Monday was Memorial Day, so the team had the day off.
On Tuesday, we had a stroke drill at WMC. This meant the head of the simulations department had to pretend she had experienced a stroke and couldn't fully operate the right side of her body, or speak coherently, or really respond to much of anything. I played the role of her son who brought her in. I wheeled her into the hospital and to the triage desk, and from there, they treated her like a real patient who had experienced a stroke, giving her a CT scan, asking her questions, and finally taking her by ambualance to the KSMC where they are more readily prepared to deal with strokes, and where they have a neurinterventionist on staff who can do a procedure to remove blood clots in the brain that they aren't able to do at WMC. I got to ride along with her in the ambulance, but unfortunately they weren't able to run the lights or sirens. At KSMC, I learned that any family member over the age of 18 can sign off on procedures for a patient if the patient is unable to do so themselves.
On Wednesday, a representative from Laerdal, a manufacturer of simulations mannequins, was visiting the sim lab to train them on the use of several more advanced features of the mannequins. I sat in with them for the training, and learned the basics of how to program a scenario into the mannequins - what symptoms they exhibit and when, and how those symptoms change based on what actions the physicians take to make them better. They can also be programmed to exhibit worsening symptoms if nothing is done for them after a certain period of time.
On Thursday, after Nichole visited and toured the sim lab and learned about the basics of the 3G mannequin, I spent the rest of the day shadowing another ED physician. I learned a lot the first time, and I continued to learn about the intricacies of working in the emergency room. It's really interesting to see the different kinds of patients. Each one is in some way unique, but they also tend to be able to be grouped together. There are drug seekers, incoherent old people, the rare totally normal person, etc. It's obviously important to listen to each patient individually and hear what they have to say, but it seems to me that half the time, doctors can have a diagnosis ready before they even see the patient. Sometimes they see the patient and it's exactly what they thought - sometimes, though, it's something completely out of left field. Seeing all this has actually made me a lot more interested in emergency medicine than I thought I was - it never really seemed like the field I would be most interested in, but it's starting to look pretty appealing to me - but I'm sure I'll find all kinds of appeals and drawbacks to each field of medicine if and when I reach the point of med school.
On Friday, the sim team was off duty, so I spent the last day of my senior project as an observer in an open heart surgery. I can't recall the official medical terminology for the procedure (I may remember to update this if I find it out) but basically, the procedure fixed a valve in the heart between the left atrium and left ventricle that wasn't closing properly. Usually, blood flows from the atrium into the ventricle via a smaller heartbeat, and then from the ventricle through the ventricle and through the entire body via a strong beat. In the case I saw, there was a tear in part of the valve tissue that prevented the valve between the left atrium and left ventricle from closing all the way, and instead it just flailed, so blood would flow back into the atrium instead of through the aorta and to the rest of the body when the heart beated. Watching a surgery made me realize a couple different things: 1. I have an immense amount of respect for anyone able to spend hours standing still and focused, working meticulously on a patient like that and 2. while I still want to pursue a career in medicine, I'm not sure cardiovascular surgery will be my specialty.
On Monday, the team and I worked on programming another mannequin by a company called METI (recently acquired by CAE Healthcare). This mannequin is modeled after a young boy, whereas the other mannequins are predominantly modeled after adults. The METI mannequin is capable of modeling a lot of medical situations that no other mannequin is able to, at the expense of being much less convenient to operate. Unlike the 3G mannequin, METI has an external computer system, and external air compressor, and must be connected with a wire. It also looks sort of creepy - it earned the nickname "Lizard Boy" from Marcio, and I'm somewhat inclined to agree. The simulations he is capable of are pretty amazing, though - he was designed alongside a very experienced physician, and he can exhibit symptoms from hundreds of different cases. The team is often frustrated by the fact that he is so realistic that programming in certain attributes will cause him to "die" - certain blood pressure or spO2 readings etc. will register in the computer as physiologically impossible, and unless the system is overridden, he will shut down.
On Tuesday, while we were all at the zoo, the sim team brought METI to the Tualitin for pediatric basic life support (BLS) code training.
Wednesday saw us back at the WMC for another round of post partum hemorrhaging simulations; one in the morning and one in the afternoon. We were pleased to learn that, in the course of some of our simulations and debriefing sessions, a few (albeit minor) changes had already been made - for instance, the identification system for the nursing staff in the OR has been streamlined to some degree. They use pink cards with a name like "Charge Nurse" or "RN" or "Runner" or "Recorder" with a list of their individual duties on the back of the card, and the cards now attach with those little retractable clips as opposed to lanyards, and a particular system for distributing the cards has been decided upon. This is a small change, I know, but it's still really cool to see these kinds of changes made in response to the work the sim team is doing as they're doing it.
On Thursday, we had the last couple post partum hemhorrage sims (or rather, the last one, being that the morning session ended up getting cancelled). I don't know how many of those I did during my senior project, but I think I can say that at this point, I'm ready for my Hollywood role as "concerned spouse #1".
