Tuesday, August 16, 2011

That's ironic right?

So all of last week and for the rest of this week I've been on doing my ward experience with the Acute Care Surgery service. This is the surgical team that deals with trauma and emergent surgical cases that present at the Loma Linda University Hospital.

Ironically even though I'm with a surgical service I somehow missed any time in the OR all of last week. I was hearing stories from classmates in other surgical services about being in the OR everyday and to be completely honest I was getting a bit jealous.

Beginning this week our team got a new attending physician and a couple of new cases that could potentially be managed surgically. Yesterday morning the team saw a woman in her mid-twenties who had a 5 month history of small bowel obstruction. In other words the thought was that something was obstructing the natural pathway of digestion.

Today I got to scrub in on the exploratory laparotomy, which means I had the ability to be in contact with the sterile area during the surgery. Its a whole different mindset when you're wearing a sterile gown. You have to resist the urge to scratch an itch on your face or adjust your glasses. Anything you touch that isn't sterile means you have to re-gown before you can get near the sterile field again. I was in the OR with the surgery attending, the senior resident and one other third year medical student. Since there were fewer people I was able to be really hands by helping hold parts of the bowel as well as suctioning.

The patients small bowel had a lot more motility than normal which gave it a pretty weird appearance. When the bowel was visible the entire small intestine was wiggling a lot more than normal. The surgeon examined the small intestine to look for a potential obstruction and couldn't find one but it soon became apparent that the peristaltic activity of the bowel was not moving any of the stool. To alleviate this problem the surgeon made two incisions in the bowel and inserted a catheter into one and flushed saline into the intestine. He then ran the bowel to force the stool out of the other incision farther down the bowel. According to the attending and the resident the consistency of the stool was abnormal and indicated the patient could have cystic fibrosis.

Since the surgery started so late I had to leave for class before they closed the wound. After spending all that time on the surgery service this one case more than made up for not getting any OR time in the past week. If I'm lucky I might get scrub in on another case later this week. On Monday we start classes and we won't get any clinical experience until next summer so I'm trying to soak up as much as possible because I know I'll need the motivation later on in the year.

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