Week 3 was our most routine thus far - Will was in the burn surgeries for the first two hours every morning while Nicole was observing and assisting in the Microbiology/Infectious Diseases department. When a natural break in the surgeries occurs midway through the morning, we switch and Will goes to the children's rooms to observe burn aftercare. It is significant to us that the actual burn surgeries are becoming routine - we're better able to participate in the burn operations as well as pay attention to the finer points of the reconstructive surgeries.
Nicole: I've been able to participate in the burn surgeries as thoroughly as the residents they train in the hospital - cleaning and debriding wounds, and re-wrapping them. I also participated in culture-work with the Microbiology Department testing antibiotic sensitivity. The parasitologist is very enthusiastic to teach, and shows me every egg, larva, and nematode that she finds in various biological samples. I toured the Pathology Department with a visiting French student - we held various organs and tumors that had been removed for analysis, and observed their slide preparation.
Will: As my time in the burn clinic has gone on, Dr. Romero has started to allow me more freedom in the OR. He will request that I scrub in with him when we have extensive cases and will allow me to practice what I have seen for the past two weeks on patients. There are patients with full thickness burns that cover all 4 of their extremities. In order to keep the children under anesthesia for as little time as possible, I join Drs. Romero and Quiroga and will debride, clean, redress, and place skin grafts under their supervision. However, I am still trusted with a certain level of autonomy with the patients that I will not be privileged with until my surgical residency.
On Thursday, we followed Dr. Montano through his high-risk obstetric surgeries, while Will Pryor and Jon Chu observed in the burn clinic. Nicole almost passed out observing her first natural birth. We also observed a Cesarian on a woman who was 32 weeks pregnant with pre-eclampsia. The child weighed 2.5lbs and has a 50% chance of survival. There were a few other natural births and a D&C, but the incredible sight was the oophorectomy. The woman was 16 years old, 90lbs, with 2 children and a husband. Her belly was distended as if she were 4 to 5 months pregnant, but once opened up, the distention was revealed to be a 6.8kg ( ~15lb) ovary which had stretched with its tumor. The entire surgery took 15 minutes from first incision, because the tumor was entirely encapsulated in the ovary and only required cutting two vessels to remove in its entirety. Dr. Montano says it is the largest tumor he's ever removed, but that the other surgeon had removed an 8kg (~18lb) tumor just the previous week. It honestly looked like a 15lb turkey, but with fimbrae.
Friday was our night in the Infant-Maternal Emergency OR. It was a slower night, several natural births that went very well and a few D&Cs. Later in the evening, we were able to observe an emergent pediatric surgery. There was a 4 month old infant with hydrocephaly that need a shunt placed. We saw the CT scans of his brain that showed drastically enlarged ventricles. The pediatric surgeon started by opening the scalp and drilling a hole in the skull with the scalpel. He then made a small incision in the abdomen for the shunt to drain. He then used what is basically a Teflon tipped metal straw to guide the plastic tubing for the shunt from the scalp, behind the ear, down the neck, over the rib cage, and into the abdomen. Finally, the surgeon inserted the shunt into the ventricle, checked the flow, and finished placing the drain in the abdomen. From open to close the procedure took only one hour. As he intends to do this post-residency - Will is geeking out the entire hour.
The weekends have been very thoroughly enjoyed by all - last weekend we all struggled up the 1400+ steps to the Cristo de la Concordia which perches above Cochabamba, and this past weekend we visited Villa Tunari in the Chapare region of the Bolivian Amazon. There was an animal sanctuary with various food-stealing monkeys and a fantastic 6 hour trek through a local valley, as guided by a friend of our host family. The path was wide enough for one person, steep, challenging, and beautiful. We hiked up to a small waterfall (3-5m) with a pool deep enough for jumping off and then moved to a second waterfall (18-20m) which we rappelled down. The clumsy gringas and gringos struggled to walk down Amazonian rocks for another hour and a half, surrounded by the most lush, verdant scenery and clear water you can imagine. It didn't look real, and the pictures will never do it justice.
No comments:
Post a Comment