We arrived at the hospital at 8:00 AM. Today, I was working in the poorest of all of the hospitals we would see. When we first walked in, we saw a lot of large rooms with people EVERYWHERE. Seriously, I wish I could describe it better than that, but there were crowds of people standing and sitting in the waiting rooms, in the hallways, and outside. Everywhere. When we finally got through the crowds of people, we went into a small room that served as the room for Oral and Maxillary Surgery. Four different surgeons would be working in this small hallway, including Dr. Avilla, who I was with for the day.
I actually got to see a lot today, even though it was nothing major. My very first minor surgery was a lymphendectomy, which they preformed in this same room, without any sort of sterile field. A lymphendectomy is a very simple procedure...the surgeon simply put a 1-1.5 inch incision on the neck (where the calcified lymph node sat) and pulled it out...thats it! Despite the lack of blood/guts, I think the intensity of the situation of having someone cut into an alive human being was hard to watch...so I got a little light headed. This obviously was not a good sign for me, because I immediately questioned how I would get through med school, if I couldnt even handle a simple lymphendectomy. Thankgoodness this quickly went away and (as I will discuss in much more detail), I have seen lots of other, way more intense surgeries, and have been totally fine with them. So, yay for getting over that quickly!
After the lymphendectomy, we say lots of other consults including a tracheotomy cleaning, oral extractions, lots of injections, an aneurism of the Parotid Gland, a post-op patient with a severed facial nerve, some suture removals, a HUGE frontal sinus tumor, and two pretty crazy mandibular fractures (one from a bar fight, one on a 1 year old boy).
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| A picture of the very small hallway that held at least 4 patients at a time! |
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| Nicole and I waited outside of the hospital for our taxi. |
1) Elderly people all take their hats off and kneel to bow down in front of church entrances. It happened over and over.
2) Man in wheel chair was sitting outside of the hospital gate with everyone's bags. The security guard at the hospital wouldn't let people in with their bags, so they would have to pay the man to watch them.
3) Doctors RARELY wore gloves at this hospital...and there was nothing sterile about the procedures. This didn't end up holding true in the other hospitals we saw throughout the weeks, but it was definitely true here.
4) Whenever the doctors needed any sort of medicine or equipment (including lidocaine and syringes), the doctor would write a script and the patient would have to go down to the pharmacy to get it and then come bring it up to the doctors hours later to have a procedure done. I know this happens occasionally in the US if the medicine is not held in the office, but it was standard procedure here.
5) In cases of oral cancer, during the operation they sever the facial nerve. While in the US you try to salvage as much of the nerves as possible, that is completely the opposite as in Peru where they take the nerve as standard protocol. As a result, many young people with oral cancer will have paralysis of one side of their face for the rest of their life.
Day 5: TODAY WAS AWESOME!!!
Today, I went to the Hospital Nacional Archbishop Loayza, the main hospital at which we volunteered. I worked with Dr. Reyes, an anasthesiologist. So, I was in the OR all day. The first procedure I saw was a Laproscopic Full Hysterectomy. In this procedure, they go in through the belly button and pull the uterus out vagionally. It really was so cool! This was my first OB/GYN thing I have ever seen, so I wasn't really expecting to like it.. but after this surgery and then the week I shadowed later on, OB/GYN has now moved to the top of my list...but more on that later.
After the Lap Historectomy, they immediately rolled in another patient, without cleaning the OR or anything...The next patient was scheduled for a masectomy. When she was getting situated on the table, she started coughing and it was revealed that she was sick with a cold. So, her surgery was canceled and rescheduled for the next week... I was kind of sad both for her and for my learning, but I guess its good to wait until its totally safe.
After that, we went into a craneotomy/brain aneurism/brain tumor resection. We watched this surgery for about 1 1/2 hours, but it had already been going for about 3 hours and still had a LONG time remaining when we left. It was pretty crazy to see an open skull, but I know for sure I don't ever want to be a neurosurgeon... that is just too terrifying to think about. One small wrong cut and you permanently damage someones ability to move, think, talk, or act. No thank you.
After the day of surgeries, we went back and had dinner at a restaurant called "Cafe Cafe" ... stupid name, but great/cheap food!
