Not to far into the surgery, one of the interns who was assisting fainted, and apparently it wasn't her first time. It caught me by surprise because I wasn't paying attention to her, I was watching the surgeon. I saw here out of the corner out of my starting to walk away from the surgery and then she said she didn't feel well and the surgeon started yelling "Cógale, Cógale" (which means "grab her"). I was on the other side of the cables that were feeding the cautery so I couldn't catch her, but she was so small I was able to reach over and hold her up by her arms until the anesthesiologist ran around and grabbed her. She was definitely out cold, I remember seeing her eyes roll up as I let her go and the anesthesiologist was laying her on the floor.
To my good fortune, the Surgeon asked me if I knew how to scrub in. I was very glad I had plenty of practice in Chone and I had been watching them scrub in for the last week. Needless to say I scrubbed in and helped finish the surgery. I held the skin separators and held two strings that were holding the Vas Deferens and the Testicular Artery out of the way. Obviously the view from the patients side is much better than peering over the Surgeons shoulder the whole time.
This picture was taken a about a minute before the intern fainted. They repaired the hernia by using a synthetic mesh called "malla". According the surgeon, this procedure is not used that often in the states because it is very difficult, I can't confirm or contradict because I don't know what is common. The mesh approach cuts down on having the suture the muscle back together in a high tension, "unnatural" way. The mesh is sutured to cover the hernia, and acts as a lattice for new tissue to grow. Therefore the mesh stays in for the rest of the patient's life. One cool things about this picture is how you can't tell due to its a picture, but every time the cautery would touch the muscles, the abdominal muscles would contract due to the electrical impulse.
At the end of the surgery the surgeon thanked me for helping. Even though I feel I should have been thanking him, I felt very honored that I was actually needed because there was no one else who could scrub in. It was a great feeling because I wasn't a burdensome student who wanted to get their hands dirty. After the surgery he explained everything I saw and how the synthetic mesh worked. I found it interesting to learn how during a surgery like this, the most common problem (and therefore cause of malpractice suits) is damage to the testicular artery and Vas Deferens. According to him, he has only seen two post surgery complications like that in his career at the military hospital (I don't know how long his career is). As a final not on the surgery, I was surprised that they only did a local on the patient's spine, they didn't put him under.
I talked to the intern who fainted after the surgery and she was telling me how much she hates surgery, but she has to do it was apart of her school. She wants to get into family practice and has no interest in surgery. After that I had a short chat with the chief of surgery about why Gall Stones are so common here. According to him, he feels the bad diet here is to blame, much like the doctor at the Maternity hospital feels the bad diet largely contributes to a high incidence of Preeclampsia (although there is still no known cause for preeclampsia). The day ended on an interesting note. My host mom's oldest daughter bought a new Suzuki SUV but is out of town. She needed to have it picked up, but my host mom was scared of how big it is, so I ended up driving it home from dealership. I know it doesn't sound like that big of deal, but one must see how people drive here before realizing how nerve racking it is to drive a brand new SUV that isn't yours in a foreign country. To add to that, i'm not sure that its even legal for me to drive here... but nothing bad happened so its just a good story!!
Now back to Tuesday, Its my blog and I'll write backwards if I want to!! Since I was fortunate enough to meet the Chief of the ICU at the military hospital on monday, I spent Tuesday morning in the ICU. Its a fairly strict area. The door to enter is locked and you have to buzz in and explain who you are before they will let you in. I met with the Chief in his office, and then we walked down to the ICU. You have to wash your hands before you walk in, and you have to sanitize your hands before every new patient even if you don't touch them. I apologize for the lack of photos for this section but it seemed inappropriate to take pictures.
