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Jeremy Senior Project Week 4

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     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.

Comments

I recognize that guy!

He looks healthier than I remembered.

Thanks for showing me the goods on Thursday! What a cool experience you've had. Next stop: assembly! Then maybe cardiovascular surgery?

thanks for sharing your experience with me, Jeremy! I learned a lot.

Nichole

Jeremy Senior Project Week 3

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      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.

Comments

Will we see your acting skills in your project presentation?

Do you get to be part of the debriefing the team does about how the care quality exercises go?
Who gets to decide whether the patient feels appropriately supported, listened to, minimally distressed, etc?
I'd imagine that what works for one patient may not be as effective for another patient and that the health care providers would need to adjust their approach with different patients.

I did get to be part of the

I did get to be part of the debriefing sessions along with all the doctors and nurses who participated, a few members of the sim team (whoever happened to be working that day), a woman who I believe was the head of the department, and another woman who happens to be a coworker of my dad's, and she's got something to do with managing quality at the hospital.
It was basically up to me to describe how I felt I was treated as a "parent", but the other employees I mentioned who were observing the exercise probably have a better grasp on how things actually go, and how they want to see the nurses and doctors react, so they also made some (probably more educated) comments during the debriefing.

Can't wait!

Tomorrow I will get to see all these crazy things you write about. Woo-hoo! Thanks for your thoughtful blog post.

See you soon,
Nichole

Margaret's Grand Adventure at OHSU: my final days there part 2

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 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.

 
In the clinic we saw a patient who had fallen and badly injured her head. She developed a large swelling “goose egg” on her forehead, the bump wouldn’t go away entirely, and some of the internal blood fragments traveled down the woman’s face and collected in the sub dermal facial crevices. We also met with a patient who had accidently amputated both her pointer and middle fingers, and she needed her stitches removed. Another patient needed his leg removed after a host of other procedures failed, and another patient sustained several facial fractures and needed screws and bolts to set everything back into place. Another patient broke his mandible and another patient needed tendon repair in both of their arms after attempting to commit suicide.
 
 
In the OR the surgeons use an instrument called a “Bovie” or a cauterizing stick. The surgeons use the scalpel very little—mostly just to cut through skin—and the Bovie does the rest. What I didn’t realize until near the end of my time at OHSU is that the Bovie is sending electric charged into the patient and is cauterizing through electrical burns. The surgeons wear two pairs of gloves (one rubber and one latex), and the patients lay on grounding pads to prevent either one from getting hurt. The most fascinating part is that if the surgeon cannot reach a tight or hard to get to spot, he or she can take their surgical tweezers, place the tip on the hard spot, and tap the end with the Bovie. Since electricity conducts well through metal, the hidden spot is zapped. I had no idea how much physics was used in a biological and chemical procedure!
 
 
Some final anecdotes include that I couldn’t touch anything in blue because it was sterile (“don’t touch the blue, or the nurses will kill you”), and I had to stand for many hours at a time and fell in love with my Dansko clogs (a little shameless product placement; every person at OHSU wears them…every). Over the course of my time at OHSU I witnessed some part of surgical and healing process behind breast reductions, breast reconstructions, preemptive and post cancer mastectomies, breast implantations, and breast tissue expander implantations. During surgery the tissue expanders—which can be filled with fluid via a long needle and expand to stretch the skin to make room for an implant—can be taken out of their packaging, placed in a person for sizing, be taken out, and re-sterilized. The implants, on the other hand, cannot be re-sterilized, and once they’re out of their packaging they have to be used or thrown away.
 
 
The attending surgeons, attending anesthesiologists, surgical residents, nurse anesthetists, circulating nurses, and scrub techs all work together as a close team in the OR, and they each do their own job to make sure the patient receives the best care. For each job there are a million was to arrive in the OR, and while there are so many ways to get to the same room, peoples’ priorities don’t change: save a life. They huddle before and after a surgery to ensure that patients receive the correct and best care, and the nurses count all the tools repeatedly to avoid objects being left in patients. It’s a terribly tricky job, putting people back together, and I have such respect fur plastic surgeons and anesthesiologists, and their entire team. As the anesthesiologists say, anyone can put someone to sleep; the trick is waking them up again.

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,
Margaret

Comments

Thank you!!!

You are a beautiful blogstress and a beautiful person. Hope the time in the San Juans is FABULOUS!!

Nichole

What a great experience you've had!

And you even got to recall a little science II physics...

Margaret's Grand Adventure at OHSU: my final days there part 1

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 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.

 
 
Today I watched Dr. Hansen perform Botox and learned that it can be used for more than wrinkles. Botox is a muscle paralytic and can be used to combat severe headaches. There are also no age restrictions and the product can be used on patients as young as babies.
 
