Week 2 Jun 13-17: Combining clinical and surgical shadowing for a holistic perspective

Combining clinical and surgical shadowing for a holistic perspective

Surgical shadowing - exposing myself to a maze of anatomy:

Wednesday was an exciting day in the OR, I saw two cases of hiatal hernia repairs. The first patient had a difficult case as the patient was in surgery to help with pain from a hernia repair a year ago. Dr. Villena was kind enough to allow me to shadow the surgery. Dr. Goudie assisted in the surgery. Due to the first repair surgery, the stomach was wrapped around the esophagus. There was a tremendous amount of adhesions, which the doctor had to clear away. Because of this, the stomach anatomy was unclear. Throughout the procedure, and especially after clearing the first bunch of adhesions, Dr. Villena and Dr. Goudie had to re-establish the anatomy, as to not cut the wrong area. In addition, they had to determine what was the main cause of the pain: the adhesions, a new problem that may have arrived, or the original surgery. They were thoughtful, slow, and careful. The procedure took about 4 hours. The second surgery, which was performed by Dr. Altorki and assisted by Dr. Goudie, was a hiatal hernia repair for a new patient. It was interesting to see the abdomen without any adhesions and before the surgical procedure. Both procedures were fascinating to watch. 

On Thursday, I also saw another case in the OR. The patient had their esophagus removed due to cancer and replaced with the colon. However, some of the stomach content leaked into the bronchi and resulted in an infection. As a result, Dr. Port had to remove part of the colon that had replaced the esophagus. This surgery is extremely complex and happens very rarely. In the end they froze the nerves for pain management. This case also had some minimal complications for the anesthesiologist. The doctors were working through the left long to get to the "esophagus" and therefore needed the left long not to be ventilated (they needed to clasps the lung). However, the anesthesiologist noticed difficulty with breathing through the right lung. The anesthesiologist hypothesized this was due to positioning and had to try different positioning options. As a result they had to put more air through the left lung. The issue later resolved and the left lung was able to collapse.

Clinical Shadowing - each patient is unique:

It was extremely interesting to watch patient-doctor and patient-NP interactions. The doctors and NP sooth nerves and help with scheduling. On Friday, I learned the extreme difficulties in scheduling appointments and imaging. One patient called 10 times to schedule pet scan appoints. Dr. Villena expressed empathy and explained that he has a team that can expedite this process. I also shadowed patients who could not speak english. When the doctor cannot speak the language, there is a virtual translator who comes and helps. Although this is of course extremely helpful, you can feel the disconnect in comparison to when the doctor can communicate directly with patient. Some patients are so upbeat given their condition.

One thing I found interesting was how treatment plans changed depending on the patient. For example, a patient with dementia might not follow through with a treatment that requires to come in frequently. On the other hand, some patients lung’s are so damaged they cannot risk a lobectomy. I also learned that the anesthesia aims to have 100% oxygen saturation, which can cause free radicals. This can be an issue for certain cases.

I also learned that although the largest group of lung cancer patients are smokers, there is a group of EGFR positive, non-smoking, mostly Asian and mostly women, who also get lung cancer.

Lastly, I learned about post-operative side effects. Most patients explained that they had shortness of breath and pain on the side of the ribcage. This is partially due to the fatigue from the surgery, but mainly the patients have to exercise to strengthen cardiovascular health the muscles around ribs to stabilize the ribs.

Research - a dive into scRNASeq:

This week was extremely eventful and I learned a lot. In the research front, I was given the data I will be analyzing as well as the first part of my project. My project will be comparing the genetic changes between solid and non-solid lung tumors, specifically in GGO cases.