Shadowing: Plastic Surgery

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After multiple shifts with plastic surgeons in the OR they take over after mastectomies or other cancers are removed.  They are called to the Emergency room to evaluate superficial , I appreciate not only their physical skill, but the variety of their patients trauma.  In clinic, they see those hoping for cosmetic fixes (closing a diastasis between the rectus muscles) and those needing long-term wound care from paralysis.  They also work on the damage caused by gunshots (sometimes while the patient is under police guard).

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In clinic the residents and medical students do a first pass with each patient, then the attending joins them to finish up.  Though a slow process, the teaching that occurs is obvious.  One particular case highlighted the need for remembering or reviewing anatomy.  The patient, a woman in her early thirties, went to the emergency department on the weekend.  She claims to have grabbed the wrong end of a “butter-knife” in order to cut some cake.  The cuts on her dominant right hand were located at the metacarophalangeal joints of fingers four and five.  After her wounds were cleaned she was asked to move each digit.  The pinkie finger would not comply.  The residents opened the skin wider to confirm the flexor tendons were intact.  While they saw and pulled on one, getting the appropriate response, at this site the superficialis divides and hides.  Though they stitched her up and expected all would be well in a week, at clinic the attending took one look at the straight finger and suggested surgery to repair a cut tendon.  The residents did no harm, and learned to be a bit more thorough even when called in on such a small injury.

Shadowing: Week 3

A cardiothoracic surgery to remove masses from the lung amazed me by not only the coordination of the surgeons, but their ability to use imaging and touch.  The patient was ventilated as needed for the doctors to reduce the size of the lung tissue to see around inside the chest.   Seeing the wounds closed with preloaded rows of staples was an “aha” moment for me.

Angiography of an aneurysm in a cerebral artery.  Source: Wikipedia.
Angiography of an aneurysm in a cerebral artery. Source: Wikipedia.

Wednesday morning: oncology.  The patient had previously had their cancerous gallbladder removed by laproscopy, but the margins came back still positive for cancer.  Today the surgeons had to open the patient to take out part of the liver.  A row of staples won’t work in this case.  Cautery, fibrin laced mesh and a tissue gel all helped seal the remaining organ.

Last shift of the week, Friday afternoon to evening.  The neurosurgeons had an aneurism to clip.  By the time I arrived the right temporal and meninges had already been reflected.  The angiogram was displayed on video screens in the operating room.  Doppler was used to “hear” if the clipped vessel was completely closed.   Before they closed the skull I noted to myself that the brain does not appear as impressive as its many functions truly are, and I don’t think I could be a neurosurgeon.  Not due to the physical talents necessary, but for the mental risks involved.

Shadowing: Week 2

Things I learned in my first week as an intern.  Don’t use the elevators or stairs closest to the operating rooms!  It was no big deal when the elevator wouldn’t go, it let me back out.  The stairs though…require a special card to get out of.  Meaning once you get to correct floor you better hope someone else shows up.  And when you are supposed to be “early to be on time” waiting around just won’t work.

Plastic surgery isn’t a service I looked forward to observing.  It has always struck me as a combination of elective and gruesome.  If I got to see reconstructive surgery of an injured child with cleft palate or some other noble procedure that would be great, but no such luck.  I got to watch the end of a “bilateral blepharectomy” (eyelid tucks) and facelift.  It was amazing the amount of spare skin snipped off after the surgeon finished “loosening up” all that tissue.   I wondered if the patient would deem her appearance that big of an improvement…I overheard she’s a college professor.

Urology service had a lecture and their “M&M’s” (morbidity & mortality conference) which wasn’t as exciting as TV.  Learned more about catheters than I hope I ever need to know, but still wonder why the bladder’s smooth muscle gets a title (the “detrusor” muscle instead of just calling it the muscularis layer).

Spent whole neurology shift in the OR watching bones being pinned together from osteomyelitis.  Lots of titanium went in to hold everything from T-10 to the pelvis together.  The surgery was a success, but the patient is elderly, and in renal failure…making me wonder if it was worthwhile.

Shadowing: Week 1

The most important thing I had to do before observing surgical shifts at the UC Davis Medical center was to get good shoes.  The recommendation by former interns: Dansko clogs.  The dress code for arriving is business casual, usually followed by a quick change into scrubs.

My first morning I shadowed a resident from the burn service.

English: Stevens-johnson-syndrome
English: Stevens-johnson-syndrome (Photo credit: Wikipedia)

Most of his patients were children seen across the street at Shriner’s hospital.  In clinic he checked on three boys: one with a dog bite, the next had Steven-Johnson syndrome (see pic) where skin is lost due to a drug interaction, a finally a burn.  The worst burn was in an adult from electricity.  The treatments are similar since all affected the integument.

