I spent all of yesterday in the clinic. My mentor was out of town at the end of last week, and I didn't get in contact with her over the weekend. So I kind of just showed up to the clinic at 8:30, hoping there'd be something for me to do. It turned out Dr. Hansen was in surgery, but there was a different doctor (Dr. Joel Solomon) in the clinic that day. However, he didn't come in until 9:30. During that time, I took a nap in the lobby which was excellent as I've had morning practices this week. 

In the clinic, I shadowed Dr. Solomon who specializes in hand surgery. Most of the cases we saw had to do with nerve damage which had caused people to not be able to use their hands very well. Two of the patients had injuries to their brachial plexus, which is a bundle of nerves that runs down near the collar bone. This nerve bundle serves the arm and the hand. One man had a 2x4 through his chest from a car accident that caused the injury. Dr. Solomon in these cases decides whether to surgically try to move some nerves around to restore movement, or try less invasive things like physical therapy. In the case with the 2x4, the man hadn't received any hand therapy after the accident, which had caused stiffness in his digits. At this point, he said you have to restore the movement (probably surgically) until he would consider moving around nerves. If you move the nerves first the fingers still might not move very well.

There was also one toddler who had Greig Cephalopolysyndactyly Syndrome. As the name suggests, this causes syndactyly, or the fusing of digits. So she didnt't have any separate fingers except thumbs. We looked at x rays of her hands, and Dr. Solomon decided from the images whether to aim to separate the bones in her hands into three or four fingers. Some of the bones don't develop fully or fuse so it doens't always make sense to try to create four fingers. Also, the parents asked how long the surgery would take and Dr. Soloman said around 6 or 7 hours!

In the afternoon, my mentor was back in the clinic. She was happy that I'd been in the clinic all morning. I followed her in the afternoon to a few different cases, and watched one procedure with local anesthetic of reparing an earring hole. 

I spent today in the OR. I observed first a different doctor performing a mastectomy. During the mastectomy, they also try to determine if the cancer has spread to the lymph nodes. (In this case the mastectomy was due to breast cancer, and lymph nodes are the first place it will metastasize to). To determine this they use a radioactive sensor. The more radioactivity, the faster the machine beeps and they decide what to cut. This was pretty cool. After they finished everything there, Dr. Hansen stepped in to perform the reconstructive work. She placed an implant on the side where the woman had had a mastectomy. Then on the other side, she did a slight breast reduction and lift. I've been talking to Dr. Hansen a lot about how you decide which procedure to do, and how you acheive symmetry. In this case it was interesting because they tried three different sizes and types of implants before they were happy. Dr. Hansen also mentioned that this patient wanted everything done in one surgery, which is why they chose to do an implant following the mastectomy. They had a originally planned to do a TRAM flap. I also know that Dr. Hansen normally uses tissue expanders. However, I wonder why they wouldn't just put in an implant like they did today. It seemed to work well, and it was all done in one day. I'll ask tomorrow...

Other notes:

I really hope someone gets a TRAM flap surgery (google it) while I'm here because I want to watch one!!! 

I have no idea how old people are and am often surprised when they start talking about their high school age kids

I don't think I could keep track of the amount of times I've been asked this in this order: Oh so you're a senior? Where are you going next year? Are you going into medicine?