Observations from the day:
1) There is a great dynamic between doctors/nurses/ect. Everyone has respect for everyone else in the OR...I don't know if that same respect always exists across doctors/nurses/techs in the ORs in the US.
2) The surgeries I saw were both very high tech! I was pleasantly surprised by the advanced practices in this hospital!
3) I felt a lot more comfortable speaking Spanish today. I was ablso to confidently order a meal, ask basic questions about a procedure, and get around a little (but still mostly with help). The surgeons again joked that I spoke "Spanglish".
Day 6: In Loayza for the second day, but this time in minor surgeries with Dr. Chico.
Today was very gross, but also pretty cool. The people that worked with Dr. Chico the day before had told us that they saw a toe nail removal...which I had absolutely no desire to see. Of course, the first three patients we saw had toe nail removals. So, yeah...pretty gross, especially because they cut off the toe nail and then part of the skin next to it...it seemed like a ton of toe was removed each time, but what do I know. After than, we say another lymphendectomy (I didn't get sick at all!), a hemorrhoid removal and 4 cyst removals.
Observations:
1) Dr. Chico was HILARIOUS!...but also slightly inappropriate. He made some jokingly sexist and racist comments, but no one seemed to care because he was just so stinking funny. He also joked a lot with his patients as a way to comfort them and it totally worked!
Ex of jokes : 1) He grabbed a razor blade, made a face and said "Freddy Kruger" , 2) He showed us a picture of a large tumor, to which I responded "Mucho grande" ... He responded to that with "Thats what I was told last night.".
2) When he asked us what specialty we were interested in most, Nicole and I both said "pediatrics". So, he abruptly stopped seeing patients and took us to the pediatrics building. We met with a young girl who had anemia and possibly cancer, but tests were still being run. He also took us to the day care at the hospital, where the kids were having a sort of fiesta...it was really fun!
3) The peruvian doctors LOVE to cut...surgeons are considered the "best" field of medicine so the standard procedure is to send everyone to them that has anything to cut out.
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| The beautiful Loayza hospital! |
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| The children's fiesta! |
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| Being Optometry students for a few hours |
Today, I worked in Kaweka Hospital, the nicest/richest hospital in Lima. Today, we were supposed to be working with Dr. Lando, another head and neck surgeon. However, when we got there, Dr. Lando was not in. So, we started going around with a general surgeon on his rounds. The first patient we met was in an explosion and had major burns on her arms and legs. The doctor had Nicole glove up and assist with cleaning and dressing her wounds. After we finished with this patient, we found Dr. Lando and went in on a Frenulum surgery on a 6-month old. It was a ridiculously quick surgery...literally one snip and sutures, but of course I loved it since it was a pediatrics case. After that surgery, we went into the ICU. While here, we watched two tracheotomies. Seeing one after the other was actually really nice, because now I think I could probably do a tracheotomy myself. After that, we went back to do rounds. We saw a woman with a GIGANTIC goiter...huge! Next, we went in to watch an endoscopy and colonoscopy.
Finally, we went back to the OR to watch a skin graft surgery. When we got there, the doctor asked me to scrub in AND first assist. I was so nervous, but very excited. The surgery started with sedation with epidural, so the patient was awake but numb. We then went to his upper thigh and cut thin strips of skin to be used for the skin graft on the foot. My role was to hold his thigh tightly with a "karate chop hand" as the doctor described, so that clean slices of skin could be made. After that, the skin needed to be aired and stretched out. Then, we went over to the foot and irrigated it like CRAZY. The surgeon scraped off all of the scar and granulation tissue. He had to dig a lot of skin away in order to have the skin graft be safe and effective. Then, he sutured part of the foot that would not receive the graft. Finally, it was graft time...I was really surprised, but the surgeon told me to do it. So, I put the skin on a square mesh patch and held it up to the foot to apply it. We then had to use a lot of gauze and bandages to stabilitze the new skin. Finally, the surgery was finished by us reapplying a few scraps of skin that we did not use back to the thigh and we bandaged that up also. So, there you have it...my first real participation in a surgery. SO COOL! What a great way to end my week of surgeries in Lima!
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