Morning rounds with the vascular team were impressive.  Starting at 5:15am they raced like a pit crew from patient to patient, not only checking for changes overnight but replacing wound dressings.  A large number of their patients are diabetics, feet having the worst circulation.  In the afternoon they began an angiogram/stent of a carotid artery.  The patient was distressed but didn’t seem to understand her movements lengthened the process greatly.  I stayed late and heard the attending checking to see if she had suffered any brain damage…fortunately not.

Shadowing: Getting Started

My internship at UC Davis Med Center began immediately following our HAPS conference in Vegas.  So, while others were touring the Hoover Dam or the Grand Canyon, I had a daylong drive north.  For the three months I rented a room in walking distance, but it’s not a very good neighborhood for walking.

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tahoepark-w2e (Photo credit: sc0ttbeardsley)

My first day was hospital orientation.  Fifty pre-meds needing badges for access to the medical center.  To pass inspection we needed a number of health documents.  I hadn’t seen proof of my own childhood immunizations so blood titers and boosters sufficed.  After paying $5 we were ready for a weekend long crash course in, of all things, human anatomy!

I must say I felt pretty comfortable hearing medical student summarize the systems.  The only new information was on taking patient histories and physical exams (neither of which we are allowed to do).  The fact that they stressed directional terms made me feel good about teaching it to my students.  And happy to say before my first shift in the med center I passed all of the quizzes at the required level of B or better.

I chose three shifts a week to start, the surgical specialties I’ll be shadowing are assigned.  The busiest shift during the week is 6am to 1pm, followed by the 1-7pm.  NIght shifts, 7pm to 2am usually only cover traumas or emergency medicine.  I’m sticking to weekdays for my first month.  Cross your phalanges for me!

HAPS and POGIL

Back on May 1st I wrote about professional development and today I would like to expand upon that post and talk to you little bit about the HAPS POGIL project. As some of you may recall one of the leaders of POGIL, Richard Moog, was an update speaker at the Las Vegas conference. HAPS member and newly elected Central Regional Director Murray Jensen of the University of Minnesota also presented several workshops and is facilitating a National Science Foundation grant to develop POGIL worksheets for anatomy and physiology. Once complete and approved as official POGIL worksheets they will be released to HAPS members for one year and then be archived in the APS archives.
This week me, Jon Jackson, Murray Jensen, and about 40 of Murray’s College in the Schools high school teachers have been working to develop more POGIL worksheets. We have been particularly focused on producing laboratory exercises.
There are a lot of exciting things that you can do with POGIL, including partially or completely flipping the classroom. Stay tuned for the release of the approved POGIL activities and development of more. Also if you would like to get involved you can contact myself at jlapres@hapsconnect.org or Murray Jensen at mjensen@hapsconnect.org.
As a reminder these worksheets will be free to HAPS members only. This is just another perk of membership in Human Anatomy and Physiology Society. Below is POGIL facilitator Laura Trout with her class. Laura was kind enough to come to the University of Minnesota this week to help us with POGIL.

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Anatomy and physiology education at Experimental Biology 2013

I am writing this latest blog while on a plane, returning home to Indiana. Like many other HAPS members, I also am a member in several of our sister societies. This past week, many HAPS members put on their American Association of Anatomists (AAA) or American Physiological Society (APS) ‘hats’ as we participated in Experimental Biology (EB) 2013. Experimental Biology is composed of multiple associations, and their yearly meeting typically is in April each year. Over 12,000 scientists and educators converge on a city and share the latest bench and educational research.

This year, the meeting was in Boston, scheduled to open the Saturday morning after the horrific bombing at the Boston marathon. Many were scheduled to arrive on Friday, the day the city was locked down as the suspects were involved in a shoot out with police. Thankfully, people were able to safely arrive (although most were sequestered in their hotel for the day) and the police were able to capture the suspect.

One of the neat things about EB is that you may attend any of the sessions offered by your or other affiliated societies. Thus, a AAA member may attend an APS session, an APS member may attend a Society of Nutrition symposium, and so on. There simply are too many interesting concurrent sessions to attend!

My focus was on the anatomy education sessions, where I listened to talks about incorporating anatomy in an integrated medical curriculum, the use of team based learning in anatomy, the flipped classroom, and more. I tweeted about the specifics of these sessions throughout the conference. (If you are interested in following me, my twitter handle is @vdoloughlin). In addition, my graduate students and I each presented posters on our anatomical education research. I was able to connect with colleagues, share ideas, and see a truly wonderful city that did not let an act of terror get the best of them.

While EB2013 was energizing and exciting, I am looking forward to going home, seeing my family, and finishing up the semester. And in less than one month’s time, I can’t wait to reconnect with my HAPS family in Las Vegas for our annual meeting! Will you be at this year’s HAPS Annual meeting? Please comment below and let me know!