Friday, June 4, 2010

Flying Solo

June 1, 2010
Today we went back to surgery after a successful day yesterday. When we got there the nurses and doctors greeted us. We were observing a shoulder dislocation manipulation. This guy had screwed up his shoulder pretty bad and it needed to be surgically. A couple of minutes into it, another doctor walked into the operating room. He was very charismatic, loud, and started cracking jokes immediately. He also wore a hearing aid so he spoke a little louder than he needed to. He was one of the consultants for ortho surgery and he was helping out Ernest. We introduced ourselves to him and he was very enthusiastic about us being there. Right off the bat he asked if one of us wanted to scrub in. Since I had the first one, Hailey got to do this one. A hour or so later it was all done. The next operation wasn’t really an operation but required sedation. This fourteen year old boy fractured had a greenbranch fracture (imagine taking a green branch and trying to bend it one direction to break it, that’s what it looks like). So obviously, this green branch doesn’t break all the way through. In order for the arm to heal properly, the doctors needed to sedate him, give the arm traction, make the fracture worse by bending in the direction of fracture, and then forcefully bend it back in the opposite direction by pressing directly on the fracture itself. Sound familiar to any of my family?? This is the exact same operation I had when I broke my radius, and I was fourteen years old too. Ernest told me I was going to do the entire thing. I got a really weird feeling inside because now I was going to find out what they did to me when I broke my arm. Actually, I was now going to do what they did to me to this kid. They briefed me on what I was going to do thirty minutes beforehand, so I was practicing on myself so I wouldn’t forget. When it was time, we knocked the kid out and Ernest held his torso. I grabbed the kid’s arm and simply just leaned back with the arm in my hand. I had all my body weight on the arm and the bones got some traction (hopefully). After that, I quickly jammed his hand upwards towards the fracture and held it with all my weight. Then I put my thumb right on the fracture sight and hyperextended the hand back down. Ernest told me to keep as much force on the hand as possible. I seriously thought I was going to break another bone or might as well rip the entire hand off. Suddenly I heard this pop and I glanced at Ernest for a look of approval or a look of terror. His face looked promising so we took an X-ray and just like that, perfect realignment. The procedure was pretty quick but thank God I was sedated. I really felt like I was flying solo throughout the whole thing. The doctors trusted me and were there if I were to screw up. I felt like this is how education should be. Both doctors are extremely praising and are willing to help along the way. I’ve got more patient interaction than ever before or ever will have for years to come. And we wonder why there are so many problems with the American medical education? As medical students, we don’t get true patient interaction until our third year of medical school, and even then you just sit in the back and shut up. Then when you’re all done and ready to practice, you’re anti social, lack patient interaction skills and overall extremely awkward. Everywhere else in the world, the medical program is combined with the university. Essentially, there is no such thing as “pre med”, just six years of education and clinical combined and patient interaction/hands on education starts at the third year. A ridiculously long, grueling, and difficult path to attaining a medical degree does not make the best doctors. It has become one of the frustrations that I’ll take back to the states. Somebody could show me how to put an IV line 300 times, but once I do it myself, it’s completely different. While on the subject, Dr. Rowe couldn’t have put it any better, “in South Africa (or pretty much anywhere else), you practice medicine. In the U.S., you practice law”. The whole purpose of medicine in the States it seems like is to cover your own ass so you don’t get slammed with some sort of ridiculous lawsuit. With that, I wonder what I’ll do when the time comes.
