10/12/2011
For my first day I was assigned to the surgery department. Here, me and about six other students in my program followed along with the residence and doctors as they went bed to bed presenting each patient’s case. A resident would explain the patient’s case and then the doctor would ask us all questions about the surgical procedure.
After rounds we went into two surgeries. The first surgery was a gallbladder removal, which I have already seen in the US. The big difference between the two surgeries is that in the US they did the surgery Laparoscopically, meaning they did the surgery with only sticking little tools and a video camera in the patient. The one I saw here was more invasive because they had to cut the person open and then do the surgery by hand. The patient had several big gallstones that had to be removed along with the gallbladder.
The second surgery I saw was much more complicated. The patient previously had some complications from an appendectomy and then had to have his ascending colon removed. The surgery I saw today was the attachment of the patient’s small intestine to patient’s transverse colon. The patient went six months with a bag acting as his ascending colon.
One of the more interesting things about surgery in Mexico is the way they perform anesthesia on the patient. In the US, the universal consensus is to use general anesthesia to put the patient in an unconscious state, which means a ventilator must be used to control the patient’s breathing. In Mexico they more commonly use regional anesthesia to block off a portion of the body, leaving control of breathing in the patient’s hands. For both of these surgeries the patients were given regional anesthesia by injecting anesthetics into the epidural area of the spine. I am unsure of their reasons for doing this but perhaps it is a financial reason.
Later that night, a few of my fellow students and I came back to spend some time in the OBGYN department. Here I not only had the opportunity to see live births and C-sections, but also got to learn about neonatal care once the baby is out. Once the baby is out of the womb, there are a series of observations that the nurse will make in order to determine the baby’s gestational age. For example, the smoother the bottom of the baby’s foot, the younger the baby is. Babies born premature often have smooth feet with zero wrinkles. Another example is the floppiness of the ears. The floppier the ears are, the later the baby is in its development. Once the baby’s gestational age is determined the baby must get a vitamin K shot to help with the clotting of the blood in the umbilical cord, and antibiotic eye drops to prevent the transfer of any bacteria as the baby exits the womb.
Something interesting that I noticed when watching my second C-section was that all incisions for a C-section in Mexico are vertical. In the US they are horizontal. The reason for this is it is easier to get the baby out of a vertical cut then a horizontal one. In the US, they use a horizontal incision because the scar is more aesthetically pleasing. It is easier to hide a horizontal scar at the waste than a vertical scar up the person’s stomach. The hospital I was working at was a hospital that covered the general public so aesthetics weren’t much of a concern to them.
After rounds we went into two surgeries. The first surgery was a gallbladder removal, which I have already seen in the US. The big difference between the two surgeries is that in the US they did the surgery Laparoscopically, meaning they did the surgery with only sticking little tools and a video camera in the patient. The one I saw here was more invasive because they had to cut the person open and then do the surgery by hand. The patient had several big gallstones that had to be removed along with the gallbladder.
The second surgery I saw was much more complicated. The patient previously had some complications from an appendectomy and then had to have his ascending colon removed. The surgery I saw today was the attachment of the patient’s small intestine to patient’s transverse colon. The patient went six months with a bag acting as his ascending colon.
One of the more interesting things about surgery in Mexico is the way they perform anesthesia on the patient. In the US, the universal consensus is to use general anesthesia to put the patient in an unconscious state, which means a ventilator must be used to control the patient’s breathing. In Mexico they more commonly use regional anesthesia to block off a portion of the body, leaving control of breathing in the patient’s hands. For both of these surgeries the patients were given regional anesthesia by injecting anesthetics into the epidural area of the spine. I am unsure of their reasons for doing this but perhaps it is a financial reason.
Later that night, a few of my fellow students and I came back to spend some time in the OBGYN department. Here I not only had the opportunity to see live births and C-sections, but also got to learn about neonatal care once the baby is out. Once the baby is out of the womb, there are a series of observations that the nurse will make in order to determine the baby’s gestational age. For example, the smoother the bottom of the baby’s foot, the younger the baby is. Babies born premature often have smooth feet with zero wrinkles. Another example is the floppiness of the ears. The floppier the ears are, the later the baby is in its development. Once the baby’s gestational age is determined the baby must get a vitamin K shot to help with the clotting of the blood in the umbilical cord, and antibiotic eye drops to prevent the transfer of any bacteria as the baby exits the womb.
Something interesting that I noticed when watching my second C-section was that all incisions for a C-section in Mexico are vertical. In the US they are horizontal. The reason for this is it is easier to get the baby out of a vertical cut then a horizontal one. In the US, they use a horizontal incision because the scar is more aesthetically pleasing. It is easier to hide a horizontal scar at the waste than a vertical scar up the person’s stomach. The hospital I was working at was a hospital that covered the general public so aesthetics weren’t much of a concern to them.
10/13/2011
After returning home at 1am from working in the OBGYN department all night, we had to be back at the hospital in the surgery department at 7am for class. The class was a presentation on the surgeries that were going to be occurring that day. Today there was only one surgery, a pancreatic cancer surgery, so the majority of the presentation was on the different ways to go about the surgery. Unfortunately, the surgery was scheduled for later that evening and we were unable to see it, but we did take good notes on the entire process.
