Week 4: Neurosurgery

This week I was in Neurosurgery, which introduced me to many new characters around the hospital and led to patient interactions where the patients were usually twice my age or older.  Dr. Cruz was very interesting man who truly is fascinated by the brain.  Unfortunately, the more routine consults and surgical procedures focus on the spine, which is barely neurosurgery in his eyes.  Since there is not a large volume of patients with neuro disorders that require surgery, the small population limits the number of surgeries.  Unlike Los Angeles which has a population of about 3 million and LA county which was upwards of 9 million, The Azores have only 250,000; 150,000 of those are on São Miguel, the largest island.  Regardless of my doctor’s outlook on life, I was able to see a surgery and learn from him.

 

Surgery:

I watched a surgery of a herniated disk removed.  A herniated disk requires surgery when the disk applies pressure onto the nerve root in the spinal canal.  Surgery is quite an ordeal since you have to go in to the space between the appropriate vertebrae and pull out the dislocated piece of bone.  Dr. Cruz tries to avoid surgery because afterwards it is common for the body to treat the surgical area like a break and try to mend it fusing the back through osteophytes.  The surgery took about 1 hour and 15 minutes and it looked like the incision would heal very nicely with little scarring.

 

Consults:

  • Hernia (multiple)
  • Degenerative lesions in the lumbar spine
  • Osteoligamentous Hypertrophy (lumbar)
  • Dislocated lumbar disk
  • Spinal listesis
  • Nodules of Schmorl
  • Disk Prolapse and Hernia

During each consult Dr. Cruz would go through CT scans of patients called (TC scans here) and would follow with either pain management, another consult, or schedule surgery.

“Flow”

Today I experienced something that psychologists call “flow.” It is the sensation of feeling time fly by because you are doing something that you enjoy, that interests you, where the clock hardly has your attention and my time is well spent.  Today in the psychiatric department I was able to observe and participate, which in the nature of my internship was unexpected.  I started out the morning with several other doctors and residents checking up on one of our more special cases with a treatment, which should work.  We were eager to show this infant’s mother how to use the treatment and the baby handled it very well.  Just seeing the joy on their faces was rewarding enough.  The girl is a very happy baby and didn’t cry or flinch to receiving an inhalation treatment for 20 minutes.  Even though I was not a part of the diagnostic or treatment team (obviously I am only premed), observing the case start to finish was very satisfying.  

Before attending the daily consults with Dr. Juan, Dr. Teresa asked me to build a template for her in word and powerpoint.  Although this is secretarial work and is something that most would prefer delegated to someone else, I loved being able to actually help the pediatric department.  I built a template for her that she can use for posters, presentations and documents.  Since I can not help or touch patients I felt like this is the best way I can help the pediatric department and made me feel a part of the team even though I am just an Atlantis Fellow, premed observing intern.

The afternoon was filled with cystic fibrosis patients, which is Dr. Juan’s speciality.  He and Dr. Alessandra (I think that is how you spell her name) a pneumologist partnered up to see patients which they see routinely every month.  Cystic fibrosis is a very peculiar genetic disease that needs to be watched very carefully.  They are susceptible to infections due to mucus build up from improper cilial function and chloride transport.  Most people with cystic fibrosis have an expected lifespan no greater than 40.  Dr. Alessandra said she would be happy to have me shadow her Friday to meet some adult CF patients.

I finished the work day with two English classes.  I taught intermediate English and introductory English.  We had a great time in the intermediate class describing people’s physique and personality as well as nationalities.  In the basic class we went over pronunciation of vowels while reviewing months, days of the week and numbers.  I will see my basic class again on Friday, and Mary Kate, another AP Fellow will teach the intermediate class on Thursday (out of convenience for the two of us). 

I look forward to dinner very soon and then hopefully USA will beat Belgium tonight and move on, but we will see! 

Good Luck USA!

Patience and Pediatrics

Some days the hospital is slow.  It is expected.  Coupled with a sleepy intern, the morning was long and boring, but luckily for me perseverance and patience saw me through. The pediatric department is the best place to be bored because there are always things to do.  I found an origami kit and made little animals. Today the residents brought cake (someone’s mom made this amazing chocolate cake) and passion fruit soda. Additionally, I saw two very raw an usual cases. One of our patients who was discharged today asked to take a selfie with me.  Lastly drug representatives came to ‘educate’ Dr. Juan on some drugs and came with samples.  One of the drugs/creams/remedies was sunscreen! Overall a pretty good day!

The cherry on top = pediatric surgeons are coming in July and I have been invited to stay with the pediatric department to keep shadowing them.  So I have a hunch I won’t be leaving anytime soon 🙂