Anyway, back to bone crushing. After the radial reduction, the next surgery was a tibial/fibial (both leg bones) shortening and reduction. This seemed like a pretty intense surgery so I stuck around to watch it. This time this fracture was a couple years old. He was given a Hoffman exoskeleton (external pins and needle apparatus) and when they took it out, the bone failed to heal properly and crushed under pressure. The Xray was insane. His tibia (big leg bone in front) essentially slipped out of place and fell all the down to his foot. It looked absolutely terrible. Of course, he waited months to come in and get it looked it. I looked at the chart and this all happened when he jumped out of a window while running from his apartment landlord… that’s one of the weirder ones I’ve seen. Dr. Rowe and Ernest began the operation and started the incision. Right off the bat they knew this was going to be a complicated surgery. Dr. Rowe turned to me and said, “we need some man power, Miles go scrub in”. I jumped up like a little kid and ran to the scrub room and got scrubbed in. We started the surgery around one and began taking away all of the erratically growing new bone formations. I held the retractor as they were scraping away. I looked inside the leg and it looked like a total mess. There were bones overlapping, in places where they shouldn’t be, and missing where there should be bone. But they continued to hack away and we were all having a good time laughing and talking about various things. A favorite amongst South Africans—U.S. politics. I explained that my dad likes Bush and they all just burst out in laughter… I think thats happened 100% of the time. You mean to tell me nobody likes Bush outside of the U.S.? Hmm news to me : )
Time chugged along and we kept hacking away at bone. Ernest is hammer happy and loves to crush things with his large muscles. Since he’s a new ortho sugeron, Dr. Rowe needs to put him in his place sometimes. Then we had a T.I.A. moment, we were going to saw off the tibia completely using an oscillating saw. The nurse hooked it into the wall and Ernest began sawing away and then the saw died. They got the back up, then that died as well. Both air hoses had leaks in them so it made them useless. All that was left was sawing manually using a hammer and chisel. Ernest set up his chisel against the tibia and just started pounding away with the hammer as hard as he could. **remember the patient is awake!** All the sudden, we hear this very audible crack and a crunch. He had broke the bone as desired, but to hear your tibia be crushed to bits must not be easy to hear. They lifted the leg up and I saw something not human. Since they broke both leg bones, when they lifted the leg, the foot just kind of fell off and hung only by its skin. It was hanging probably four inches above the ankle so it looked completely abnormal and inhumane. I was told to hold the foot and leg at a 90 degree angle so the leg bones stick out and they could do their carpentry. I almost forgot we were working on a person, this had become a butchery experiment. A couple hours later, we were ready to put screws and plates into the newly formed tibia and fibula. We had taken out about two inches of bone so his leg was going to be permanently shorter. I had the honor of doing three screws with the drill gun along with putting it in with a screwdriver. The entire operation lasted three a half hours and I definitely felt like I helped out a lot without being a nuisance. It took a lot of force to manipulate everything back together. Plus, we all had to wear really heavy lead filled vests so we didn’t get penetrated by the x-rays. When we took it all off, we were all sweating through our scrubs. I had no idea it was that grueling. Surgeons always talk about how time seems to fly by and you feel nothing until you’re done, and it’s true. I had no idea I was sweating that much and all the back pain came after I was done. So another surgery down, assisted in a tib/fib shortening and reduction. Pretty cool I think! As of right now, I’ve really come to love this week in surgery. I have learned so much from the doctors and have received so much opportunity.
Final Countdown: 4 days

Doctors of Carpentry

May 31st, 2010
As winter progresses here in South Africa, so does my inability to wake up in the morning. It is pitch dark whenever I wake up and it doesn’t get light until I get to work. Also, for those who think Africa is just one big giant sun-fried continent, that is so far from the truth. The African sun is not what kicked my ass (well maybe in Durban, but this is like comparing Costa Rica to Finland), it was the African cold! There is no central heating in any of the houses and as a result, the houses are generally freezing. My house is full of tile and hardwood, and my room feels the coldest. For the past week or two, I wear socks, BOTH pairs of pajamas, a thermal shirt, my black sweatshirt with my hood on, and a beanie to bed. Yet, I’m still cold. Also, my family’s hot water isn’t the greatest so I have learned to take cold showers…a lot. Additionally, as the days get shorter, the calls for prayer start later. Now I didn’t think these existed, and then I went to Dubai. Then I thought it only exists in the extremely Muslim countries. But these occur throughout South Africa as well. Muslims pray five times a day for twenty minute each session, and they like the whole world to be aware of it. There are speakers at the mosque about a mile and a half way in a town called Gatesville (same town as the Gatsby). So every morning at around 6:15 I am “gently” wakened up to some man screaming to Allah. I can only imagine how loud they are at the mosque. In the summer, they start around 5:20AM. I didn’t realize how strong of a Muslim community I lived in. Our driver, Uncle, is Muslim as well. The mall across the street is strictly Halaal, which means no pig products are sold. At Mugg and Bean, bacon is called macon…and to be honest I have no idea what macon is, so I don’t order it.