On Friday, because the team didn't have much going on other than a 0900-1100 simulation with several ED physicians (which I'll go into further detail on later) I spent most of the day shadowing a doctor in the ICU. I met up with him at 0700 and followed him as he checked in with several of his patients at the start of his shift, and at 0900 I headed back to the sim lab for the simulation session. They do these care quality exercises periodically with different departments, and today, they were working with 3 ED physicians. They hire an actress to play a few different roles as patients with various ailments, and the doctors treat them as they would any other patient. The goal is to analyze the way in which they interact with patients, and to find the ideal methods of demonstrating their concern, discussing the course of action the plan to take, and minimizing distress. They had me act again, this time as either the patient's son or their husband. I had no idea I was going to be doing so much acting during my project - not that I have any problem with it. After the quality excersice, I took lunch and headed back up to the ICU, where I spent the rest of the day. I got to watch two different intubations, one fairly routine and one extremely complicated - not sure how much I can divulge about why it was so complicated, what with confidentiality laws and all that, but rest assured, it was pretty interesting. I also watched the process of draining built up fluids around a patient's lungs, which was very interesting.
I'm coming up on my last week, and I'm amazed how fast everything has gone by.
Dr. Hansen explained to me that more is not always better when it comes to screening, because if she finds something she has to do something about it, and that could lead to more complicated and less ideal situations. For example, if she could screen for one thing and instead find another—say, a benign tumor in the colon. If she operates on that tumor, even though it will most likely never become malignant, and there’s a complication, it could result in a hernia and cause havoc. So, while I think that I would always prefer to know what is going on with my body, I can understand not treating everything we could potentially find. There is a gene that can predispose a person for breast cancer, and I would love to know whether or not I have it, and I hope that I would have the courage to face the likely possibility of cancer. Angelina Jolie just had a preemptive bilateral mastectomy because of this gene, and I dearly hope that her bravery and openness give other women the strength to fight their battles.
I has such a wonderful time and would like to thank my lovely mentor, Dr. Julie Hansen, her fantastic residents, the entire OHSU staff, and my senior project teacher advisor, Veronica Ledoux. This has been a fantastic month, and i hope to stay in touch often.
All my love,
From now on I lost track of what happened on which corresponding number day, so I’ll just talk about everything that I saw or did in the rough order that it happened.
Later on in the clinic I saw postop visits for breast implantations and reductions, a preop for a breast reduction patient with size G breasts and chronic back pain, a preop for chin surgery to remove an unknown lesion, and a postop for a facial laceration surgery that I saw on the first day. During one of these visits I encountered my first unhappy patient who received faulty postop instructions in regard to the process of scheduling a postop visit, as well as where to fill their pain medication prescription. This made me realize OHSU is a big facility and is prone to some errors just as a result of the it’s size, but also that there are patients who can get a perfect result and be disgruntled, and then there are patient with terrible options or results who remain positive and appreciative. These are just different approaches and outlooks, and as my granddad used to say, “that’s what makes horse races.”
Later in the day I was reading a medical magazine and found out that a company names “Pear” claims that arnica can be used to minimize surgery related bruising, both through the usage of a external/topical gel and internal pellets.
As you may know, I haven’t posted a blog in many days. I apologize for the delay, there were a number of deaths in the family—one of which included my grandmother—and the past couple weeks have been tremendously difficult. Time is still scarce, but I have been steadily compiling notes on my daily activities and need to organize them into complete posts.
Prodcedure picture found from: www.mayoclinic.com/images/image_popup/br7_free_tram_flap.jpg
Today was another clinic day, and my time there was cut short by my visit to see the Dalai Lama speak--what an absolutely amazing experience!!
In the morning Dr Hansen and i met with 2 of the 4 scheduled patients because 2 didn't show up. One of the ones that did arrive wanted a breast augmentation. They had received a free muscle flap to reconstruct one breast after chemotherapy. During this consultation, Dr Hansen explained that radiated skin usually hardens in a process called capsular contracture, but any skin around an implant is prone to a similar result.
Another term that I learned (I forgot to mention in in my post about day 3) is surgical procedure called a lumpectomy, in which only a small portion (or lump) of a breast is removed.
Another patient wanted cosmetic breast implants, and this demonstrates a different side of Dr Hansen's services. She mostly operates on cancer-related cases but also performs purely cosmetic procedures. Another area of her practice (one i forgot to mention in m day 3 post about a patient) is the female to male / male to female transition surgeries. Dr Hansen commented that this is a newly booming part of her practice, and that she specializes in performing breast removals (mastectomies) and breast implants.
A surgical note: often the nipple is grafted onto the newly reconstructive breasts straight from the old breasts, and this is as 'simple' and removing the nipple, removing several layers of epidermis on the reconstructed breast, and sewing on the nipple.
