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

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