We got picked up at the usual time without Lauren. It was strange not having that third person in the car. We got to Jooste and went about our business. I feel so ready to come home so it becomes difficult to keep my head in the game here. The motivation is beginning to fall and the daydreaming continues to increase. For our final week, Hailey and I decided to challenge the surgery department. After our disastrous beginning in Durban, we had been apprehensive to go back to the surgery department. We put on our scrubs and had a choice to go into the orthopaedic theatre or into the general theatre. I’ve always wanted to see how barbaric carpentry works, so I went into the orthopaedic theatre. When I walked in, I saw the surgeon at work doing a tendon repair on a hand. She had been stabbed seventeen times by her ex boyfriend because he didn’t want to let go of her. It was sad because I could tell which wounds were defensive and which ones were inflicted unknowingly (yay for watching years of crime shows). Thankfully, I didn’t get nauseous at all. I wasn’t expecting it though because I really have an interest in it and anything beats perianal abscess drainages (there was three of those happening back to back in the other room). He introduced himself as Ernest and he was wrapping up the surgery. He took off his scrub gown and WOW what was underneath was insane. This man was built like a train. He had huge arms, shoulders, back, chest…everything. I guess you really need that build for this occupation. We watched another surgery after the tendon repair and I was really enjoying what I was seeing. After he wrapped the next one up, he turned to me and asked, “are you keen on scrubbing in on the next surgery?” Hell yes!! But then I retracted and asked what that consists of and he says just holding things and helping out.
So I was hustled into the scrub room and was taught how to properly scrub in. I walked into the operating room, hands in the air in order to keep sterile and was dressed by a nurse into a scrub gown. She asked what size gloves I am and I had no idea. I compared with Ernest and I actually dwarfed his hands. Turns out I’m the biggest size of gloves you can get, sad. After I was all gowned up, I approached the table careful not to touch anything non sterile. My first operation would be a complete ankle reconstruction filled with plates and screws. The lady fractured her foot 10 weeks ago and is just now coming in (nothing out of the ordinary). Her ankle had essentially fallen apart and had shifted to the left. Also since it’s an old fracture, tons of new bone grew erratically. We had to take away all of the new bone and then reposition the fibula in an attempt to shift the ankle back into place. We opened her up and it was quite a rush. It was so amazing because I looked around and it was just Ernest and I on the table and a couple scrub nurses helping us when we needed it. I was told to hold the retractor and put a couple clamps down. Things were running somewhat smoothly (it had been difficult to remove all of the improperly grown new bone) and we began to get the plate ready. Ernest put the plate against the fibula and asked for the drill gun. The nurse pulled out this giant drill gun hooked to an air compressor. With help from the X-rays being taken every minute or so, he began drilling into the ladies fibula. He did the first and last screws with ease. After he drilled, he inserts a depth gauge to see what size screw needs to be inserted manually with a screwdriver. Right as he finished his second screw, he looks at me and says, “your turn” and hands me the drill gun. I don’t exactly remember what went through my head; I think it went a little like “no way. YES. No I can’t. Oh my God it’s a human leg. Now is my time” so I said yea, sure. He put the drill guide into place for me and said to drill away. I put the bone-residue covered drill bit into the guide until it clicked against the bone. Then I realized this city boy has never really used a drill gun before. I put some elbow grease into it and drilled into the damn thing. Midway into the drill I realized he didn’t tell me when to stop, but I remember hearing how it went. I pierced the fibula, which took some force, and the drill went straight through the marrow like butter and then hit the other side. When I felt the drill exit the other side I stopped immediately. I put the depth gauge in, took the X ray and it was in the right spot. The proper measurement for the screw was between 14-16mm. My measurement: 14mm : ) and I repeated this procedure three times and got 14 each time. After each drill I was given the screwdriver and screwed the screw in. Under all those blaring surgery lights, I broke a sweat putting those screws in. It takes a lot more effort than I thought! I guess when you’re trying to bore a screw through some bone; it does take some intense effort. Now I know how Ernest got his massive arms.