Today we spent the day at the clinic for preop (pre-operation) and postop (post-operation) consultations. One of the patients had received a mastectomy and needed to reconstruct one or more of their breasts. Another patient had implants but needed an augmentation to fix existing complications with the breasts' appearances.
Interesting fact: saline implants can remain in place for life, while medical professionals recommend replacing silicone implants every 10 years or so.
Another patient had sustained a crush injury to their pointer finger and met with Dr Hansen during the recovery process to determine the best course of action as the finger continue to heal. The finger had sustained multiple fractures, as well as concentrated cell death and partial amputation.
Another patient in the clinic had battled a reoccurring type of cancer, which contributed to an infected open-leg wound with tissue damage, inflammation, and decay, as well as bone visibility. After a failed skin flap graft the options were limited to a transverse free muscle flap from the back area, or an amputation.
What surprises and inspires me most is the energy and passion that remains so vividly alive in these patients, despite the hardships they have had and will continue to endure. Their vibrant spirits are catching, and they give me hope; pure, sweet, hope.
Today was a SURGERY day!! After arriving at OHSU South (the upper campus) I suited up in my scrubs, hair covering, surgical mask, booties, and Dansko clogs. The clogs were essential, practically every surgeon, nurse, technician, anesthesiologist, and person in between wears these Dansko clogs, and the shoes' strong arch support helps relieve stress on the feet, knees, and back during a long day in the OR (operating room).
The first surgery I watched was the tail end of a facial surgery. The patient had suffered facial drooping as a result of an accident, and Dr Hansen reopened the old scar and repaired muscle damage. As you know, I cannot release the names or specifics of patients (I don't even know most of them), but I will discuss the types of procedures from a surgical standpoint.
The second surgery was a rather unusual one, even from Dr Hansen's extensive experience. The surgery was called a labiaplasty, or a surgical reduction of the labia. The labia minora and majora are the folds of skin surrounding the human vulva, and anatomically these are found in the female sex genitals. This was an interesting procedure to watch, and the whole process didn't take long. During the labiaplasty, Dr Hansen and one of her residents removed wedge-shaped flaps from the patient's labia and sutured the remaining tissue together, with a net result of reduced labia size.
The last surgery of the day was a bilateral breast implantation. I believe that the patient had sizer implants in place to stretch the tissue and make room for the permanent implants, and those were removed during the procedure. The surgeons chose a permanent implant size by testing different sizers to test the shape of breasts. The sizer implants can be re-sterilized and used again, while the permanent implants cannot, so they surgeons wanted to be sure of what they wanted before inserting the permanent ones. I loved watching the miracle of the whole process; everything from the surgeons' ability to create breasts from skin and silicone, to the anesthesiologist's ability to put the patient under and then bring them back again. I look forward to many more days like this one!
Howdy there! This week I spent 5 wonderful, jam-packed, intense days shadowing Dr. Julie Hansen at OHSU. She's a reconstructive plastic surgeon there and I got to follow here around her clinic and her operating room. Dr. Hansen and I met during my advanced biology class when I shadowed her for several days, and during that time I also got to know the plastic surgery residency coordinator, Amanda Kotsovos.
Now let me summarize each day of senior projects so far one at a time, starting with the first:
I showed up to the south campus of OHSU bright and early in the morning (so much for sleeping in on senior projects, eh?), and I met with Dr. Hansen for the first time in several months. We discussed the possible directions/focuses of the project and then she showed me around her office in Mackenzie Hall and introduced me to some of the staff. Next Dr Hansen had to make some phone calls and do paper work, so Amanda and I went to the parking office to get my ID badge. However, we ran into an snafu: the regulations changed and became stricter since my last visit (unbeknownst to Amanda, Dr Hansen, or me). Instead of a 5 minute process similar to what I experienced in the fall, I suddenly had to take several online classes, pass several online tests, and get a background check. I received a temporary 2 week pass, and Amanda and I returned to Dr Hansen's office where I spent all day passing the classes and tests. However, it wasn't that bad, and I learned more about hospital regulations and expectations, especially in regard to patients' private information. We're still awaiting the results of the background check, and we all joke that my "dark past" will come back to haunt me (haha, just kidding). After all the bouncing around and test taking I got few minutes to browse through a plastic surgery journal before heading off to track practice. It never occured to me that science magazines would have different advertisements than non-scienctific ones, but it makes perfect sense now that I think about it. Still, I don't know whether I'll ever be able to consider the ad selling leeches as 'normal.' It read, "Leeches! On call 24 hours. Just like you."
It's the little things that me you simle, right?
Welcome to my blog! Ready for and adventure?.... LETS GO!!
I will be shadowing Dr. Juliana Hansen, a reconstructive plastic surgeon, at OHSU.
Sadly, I can't take pictures in the hospital, so there won't be much footage of my actual work. However, i will still upload interesting pictures about the topics I learn about.
I'm excited, are you?!?
I will be working in two different medical clinics who work in partnership: Internal madecine and physical therapy.