The ICU is a 13 bed unit with a mix of pediatrics. While I was there the Pediatric Doc was gone so they just refer every case to another private military hospital. The first patient was a 53 year old man who had prostate cancer (along with a long list of other illnesses). He was going through chemotherapy and was having heart complications which was related to his cardiac bypass three years prior. He was suffering from supra ventricular tachycardia when he was brought in, but was stable when I saw him and they were planning on continuing the chemotherapy. The next patient was a man in his sixties who suffered an Ischemic Stroke. He lost all movement on his left side so guess what side the stroke was on. He was in the ICU when he had the stroke, he was recovering from surgery on a left side aneurism. According to the doctors he had aneurisms on both sides but they only operated on the left side. During the surgery he began hemorrhaging, and suffered from cerebral edema. When I saw him he was intubated with a feeding tube and the Doctors felt he didn't have a very good prognosis, but they were waiting for the next day to take more CTs. I'm not sure if they have DNR's here, but they told me it will be the decision of the family to keep him alive if he is in a vegetative state.
Other patients included an older woman who was in a car wreck who suffered from cerebral trauma and trauma to her hip and chest. Another patient was an alcoholic with a whole list of problems. He was in for kidney failure. He had a transplant 10 years prior and his "original' kidney was failing. Another interesting case was a man in his 60s who suffered a bilateral stroke. He was intubated and I found it interesting how they used a sternal rub test on him, and also nipple twist (Not sure if there is a medical term for that).
Wednesday wasn't very eventful. The doctor I work with had consults, so I went down to the OR. It was fun because I just floated from surgery to surgery and watched. Some of the ORs have windows so you can watch from outside. There was one plastic surgery (not esthetic) and they were working in a man's right nostril but I was only watching from the window so I don't know what they were doing. I watched some of another Cholelap, what looked like some type of angiogram, and surgery of a the ductus arteriosus of an 8 month old boy. By concept it was interesting, but I couldn't see anything so it wasn't too interesting. It was interesting how the Surgeon worked from the child's left side.
Thursday I didn't go to clinic because we went to the Toros. So now i'm going to talk about the Toro so if you're strongly opposed to animal abuse or anything along those lines I suggest you skip the section (that means you mom!!)
Now I will not deny that yes the Toro is celebrated animal abuse, but it is much more. Above is the Plaza de Toros. Its a fairly large stadium, I couldn't begin to guess how many people it holds but there wasn't a single empty seat in the entire stadium. Its a fun stadium because its next to the airport so you get 747 flyby's every ten minutes. As abusive as the Toro seems, it is a very artistic display.
Now on to how these particular Toros work, because there are different types. It starts out with releasing the bull into the stadium. Several men are in the ring with yellow and pink sheets (capós). I think its a process of fatiguing the bull but don't quote me on that. The first bull that came actually got loose for a short period. The gates that open to the stadium for the horses to come and go wasn't completely closed, and the bull rammed the doors open. There were several people behind the door along with a couple horses. The crowd started screaming (in horror) but no one was hurt too bad. After a while two men on horses come out carrying large lances.
The horses are dressed with large blankets that extend down to their hoofs for protection. I think it has some form metal also to protect the bull. At this point they basically purposely let the bull ram the horse (stop reading mom) but the horses aren't harmed. While the bull rams the horse the guy on the horse lances the bull. Then the men on horses leave while several men distract the bull.
Here you can see the men with the pink and yellow sheets. Next the men come out with short spears that are dressed with assorted colors of fabrics (banderillas). They definitely have a very dangerous job where they run straight at the bull and lance it. Two men do this with two banderillas each. After this the main Torero comes out. He has a red capó and a sword. This part is seemingly artistic because they appear to be dancing with the bull.
Here is one of the main Toreros. I believe this one is El Fandi, who is a favorite with the women. Each Torero has their own style and routine. One got on his knees while the bull was running at him and others would do things like make the bull do circles and put their hand on it (which was another favorite with the crowd). The bulls did get some revenge. One Torero got a horn right to the shoulder. He was pretty hurt and very fortunate he wasn't stabbed, or maybe I would have been seeing him in the hospital haha. Another guy was hit and tossed over the top of the bull but he was fine, just a little shaken up. Then it would get a little more graphic. The object is to get the bull to charge and then stab its heart from above (ie through its shoulder). Only one Torero successfully killed the bull the first time with this technique. In the case that they don't, they use another sword to stab the bulls spinal column. Then horses come out and drag the bull away. Sorry if this section was a little unpleasant to read, but I felt the need to tell it how it is.
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