Monday, August 11, 2014

Cardiology and General Surgery W3 (w/ Drs.)

I have been looking forward to my Cardiology rotation for awhile because this is a topic I felt I did more strongly on in school. I was hoping my knowledge would help me understand a lot more of what was going on around me.

Right from the start, my experience in this department was intense. There was a relatively young patient, 51 years old, who just suffered an acute myocardial infarction. He was rushed pass the rest of the queue into the catheter lab for testing. During this entire process, I felt rather alienated. I am not sure if it is because of the more tense atmosphere or for some other reason. I had to derive much of what was going on myself instead of relying on the physicians around me. I continually observed the patient's vitals as wells as the digital images of the patient's heart vasculature. This patient seemed to have three areas of occlusion where the injected dye either could not pass or was narrowed. As with most AMIs, this patient's most drastic problem was a complete occlusion of the left anterior descending artery. The doctors also said the ballooning of the occluded vessels caused reperfusion injury, which led to his continuous vommiting. What amazed me the most during this procedure was the fluctuation in the patient's vitals. I saw his systolic blood pressure drop to 50s and his heart rate plummet to 40s. Of course, these vitals were quickly compensated with drugs or volume infusions. Sometimes the opposite would occur where BP was in the 200s and heart rate 140. The doctors suspect that the patient will most likely require multiple stents. They continuously informed the immediate family of the situation and what needed to be done. The rest of the catheter lab patients was more of the same.

One of the days in this week, I asked to continue shadowing in general surgery because there was an operation I really wanted to watch. Dr. Ou was scheduled to perform a gastrectomy laproscopically. Based on the patient's condition, the surgery was deemed too risky to do laproscopically because the patient was too thin. The surgery was only a partial resection of the stomach (about 50%). The distal end of the stomach left intact was attached to the jejunum (B2 procedure, roux-en-y).

The surgery was really hard to observe. It seemed like only the physicians at the table could really see what was going on. I had to rely on the intermittent talks from the surgeons to decipher what was going on. However, I feel like I was still able to absorb a lot. My interest in becoming a gastroenterologist made this surgery particularly appealing to me. I think the most important things I learned from this operation is the need to improvise while operating. A lot of new information presents itself when you can actually observe the patient's inner workings instead of simply relying on tests. With this new information, the goals of the procedure may change. In addition, it is often best to err on the side of safety by excising more versus less in case of malignancies.

This is a rewrite of missing entries due to unforeseen technical problems publishing the original, so a lot of information might have been lost.