I also learned about breast reductions…for men. Yes, this is a thing. I had no idea. Sometimes men develop excess breast tissue, and in some cases this results in fully formed breasts. The patient I watched Dr. Hansen operate on was young and suffered from a mild case of the condition, but his excess tissue and protruding nipples had negative psychological effects. I hope the best for him and that the procedure gives him the desired effect, as well as some relief and renewed confidence to feel comfortable skin.
 
I also attended another preop meeting in which we discussed upcoming cases, as well as previous ones. One of the residents presented on hospital regulations that aim to ensure patient safety. During the presentation his computer froze, the little spinning rainbow wheel of doom appeared, and PowerPoint became unresponsive. As a joke, another resident exclaimed, “Doctor, he’s unresponsive!”
That comment made the whole room laugh a lot.
 
During this day I also looked more case pictures, in particular gunshot and bike accident patients. In one of the bike cases a patient got their tires stuck in the Max tracks and took a nosedive over the handlebars. The fall caused them to skid across the pavement and their nose and upper lip were ripped off. Other violent accidents included hand and arm avulsions (i.e. arms ripped off by machinery), hand de-gloving and finger amputation injuries (i.e. hands caught in lawnmowers), genitalia avulsions (i.e. penises being torn off), and crush injures (i.e. hands and arms crushed in metal presses).
 
 
 
During one procedure a patient had small residual cancerous tumors in one breast after the majority of them were removed. A breast cancer surgeon was called in and she only operated on the “dirty” side and used the “dirty” tools, and Dr. Hansen took over afterward and used the “clean” tools. Anything that could possibly come in contact with cancerous tissue was regarded as “dirty, “and it was essential that unhealthy tissue didn’t come in contact with the healthy breast.
 
In clinic I met with the patient who received the tram flap operation I saw. During her postop appointment she got her drains removed and her scars were healing well. The surgical glue—which is applied right after the incisions are closed with sutures—was still covering the stiches, and I was told that it flakes off over the course of several weeks.
 
In clinic I also got to feel a patient’s abnormally shaped breast and capsular contracture around their radiated skin, and this was my first significant physical patient contact (other than shaking hands). Later I got to assist in taking out a patient’s wires that had held his broken jaw in place for several weeks. Aric, an extremely helpful and friendly resident, had me hold the tongue depressor and a long Q-tip in place to keep the patient’s cheeks out of the way while Aric works. I have a moderate phobia of not being able to open my mouth, and I have no idea how this patient did it for so long. He had such an energetic, positive, and grateful attitude that again reminded me how fortunate I am and how much I take being healthy for granted.
 

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.”

Margaret's Grand Adventure: My time at OHSU Days 7-11

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 Day 7

My grandmother died this day. Spent far too much time in the hospital for the wrong, hard reasons,
 
Day 8
Didn’t go to senior projects because I needed to be with my family
 
Day 9-10
At the state track meet, and my mentor was out of town for a conference in Mimi.
 
Day 11
Today I attended the weekly Monday pre-op meeting and we hosted a visiting professor from New York. He talked about rhinoplasty and showed slides about some of his patients and techniques he used to reduce error. Afterward I followed him on his resident-guided tour of both upper and lower OHSU campuses, and learned some history about the school’s location. Apparently, many years ago, a railroad company bought the property without looking at a topographical map, but upon arriving for construction they noticed a minor problem: the land was located entirely on the side of a hill. This, of course, was useless to the railroad company, and they had to find a different route around the mountain. In the meantime the company donated the land to the hospital. Now days there’s a tram, but before that it was extremely time consuming to travel in between the upper and lower campuses (the lower campus is much more recent). That being said, the tram is not a “trambulance.” This means that patients often have to be transported between campuses by way of an ambulance because they cannot use the tram.
 
Later in the day I looked at more case photos and talked to Dr. Hansen about a number of them. I also learned about radiated skin and how hard it is to work with. Tissue that has undergone radiation is highly unpredictable, and capsular contracture often develops in radiated tissue around breast implants. This is an abnormal immune system response to foreign materials in the human body, and follows the formation of capsules of tightly woven collagen fibers. The capsules contract and tighten around the implant, resulting in misshaped tissue and moderate to extreme physical discomfort.
 

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.

Margaret's Grand Adventure: My time at OHSU Days 5 and 6

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 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.

 
On day #5 I witnessed probably my favorite operation during my month at OHSU. In this procedure a patient received a breast reconstruction by way of a rectus muscle and skin flap. That means that Dr. Hansen removed the abdomen skin and fat, as well as the lower portion of the right side of the patient’s rectus muscle (a.k.a. the ab muscle, or abdominis rectus). That skin, fat, and muscle flap was then moved to the previously mastected breast area—along with am artery and vein, which were attached under a microscope to a vein and artery found in the chest. A sounding probe was used to affirm the restoration of blood flow throughout the procedure. The rest of the extraneous lower abdomen tissue was removed but the remainder of the rectus muscle was left intact. The remaining lower abdomen tissue was then sutured together, producing a “tummy tuck.”
 