After class we went on rounds and examined the patients that we saw receive surgery the day before. I felt like rounds were much more beneficial this time after going to class in the morning because we had a little more understanding on the general process of surgery. Once rounds were done there were no surgeries to view so we spent the rest of the day practicing laparoscopic surgery on a simulator that they had. The technique was completely awkward at first but after 3 or so tries we were all starting to become experts.
After class we went on rounds and examined the patients that we saw receive surgery the day before. I felt like rounds were much more beneficial this time after going to class in the morning because we had a little more understanding on the general process of surgery. Once rounds were done there were no surgeries to view so we spent the rest of the day practicing laparoscopic surgery on a simulator that they had. The technique was completely awkward at first but after 3 or so tries we were all starting to become experts.
10/14/2011
The next day in Hospital Civil I was placed in the OBGYN department once again. I was excited to return because this was probably the happiest department in the entire hospital. We started off the day by seeing a vertical birth, which is a new process for birthing that is being tested. In Mexico, they choose women to have a vertical birth based on a lottery system and then evaluate the outcome compared to the general birthing position. A vertical birth is where the woman is placed in a standing position so that gravity can assist in the birthing process. This procedure is becoming more and more popular all over Latin America, and from what I witnessed it seemed a lot easier.
After seeing the real birth, I ran to another room to see a C-section. This C-section was the same as the others I have seen except before they closed the woman up, they placed an Intrauterine Device (IUD) in her uterus. An IUD is a t-shaped device that releases birth control hormones and last for about 5 years. This was an important procedure to witness because overpopulation is a serious issue in Mexico.
We spent the rest of the day watching a hysterectomy. This is a very serious procedure where they remove the woman’s uterus. In this case, the woman had several tumors growing in the uterus and, since she was done having children, it was best that it be removed. This was an elaborate procedure because the uterus had to be removed from the cervix and the two fallopian tubes. They also had to carefully cut off the round ligament attachments on each side of the uterus. But the biggest thing I learned from this procedure was the importance of being thorough and following surgical protocol. As the surgery was coming to and end and the surgeons where closing the incisions, the nurses began to count all their tools, gauze, towels, and any other tools they used to make sure everything was accounted for. It turns out that one small towel was missing and nowhere to be found. After spending several minutes searching the operating room, the towel was finally found inside the incision, where it was placed to clean up some blood. The surgeons then had to cut a few stitches they already made in order to remove the piece of cloth. Everything worked out in the end, but it could have been a disaster if that towel was not accounted for.
After seeing the real birth, I ran to another room to see a C-section. This C-section was the same as the others I have seen except before they closed the woman up, they placed an Intrauterine Device (IUD) in her uterus. An IUD is a t-shaped device that releases birth control hormones and last for about 5 years. This was an important procedure to witness because overpopulation is a serious issue in Mexico.
We spent the rest of the day watching a hysterectomy. This is a very serious procedure where they remove the woman’s uterus. In this case, the woman had several tumors growing in the uterus and, since she was done having children, it was best that it be removed. This was an elaborate procedure because the uterus had to be removed from the cervix and the two fallopian tubes. They also had to carefully cut off the round ligament attachments on each side of the uterus. But the biggest thing I learned from this procedure was the importance of being thorough and following surgical protocol. As the surgery was coming to and end and the surgeons where closing the incisions, the nurses began to count all their tools, gauze, towels, and any other tools they used to make sure everything was accounted for. It turns out that one small towel was missing and nowhere to be found. After spending several minutes searching the operating room, the towel was finally found inside the incision, where it was placed to clean up some blood. The surgeons then had to cut a few stitches they already made in order to remove the piece of cloth. Everything worked out in the end, but it could have been a disaster if that towel was not accounted for.
10/19/2011
The next day I was back at the hospital at 7am for surgery class. Today’s class was much more interesting because we were learning about hand surgeries. The reason I am interested in hand surgeries is because my dad was in a work-related accident that chopped off one of his fingers and left the rest of the fingers really beat up. After a quick debate they decided to reattach my dad’s finger and to this day we debate whether that was the right call. After three surgeries, although attached, my dad’s finger has limited movement, is constantly sore, and aches when the temperature is slightly cold. In class we learned that the goal of hand surgery is to conserve utilization and function for the longest time. They also told us that in Mexico they will only consider reattachment if the finger has 3 factors that are met: the finger must still be receiving blood, the segment being reattached is small, and the person is young enough where they can heal easier and the risk is more worth the attempt. My dad would have qualified for the first two factors, but is obviously to old for qualify for the last one. I if they would have just amputated the finger here in Mexico.
After class we headed to the surgery room for a busy day of surgery. We saw three surgeries that day: a gallbladder removal, a broken femur reconstruction, and a finger amputation. All of these surgeries were happening simultaneously so I obviously spent the majority of my time watching the hand surgery. The gallbladder surgery was similar to the one I saw earlier that week so I spent little time in there. The femur reconstruction, on the other hand, was very interesting because it required some carpenter-like skills to mount a steel rod to the patient’s leg. But my emotional attachment to the hand surgery had me drawn to that surgery for almost the entire time.