This truly felt like a pinnacle moment in my experience here in South Africa. I couldn’t believe I scrubbed in as a first assist for an ankle reconstruction and was able to drill holes into some ladies leg. It felt so good to do it (not in a sadistic way) but I thoroughly enjoyed the entire surgery and think orthopaedics is an awesome field. Here is the craziest part of it all; the entire time this operation happened she was AWAKE and alert! She was given an epidural before the surgery began so she couldn’t really feel anything. But I’m pretty sure she can hear a drill going into her leg. Oh well, welcome to Jooste.

12 course meal with UFC fighters

May 30th, 2010
Sunday morning Gregg picked us up, our friend who owns an adventure tour company. We were going to west coast where they are known for their seafood. When he picked me up, I saw this huge bus out front with about 15 of his friends piled in. I had no idea who any of them were so it took a while to get to know everybody. Two hours later we pulled up to some beachfront that was covered with netting and buoys. We walked through this little tunnel and came out into this open area filled with grills, brick ovens, and benches sprawled throughout. This was all on the beachfront and the people were grilling freshly caught fish on an open fire. We sat down and got informed what we were getting ourselves into, a twelve-course seafood meal! He said the meals come out throughout the day and it is a self-serve method. They also are known for freshly baked breads. I could see bread being put into the brick oven to be baked. The finished result was incredible looking. We began our first course and it was just some sort of fish, I can’t remember the exact kind. All I remember was snoek (fish only found in Cape Town), Hake, Angelfish, and something with the word “stump”. When I dished myself a piece of fish with my friends, I was wondering where the utensils were. I must have looked confused because some man came over and said the utensils were right there in front of me. I looked down and into this bucket and saw the utensils. How fitting, they were emptied mussel shells. Cheap beer and wine flowed everywhere and the environment was very relaxing. Again, I’d love to take my friends and family someday. This city continues to amaze me with the amounts of activities to do. You don’t even have to be a tourist and you’ll still be able to go here whenever and have a good time. As the day progressed I noticed a lot of the conversation was about beating people up. Most of the friends were comparing one to another saying who could take on who. I asked why everyone is having this fascination with beating each other and got the strangest answer, “Oh, we’re all UFC fighters”. So I was having a 12-course seafood meal with 15 UFC fighters. They are all friends and train 5 days a week, 4 hours a day. At that point, these people became instantly cooler yet instantly weirder at the same time. I would have never thought any of them were UFC fighters but I found it kind of cool that the cute blonde girl next to me was a ferocious cage fighter. At the end of the meal, they started to make some coffee the old school way. They threw everything into a giant cast iron pot and let the coffee percolate over the fire. Towards the end they take one of the steaming logs from the fire and throw it into the coffee pot. In the end, I got the best coffee I’ve ever had… done over the fire with a smoky chicory kick.
That night I realized where I was at in my trip, the end. I was going into my final week and couldn’t believe this was all coming to an end. I was looking through my pictures on my laptop and did the whole beginning to end thing. I couldn’t believe over two and a half months ago, I was roadtripping with Jayson (who I miss terribly) down to California. Then came the Dubai pictures, I can’t believe I actually traveled there! By myself! That was the just the beginning of this journey. The pictures of my host family in Durban made me smile, and they seem like such a memory already. Time has truly flown by in some regards, but I can appreciate its duration through all the photos. Lauren left on Saturday and it was so strange because I felt like I was saying goodbye to a friend who came to visit me at home. The reality is that I will be in her position 7 days later. I think I’m ready to come home but I know will be an adjustment.
Oh ya, and another crazy revelation, I graduate from University of Washington in a week and a half. That was weird to type.