospitals utilize Apache 2, a scale that estimates ICU mortality based on a number of laboratory values and patient signs, instead of the newer Apache 4 due to the cost. I believe he was going to talk about the test reliability and validity until residents started pouring in at 6:59 AM.

Dr. Harken began critiquing papers that studied the usage of pulmonary artery catheterization (PAC), which is the insertion of a catheter into a pulmonary artery. PAC allows the direct measurement of pressures in the right atrium, right ventricle, pulmonary artery, and the left atrium. While PAC is used to detect heart failure, the papers’ findings suggest that PAC is not very useful and has been linked to negative patient outcomes. I would have to read the papers to provide further detail, but Dr. Harken’s main message is to “question everything.” Just because a paper has over five thousand participants in it doesn’t mean that there isn’t selection bias or other such confounding factors.

I wandered into the OR alone and a little bit later than usual because there were some very lost looking families that needed to be taken to their appointments. I was awkwardly looking around and saw this blaring pink badge on someone’s chest that said, “MEDICAL STUDENT,” which meant, to me, they must be shadowing a surgeon = there is hope for me!

Matthew Crimp is currently doing his first surgical rotation at Highland, and introduced me to Dr. Berletti, who is simply amazing! In both surgeries I was to see today, she would be assisted by Dr. White. He was not as friendly, so I stayed out of his way. Dr. Reddy, the anesthesiologist is very kind and allowed me to stand near his area so I could watch.

The first operation was a bilateral ovarian cystectomy, as well as a diagnostic laparoscopy. The patient was an overweight 33 year old female.  A small incision was made near the umbilicus (I think), and a tube was introduced. This tube was then connected to a machine that pumped oxygen into the abdomen, inflating it and allowing the doctors to see the insides clearly. Dr. Berletti and Dr. White used both palpation and scope to locate the ovaries and the cysts. It was strange seeing the needle for the local anesthetic on the other side of the abdominal wall. Several holes were made for moving the clamps and cutters around.

There were intestines and what looked like the top down view of a very small naked chicken (turned out to be the uterus…) and two hidden large white eggs. I have taken anatomy and I had no idea what I was looking at. I had THOUGHT that ovaries are smaller than that and were lumpy. Not round and egg-shaped. Until it hit me that this patient may probably need both taken out.

On the screen, I watched as Dr. Berletti lanced the left ovary and, I’m very proud of myself for this, did not wince as everyone else did when loads of yellow pus poured out into the internal cavity. Dr. White suctioned it up but had to rinse several times.

The right cyst was harder to get to. It was hard, slippery and swollen. After opening the ovary, Dr. Berletti was able to retrieve two pieces of the inside, asking the nurse to change this into a biopsy. The inside was crumbly and dark. The calcification was hard to get out, and so Dr. White suggested they leave it as it was attached to the peritoneal wall.

The clean-up of this involved some gel injected to help coagulate (?) the blood. After gauze and rinsing multiple times (also removal of hair), the main hole was stitched and the smaller ones were closed with adhesive glue.

The second operation was on 43 year old female, a laparoscopic bilateral tubal ligation.  I had asked Dr. Berletti if I could follow her around for this. She left me in the prep room with Matthew and the patient. It was great talking to a patient who was so driven and optimistic. She wants to be a nurse and is now trying her best to finish prereqs.

This operation was finished very quickly. Because her ovaries are within normal limits, as are her tubes, the cauterization happened very quickly. Dr. Berletti even let me see the specimens after!

Today was a wonderful day. Doctors such as Dr. Berletti exude such competence and consideration that her patients feel at ease and her coworkers readily listen to her advice and input. I am always glad for OREX because I can be around people like her and have the opportunity to try to absorb some of their expertise.