Written by Amari Washington (class of 2015-2016)
My first day with OREX was interesting to say the least!
I arrived in the OA-2 room at 6:30am. I signed in and walked towards the table. I paused and looked at the chair in the corner across from the table, next to the door. I laughed a bit remembering what Lucy said about hiding behind the wall, I was tempted, but decided to sit at the table, in the same seat I took during our orientation. I did some reading as I waited for the rest of the group to arrive. When 6:50am came around I began to wonder if I was in the right room. At 6:55 I thought maybe it was Saturday and I had gotten my days mixed up and missed my OREX day due to extreme exhaustion (ridiculous, I know haha).
At about 7:01am three people walked in. I greeted them. The women said hello and took their seats on the opposite side of the table. The man that walked in with them remained silent and sat in the back corner of the room (I’m guessing he was tired). The rest of the group began to trickle in, exchanging stories about things they had seen on previous shifts and preparation for the day’s cases. One of the residents told his colleagues about a case he had regarding an elderly woman who had been in a car accident. I am not completely clear on the details, but it sounded like some “young reckless driver” ran into her and her seat belt sliced her neck. I believe about two weeks later she was still having pain, and they determined that surgery was required. They found her earring inside of her neck. The resident passed around his phone so everyone could see the earring he removed (it was pretty big). He mentioned that she was unaware that it was in there, and that she just knew she was in pain. Crazy, right?!
I introduced myself to Dr. Harkin. He was very kind and told me he was happy to have me there (Yay for OREX student!!). He then introduced me to a fourth year resident by the name of Dr. Jessica Williams. He asked her what she had on her schedule for the day. She explained that she was with ENT for the day. Dr. Harkin asked if she minded if I tagged along and explained that I could hang out with Jessica for the first part of the day, and that we would link up later on so that he could take me around the OR. She agreed. She was very warm and welcoming. We discussed her journey through medicine and she inquired about mine. We also discussed her schedule for the day. She explained that ENT was Ear, Nose and Throat, and that the surgeon she was going to be assisting was Dr. M. McDonald. Jessica took me to the 5th floor and helped me work the machine to get my scrubs. That machine was awesome! Pretty cool how the scrubs were neatly folded in a little section of the machine. After changing into my scrubs, Jessica allowed me to place my belongings into her locker. I put my cap and shoe covers on before completely exiting the locker room.
We then walked over to the pre-op area and approached her first patient. She greeted her warmly, introduced herself, then me and asked if it was okay that I was present during her procedure. The patient agreed. The patient was a young woman, perhaps late teens, no more than twenty years of age. The first procedure was a tonsillectomy. Jessica explained the case as we put on our masks and entered OR 4. I watched as everyone set up the OR; the surgical tech, Joe, set up his station with the RN, Glenda, assisting him. The anesthesiologist, Becca, was instructing the resident, Justin, on how to help set up their station, position the patient, and how the medication would affect the patient. Jessica was paired with Dr. McDonald and the PA, Ingrid. I enjoyed watching them work as a team, each component coming together in order to ensure that the procedure ran smoothly for the patient.
Once the team was ready to start, after Dr. McDonald, Jessica, and Joe were scrubbed in (Ingrid exited the OR to attend to something else), they read off the start time, procedure and information about the patient. They began by placing some sort of instrument (I didn’t catch the name) into the patient’s mouth in order to keep it open during the procedure. I wanted to make sure I was not in the way, so I tried not to get too close to the table. Justin grabbed a stool and placed it directly behind Dr. McDonald so he could get a better look. Since everything was done inside of her mouth I couldn’t see much. When the tonsil was removed, Jessica told me to take a closer look. It was huge! Maybe around the size of the circle you can make with your thumb and index finger. Once the procedure was finished, they asked me to come stand on the stool and look at the stitch they made. Once they removed the instruments from the patient’s mouth Dr. McDonald left the OR. Jessica, Justin, Becca, Glenda and Joe all began prepping the patient for recovery. She began waking up, and as she became more alert she began to twitch, and push away from the OR staff. She was disoriented and pretty aggressive. She tried talking but couldn’t since her throat was sore. She started crying and kept pulling her oxygen mask off of her face. The OR staff did their best to comfort her and keep her calm. Jessica explained that this reaction usually happens with pediatric patients when they first wake up, and that for some reason, the adult patients don’t normally react that way. Once they were able to calm the patient a bit and transfer her to the other bed, they rolled her over to recovery. There, we sat and waited for the next procedure.
