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.



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.



  • 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.



Upon walking back from the festival, some of the AP fellows found a kitten in the field next to the cookie factory near to our residence.  As expected, we decided to take her in.  One of our colleagues has family on the island who will actually care for the cat.  Until they arrived I housed/hid the kitten in my room after sneaking her past the security guard in my jacket.  We bought her food, water and some milk.  She was a very sweet and kind kitten who liked to cuddle.  We named her Carina.  She is already off to her new home, but she definitely brightened our day.

Kitty Carina

“Mommy, can we keep her?”

Carina and me

-“Is she clean? She could have ticks or fleas or rabies.” -“I have had cats before and I am premed, let me take a look” -… -“yeah she is fine, pretty clean” We tried and check her out to see she was clean, and we didn’t find anything, but we are no experts. But who are we kidding, we were going to snuggle her anyway. She was so loving!

Sweet bread and wine: The Holy Spirit Festival

Today was the festival of the Holy Spirit, which traditionally had more of a religious significance, but today in Ponta Delgada it manifests itself as a giant parade and gathering where people give out free soup in the morning and in the afternoon sweet bread, wine, and even beer.  Each town in São Miguel has a representative float of a craft or product and goes down the main street by the marina.  We had an amazing time exploring this parade.  This is something that was so genuine to São Miguel and I know could never happen in the United States.  Giving out free wine poured from barrels from the back of the float? Even with a permit, people would need wrist bands and tight security.  Here the people just come together, celebrate, dress traditionally, drink wine and eat bread.  Here are some of my favorite pictures from the festivities.  Honestly the bulls were my favorite.

Bull wagon

Crown of Divino Espirito


House of Soup

Throw a stitch

Fishing off the truck


Two More

Today I watched two more pediatric surgeries. I also was able to learn more about the surgeons. One of the surgeons, a colleague of Dr. Juan does not actually live in Azores, but rather Porto. He comes every two months to do pediatric surgeries. He was explaining that he prefers to do the most minimally invasive surgeries back in Porto, using high tech tools and techniques to limit risk and scarring. However modern I found the São Miguel Hospital to be, I guess it is not the most current on cutting-edge technology and thus sometimes they have to do some surgeries “the old-fashioned way” (which was probably only changed in the last few years).

The first surgery was a herniorrhaphy. This surgery took about one hour and left only two inch sized incisions around the pelvic area. The second surgery was a nephrectomy, in which I saw an entire kidney removed due to dysfunction. The incision was quite large, probably about 6 inches long and obviously went as deep as the kidney. This patient was not very lean and the doctors had to cut through many layers of fatty tissue to reach the organ. They had to use spreaders and were hands deep to reach the arteries, ligaments, and other tissues connecting the kidney to the whole system with a super precision scalpel and cauterization device. The surgery took about 2 hours and a half from the first cut until the last stitch. It was really amazing how much technique and checklists go into one surgery. I feel as though most people take losing a kidney as a minor procedure, a common thing, living with one kidney is completely do-able, however the actual procedure it extensive, even if it is frequent. So many people complain about the cost of surgeries and health care, here in Portugal it is practically free. Today I was calculating in my head just estimates of how much each piece of equipment cost in addition to the operating room, the lights, the doctors, the nurses, and anesthetics. I could see how a kidney removal could cost more than a machine manufactured car. People take so much for granted when in reality it is truly a detailed spectacle. It makes taking a test or learning choreography for a show seem like minor tasks.

First Surgery

Today I watched my first surgery: a pediatric urethroplasty. This surgery is all about finesse. A baby is fragile enough, but a surgery on a baby’s reproductive organs is incredibly sensitive since it is a functional organ that needs to be able to react and respond as well as grow with age. I never would have thought my first experience in an OR would have been watching rerouting of a urethra to the proper urethra opening, but it was, and it was still awesome. The surgeon told me that this is a very frequent and common procedure done on infants from a very young age (months old). The surgeons were very gentle with his organ and had to make many small sutures, which one day will not be seen. Tomorrow I believe I may be able to watch a kidney surgery, however it is up to the digression of the surgeons. I was so nervous watching the surgery since I have always said I wanted to be a surgeon without actually seeing a surgery. Good news! I did not faint, vomit, or even freak out. Honestly, the whole time my jaw was dropped, gaping in amazement at their technique and skill. Thank goodness I had a mask on and they couldn’t tell!
I hope that one day I have the same precision and accuracy and will be able to have as successful of a surgery as the doctors did today and many more. This is why the Atlantis Project is so incredible. I get to live my life for five weeks right behind the doctor and almost step into his/her shoes and see if this is the life I want for myself, and so far I think that med school is a pretty good next step. Hopefully I can get my EMT certification at Wellesley during wintersession!
*Edit – the specific surgery was due to Hypospadias


The art of diagnosis and efforts of doctors

Every day I am absolutely awestruck by the amount of thought and energy that these doctors put into their patients. They think and rethink, group and regroup their symptoms, call and connect with experts in Lisbon or in other branches … Continue reading

Daily life in Peds

As this is my third week in pediatrics, I have gotten used to the rhythm and expected layout of the day. Upon arriving to the meeting room, the doctors are greeted with a sheet with a list of all of their admitted patients. As a team they go through each case and the proper treatment. After this discussion the doctors check on their individual admitted patients, doing rounds with their residents and colleagues. There are usually some extra complications after checking on the patients, but once it is all resolved they usually get a coffee. I really love the European appreciation for a small espresso. These doctors do not walk around with their Starbuck’s cup as we do in the US but take just 10 minutes to sit or stand in the café to enjoy a coffee before going back to work.
Once they return they recheck up on the admitted patients if necessary and then head to consultations. These consults are like a typical doctors appointment. These appointments continue through the day until the doctor goes home.
* Once a week hospital doctors work in the pediatric ER instead of the daily hospital wing. This is much more upbeat and based on urgency and quantity of people.
**I have been told that many people try to sneak their children for regular check-ups by coming to the ER because it is free. However, if these patients try to do this, they are in a triage system and since they are green, meaning they can wait, they may wait all day.

Fourth of July

On this beautiful day there were only 7 Atlantis Fellows. To celebrate the long weekend people went to visit family and tour, however the 7 that remained had an amazing time. We started off our morning with a sail on a gorgeous 37′ catamaran that had netting in the foreward part of the vessel to sit on top of the waves. We went our for two hours and were able to sail around the south side of São Miguel and we saw dolphins! The dolphins swam alongside our boat for approximately 20 minutes. They were amazing. There were at least 12 dolphins and there was one calf with his/her mother. They were inseparable. We decided to not jump in and swim with them, since we were afraid it would scare them away. We followed up the morning sail with a delicious lunch : Hamburgers. It was fourth of July, but our azorian beef was tastey, and my burger had fresh, local pineapple too. After laying out on one of the cement beaches and taking naps, we returned to the residencia. We ended the night with homemade lasagna. I will definitely remember this holiday because it was truly special.

P.S. While we did all these amazing things, Dr. Juan messaged me about our urgent patient yesterday. He had me read a paper (which was in English) and write him a little summary so that he and the doctors could be sure that if she matched the symptoms, the follow-up according to this research. Turns out the patient matched all the criteria I summed up and translated into Portuguese and they continued with the treatment I wrote and translated from the article. I really feel like I was able to make an impact on this patient’s success and treatment, even though I just read and translated parts of a medical article.

Happy Fourth!