After explaining my story to the surgeon he even let me sit right next to him, only a foot away from the hand being worked on. I am grateful for that experience because seeing how intricate and complex the hand is makes me more amazed at the ability of my dad’s doctor to reattach my dad’s finger. Unfortunately, this patient wasn’t so lucky. He had already had his pinky finger removed and after trying to save his ring finger, they had to amputate it today. The surgery made me think about the amazing medical advancements that are going to be available in the future and how medicine is never finite. We will always learn new things about the body and its reactions to stress and medicine is always evolving.
After class we headed to the surgery room for a busy day of surgery. We saw three surgeries that day: a gallbladder removal, a broken femur reconstruction, and a finger amputation. All of these surgeries were happening simultaneously so I obviously spent the majority of my time watching the hand surgery. The gallbladder surgery was similar to the one I saw earlier that week so I spent little time in there. The femur reconstruction, on the other hand, was very interesting because it required some carpenter-like skills to mount a steel rod to the patient’s leg. But my emotional attachment to the hand surgery had me drawn to that surgery for almost the entire time.
After explaining my story to the surgeon he even let me sit right next to him, only a foot away from the hand being worked on. I am grateful for that experience because seeing how intricate and complex the hand is makes me more amazed at the ability of my dad’s doctor to reattach my dad’s finger. Unfortunately, this patient wasn’t so lucky. He had already had his pinky finger removed and after trying to save his ring finger, they had to amputate it today. The surgery made me think about the amazing medical advancements that are going to be available in the future and how medicine is never finite. We will always learn new things about the body and its reactions to stress and medicine is always evolving.
10/20/2011
I spent the next day in a specialties department, oncology. The day started off a little scary because we watched a 7-year-old boy have a tumor removed from his shoulder. It was scary because the boy was so young, but the good news was that the tumor was not cancerous. The surgery was really quick and the boy was awake and fine in his room within a half hour.
The next surgery was much more serious. The woman had kidney cancer and had to have a Lumbotomy to have it removed. The woman’s left kidney was about three times as big as her right and she was showing all the signs of kidney cancer: blood in urine, abnormal growth of kidney, and pain while urinating. One of the surgeons showed us how we could feel the big solid kidney by pushing on the woman’s back and then feeling the kidney in the front. It felt like a grapefruit lodged in the woman’s abdomen. The surgeons then used anesthesia to knock the woman out; but, surprisingly, the woman had a bad reaction and went into cardiac arrest. The nurses rushed us out saying it was an emergency so we hugged the window looking at the patient with concern. The doctors performed several minutes of CPR and then brought in the Defibrillator. After about ten minutes of constant CPR the woman, finally became stable and was okay. It was a relief to see the woman was fine but the doctors agreed that she was in no condition to have surgery so, although she was alive, she was in for more problems in the future.
Since the Lumbotomy was cut short and there were no more surgeries in oncology, I went over to the surgery department to see the installation of a ureteric stent. This was another interesting surgery for me because I have seen the same surgery in the US, but again, it was very different because of the different technology in Mexico. In the US, they use Ureteroscopy, which uses cameras and tools placed through the urethra to perform the procedure. Although it sounds rough, this procedure is very simple and involves no cutting or long hours of recovery. The surgery in Mexico didn’t have this option and they instead had to cut the patient open, find the ureter, and then place the ureteric stent manually.
The next surgery was much more serious. The woman had kidney cancer and had to have a Lumbotomy to have it removed. The woman’s left kidney was about three times as big as her right and she was showing all the signs of kidney cancer: blood in urine, abnormal growth of kidney, and pain while urinating. One of the surgeons showed us how we could feel the big solid kidney by pushing on the woman’s back and then feeling the kidney in the front. It felt like a grapefruit lodged in the woman’s abdomen. The surgeons then used anesthesia to knock the woman out; but, surprisingly, the woman had a bad reaction and went into cardiac arrest. The nurses rushed us out saying it was an emergency so we hugged the window looking at the patient with concern. The doctors performed several minutes of CPR and then brought in the Defibrillator. After about ten minutes of constant CPR the woman, finally became stable and was okay. It was a relief to see the woman was fine but the doctors agreed that she was in no condition to have surgery so, although she was alive, she was in for more problems in the future.
Since the Lumbotomy was cut short and there were no more surgeries in oncology, I went over to the surgery department to see the installation of a ureteric stent. This was another interesting surgery for me because I have seen the same surgery in the US, but again, it was very different because of the different technology in Mexico. In the US, they use Ureteroscopy, which uses cameras and tools placed through the urethra to perform the procedure. Although it sounds rough, this procedure is very simple and involves no cutting or long hours of recovery. The surgery in Mexico didn’t have this option and they instead had to cut the patient open, find the ureter, and then place the ureteric stent manually.
10/21/2011
Today was a medical holiday for most the doctors that work in Hospital Civil so we were given the day off. Overall, my experience at hospital civil was full of excitement and new experiences, but it also helped to confirm my suspicions that surgery isn’t my cup of tea. I’m looking forward to returning to a clinic where I will feel more in my element.
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