During the wait, I overheard the staff discussing a few issues with the day’s schedule. The next two surgeries were delayed due to issues with paperwork and insurance. The staff expressed their frustrations with the issues that caused the delay. While we waited, Jessica took me over to the OR board. It was set up much different than the board I was used to reading for the OR on the 9th floor. She helped me to better understand how to read the board and walked me over to two of the ORs. One was performing a mastectomy and the other was dealing with a hernia. The hernia had just finished and the mastectomy was extremely difficult to see, so we hung out in the pre-op area until it was time for the next procedure.
The second procedure was a Thyroidectomy vs. Right-hemi. This patient was a woman in her late twenties/ early thirties. This procedure was much easier to see. Jessica told me that the best position would be next to the anesthesiologist, so I positioned myself right next to them. Justin brought me a stool so that I would be able to see a bit better. Before they opened her up, she instructed me to feel my own neck and then feel the patient’s neck so that I could get a better idea of the size, position and feel of the mass. They started by making a small, horizontal incision across her throat, in the middle of the area they marked for the mass. They then used instruments to cut and burn through the fat and muscle in order to get past the many layers that covered up her thyroid. Dr. McDonald allowed Jessica to do the majority of the procedure as he guided her along. Ingrid assisted with the positioning and Joe provided all of the necessary instruments. One in particular was the harmonic, which they used quite a bit in order to make it easier to cut and burn through the fat and flesh. During the procedure, Jessica was sure to explain every step as she proceeded, moving certain muscles rather than cutting through them, identifying major arteries and nerves and explaining the severe consequences of damaging them. They eventually removed the right side of her thyroid and then flushed out the area. Once finished, they began to stitch up each layer, thicker sutures (surgical thread) were used for the more inward layers. Jessica explained that they did not want to make the stitches tight in order to allow for oozing. If the patient began to bleed, the build up of blood would result in the formation of a large lump in her throat that would press on her airway and eventually stopping her from breathing. Once they got to the outer layer, they used smaller sutures (surgical thread) and made them tighter in order to reduce the visibility of the scar that would eventually form.
As with the first patient, when the procedure was finished, Dr. McDonald left the OR (he actually left before the suturing was finished – Jessica completed the suturing and Ingrid assisted). When the patient woke up, she too was disoriented, but as Jessica explained, she did not react the same way the first patient did. She was a lot more calm and less aggressive. She quickly relaxed and was rolled over to recovery.
The final procedure I saw was called a Functional Endoscopic Sinus Surgery. This patient looked to be in her mid to late fifties. Before the procedure, Jessica showed me some of the images from her chart to help explain the issues the patient was having. The right side of her nasal cavity looked normal, but the left side looked like she had a huge blockage. Once we arrived in the OR, everything was already set up. This procedure was going to be viewed on a huge screen. Dr. McDonald began by sticking white strips with blue strings into the patient’s nostrils. Jessica explained that the medication on the strips would help reduce bleeding and also help open up the cavity. After a few minutes, the strips were removed and they began inserting the camera (which was actually a long rod with a small camera at the tip). They used the camera to navigate and identify the different structures in the cavity. First they viewed the normal nostril (on the right), then moved to the left side and pointed out the huge differences between the two. I was able to see where the mucus was dripping and where the polyps were located. Dr. McDonald started by using an instrument (I cannot recall the name) to break the maxilla bone. He then broke into a mass that caused a bit of mucus to leak out. He began removing the pieces of bone and the polyps. Dr. McDonald allowed Jessica to navigate around the cavity to make sure everything was removed. Once the cavity was cleared, they flushed it out. They made sure that there were no polyps, left over bone fragments or liquid left in the cavity. Once the procedure was complete, they placed what they referred to as a “mustache” (a large bandage with tape) under the patient’s nose in order to catch any blood, mucus and additional leakage.
I was sure to thank Dr. McDonald for allowing me to watch his procedures for the day. He was very kind. After he said his goodbyes and thanked the team, he exited the OR. After thanking the rest of the OR staff, Jessica and I exited the OR as the rest of the staff prepared the patient for recovery. Jessica explained that they were essentially done for the day and asked if I was planning to stick around to catch a few more procedures. It was actually time for me to leave, so I went back to the locker room to return my scrubs. The machine is pretty cool, I didn’t know that it accepted “deposits” as well. Once I turned in my scrubs, I said my final goodbyes and expressed my gratitude to Jessica, who said that hopefully next time they can get me in to see some other procedures that I will be able to view a bit better. I did not get a chance to meet up with Dr. Harkin before I left, but I am hoping I can catch him next time!
Woohoo for day one!