Farewell Atlantis Project

I am so lucky to have been able to combine two of my passions into one epic summer internship: medicine and travel. Continue reading

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Orthopedic Surgery

Wow.  The first word that comes to my mind.

Orthopedics was absolutely jaw-dropping.  Every surgery was dynamic and intense, yet generally short and sweet taking anywhere from 45 minutes to 2 hours.  I am not sure if it was the bone sawing, the prosthesis, or the encouraging doctors, but I could totally see myself becoming an orthopedic surgeon, maybe even a pediatric orthopedic surgeon.

The orthopedic surgical team was a fun group of individuals who are all very good at their jobs, but still have a good time.  There was often music in the background of the OR and the surgeons and nurses all seemed to be good friends.

The surgeons and scrub nurses really went the extra mile to explain the medical procedures to me.  One of the scrub nurses was one of my students in the English class so she introduced me to the staff, told them to not say anything bad in Portuguese since I speak it, and basically explained that she loved me and they should too.  I was extremely flattered.  She showed me how they fit the prosthesis and pick the sizes from the storage.  They also let me have a birds eye view at the surgery.

Surgeries:

  • Partial Hip Replacement
  • Complete Hip Replacement
  • Femur reinforcement – DHS (dynamic hip screw) & EMOS (Extraction of Osteosynthesis material)
  • Shoulder Dislocation – acromioclavicular dislocation
  • Total Knee Prosthesis

These surgeries were absolutely incredible.  Dr. António Melo and Dr. Luis Soares even let me take a photo of the knee replacement surgery.  It is quite graphic so *trigger warning*. Knee Replacement

Gynecology

Gynecology was a very different experience than what I expected.  There is such a hype about child birth, about the miracle of life, yet I found that the doctors and nurses were so accustomed birth that it did not phase them.  Since only some gynecological procedures are planned and some can happen at any instant, the department has many slow, quiet days and other busy days.  The doctors explained to me that you can never really anticipate any activity unless it is a planned procedure.  

While in gynecology I was able to see what I will consider 3.5 different procedures/events.  

  • Curettage – this is a procedure to remove tissue by scooping or scraping.  This was once an abortion technique, but now they use vaccum aspiration for that.  We were told that the patient had miscarried and that was the reason for the procedure.
  • Cesarian Section- a few cuts right below the abdomen and boom there is suddenly a baby! Quite literally felt that way.  
  • Tubal ligation “tubes tied” – after the C- section she had asked to have this procedure.  They tie a string on two sections of the fallopian tubes and then cut the region between the ties.  This is considered a permanent form of birth control. 
  • Natural delivery – it happened simultaneously with the C-section so I only saw the baby who was born at an early age and taken to neonatology.  (I only saw 1/2 thus the total of 3.5)

Although gynecology was very interesting, I think the babies were much cuter than the birthing process as a whole.  I do not think I will become a gynecologist, but sometimes it is just as important to find out what you like as it is what you do not like.

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.

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.