While Dr. Hansen and one of her residents connected the veins and arteries (a micro vascular surgical procedure), another resident demonstrated different suture techniques on a portion of removed tissue. I was able to glove-up and practice the sutures for myself. When first going into the operating room, I had no idea stitches were so difficult!! Ina (the resident) carefully showed me the different kinds of sutures and explained what each one was predominantly used for. To be perfectly honest, I’ve never been handed a body part before and been told to “play with it,” but I had a great time handling and working with the tissue.
 
During this surgery, Dr. Hansen mentioned something called a “beta blocker”—which I learned about in science class this year—and it was fun to see the connection. Beta-blockers are a class of drugs that target the beta-receptors on cells found in heart muscles, smooth muscles, airways, arteries, kidneys, and other tissues involved with the sympathetic nervous system.
 
(See a picture of the flap PROCEDURE and SUTURE STYLES in the attachments)

Prodcedure picture found from: www.mayoclinic.com/images/image_popup/br7_free_tram_flap.jpg

 

Day 6:

Today was a slower day in which Dr. Hansen had to catch up on office work, so I spent my time looking at pictures of past patients. The cases included breast reconstructions, mastectomies, breast reductions, avulsions (i.e. hands ripped off), de-gloving injuries (i.e. skin being pulled off of the muscle), crush injuries, tumors, facial fractures, tummy tucks, dog bites, gunshot wounds, trunk injuries (i.e. on the chest or abdomen), and many more.
 
One patient who Dr. Hansen spent a lot of time with was one who attempted suicide by shooting themself in he head. However, instead of destroying their brain or brainstem—which would have taken out necessary functions such as breathing and blood pressure—the patient accidently blew their face off. This tragic incident led to tens of surgeries and years of work, and the end result is remarkable. If you look at the reconstructed face without looking at the bloody beginnings, it doesn’t look nearly as impressive, and this patient stands as a strong example of the powers of plastic surgery.
 
Later today I attended M&M, which is a conference in which attending (senior) doctors from different fields and their residents gather to discuss cases that ended with a poor result (i.e. an unforeseen complication, a human error related complication, and/or a fatality). The plastic and vascular surgeons each presented a case to the assembly, and different doctors from a number of fields discussed what wen wrong, why, and how/if these complications can be avoided in the future. Residents from each surgical division take turns presenting at M&M, and while I know that I’d be terrified to get up there in front of all those doctors and showcase a medical error and/or mistake, these residents handled the pressure remarkably well.

Margaret's Grand Adventure: My first week at OHSU! (Day 4)

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Day 4:

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.

Comments

timely NYT articles for you

Check out yesterday's NYT Op Ed, written by Angelina Jolie, about her recent double mastectomy, and today's piece in the Health section describing how genetic testing is leading to more and more women electing to have surgery before being diagnosed with breast cancer.

Pure, sweet hope

Miss Margaret! What thoughtful, informative posts! Your first week sounds incredibly educational and varied--let's hope your dark past doesn't catch up with you and cut your job short!

I love your attitude, as always. I, too, find that the best way to deal with the blows that life throws at us is to concentrate on the beauty and hope that emerge--just like you've noticed in the patients you've seen. And a visit with His Holiness doesn't hurt, either!

An idea: since you need some photos, can you show us what you look like all suited up? I'd love to see you in your glory.

Miss you!!!

Nichole

Margaret's Grand Adventure: My first week at OHSU! (Day 3)

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Day 3:

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.

Comments

This is fascinating; thanks

This is fascinating; thanks for the thoughtful and detailed posts! Given the longevity of saline, why would one choose silicone implants instead?

Saline vs. Silicone

That's a great question! I wondered the same thing when Dr. Hansen showed me the two different models, and she said that silicone feels more natural to patients. Silicone implants hang more naturally than saline implants, and the texture is different. There have been allegations that silicone is damaging, but the two implants are virtually the same, other than what i previously mentioned. Often times, it just comes down to patient-preference, but doctors usually suggest silicone.

Margaret's Grand Adventure: My first week at OHSU! (Day 2)

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Day 2:

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!

Margaret's Grand Adventure: My first week at OHSU!

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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:

Day 1:
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?

Margaret's Grand Adventure: Exploring Surgery and the Medical World

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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?!?

Comments

Yes, I am!!

And I love your title! You are amazing, and we miss you. Great to see you for a second today! Hope you're finally getting some sleep!!!!

xoxo
Nichole

Matt Junn Senior Project: Physical Therapy and Internal medicine

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 I will be working in two different medical clinics who work in partnership: Internal madecine and physical therapy.

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Dr. JUNN!

Exactly what have you done this week? We are excited to hear everything about it.
Madeleine

ANY MEDICAL NEWS MATT

How are you doing in this new environment? Can you give us some details of your first week? Are you giving shots yet?
Madeleine

Week 1

Hi Matt,

How did your first week go? I'm looking forward to reading all about it!

Robyn