It was ironic being in the ER here, it was like a "student becomes the patient" experience.... I look at it all as part of the cultural experience. But enough about poor, poor, pitiful me, lets get to the good stuff.
After an initial two days of full-day classes I started back up rotations at Hospital Militar (try to say it with an ecuatorian accent). Above is the view from the eight floor looking north. Here I work with Dr. Vargas who is a GI surgeon. My first day here was a very eventful day. Within twenty minutes of being there we headed down to the OR. This hospital is much bigger than in Chone. I never got an accurate count but I saw around 10 ORs. I actually didn't get to see a surgery with Dr. Vargas this day (or any day for that matter) because he sent me to watch an aortic valve replacement.
Getting to see this was a very rewarding experience. The surgeons were obviously very busy and not able to explain much but I was fortunate that there was an anesthesiologist who was very helpful. Initially I was every surprised how much human ribs can stretch apart with minimal damage. I was honestly almost more fascinated by the cardiopulmonary bypass pump than I was the actual surgery. It was very interesting to see the process of when they had the patient intubated and then switched to the
CPB pump by using propofol to induce sleep. Then they packed around the heart with frozen saline solution to lower the heart's metabolic activity. It was surprising how at that point the heart could go over 3 minutes without any tissue damage. If I remember correctly they ran a line directly into the aorta, and one coming out of the Superior Vena Cava but don't quote me on that. They also ran a line to each coronary artery and would feed it every three minutes.
No real justification for posting this picture other than I think its was a good picture. To the right closest to the patient is the chief cardiologist at Hospital Militar. Unfortunately I couldn't stay for the entire procedure. I left when they were suturing in the valve into the aorta. I would have liked to see how they brought him back and closed him up, but not this time!!
The next day at Militar was not quite as eventful as the first day's surgery but I learned a lot. The day started with rounds with Dr. Vargas. Almost every patient we saw were post-op cholecystectomies. I never got a chance to ask why gall stones have such a high prevalence here. It was fun to watch the Doc quiz all the interns and try to answer the questions myself (in my head). Dr. Vargas grilled one of the interns pretty hard about he thinks of medications first for a post-op patient, not wound care, vitals signs, physical exams... etc. The day ended with a presentation the human bodies response to surgery. The doc had some great points that really hit home: Most people think of surgery as a benign process, but it is indeed a trauma. Its comparable to a car wreck or some other major wound, the only difference is with surgery you're asleep. Although you're asleep, the body still has a stressful response to a major trauma. For this reason they're pushing more and more towards less and less invasive procedures. The presentation went over all the different responses the body can have to the trauma of surgery like anxiety, pain (obviously), hemorrhaging, increased vasopressin levels, increased cortisol levels... etc.
The third day at Militar started out routine but turned around quite quickly. I went straight to the OR (they call it Quirófono in Spanish) to see two cholys. I'm not sure if thats how you spell the abbreviated cholecystectomy so forgive me!! The first surgery was a laparoscopic choly, as I believe all are at Militar. Everything was going to plan until the surgeon hit an artery. He was unable to stop the bleeding so they had to pull all the laparoscopic tools and switch to a full-open surgery. It was amazing to see how fast a surgeon can open someone up when the time calls for it. I want to make it clear that by writing this I mean no disrespect to this surgeon, the hospital, or any surgeon in Ecuador for that matter. Even surgeons are human and make mistakes and this was not due to carelessness but simply a mistake. From there the surgery went very smooth and the patient was fine.
I watched a second laparoscopic choly. Basically identical minus the mishap, but it was interesting to watch how two different surgeons have their own styles. For example one surgeon worked from the patient's left side while the other worked by standing between the patient's legs. Due to their different positions they also made incisions in different places, and how they went about cutting and cauterizing the arteries feeding the gallbladder.
This week I started in the ER with a resident at Tierra Nueva. By far the most advanced hospital I have seen here. Its brand new and is a very classy hospital. I was pushing it going to clinic that day and paid the price. I was pretty sick for all of the day and was unable to make it to class. I haven't been back since, but hopefully i'll be 100% ready to go back next week.
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