Last Day :(

Alright so today I met with Dr. Moore at the Heart Hospital cafeteria for breakfast. We talked about what practicing medicine would be like in the future, how as the baby boomers were needing more and more specialized healthcare, less people were actually entering the fields that are most needed. He also talked to me about life for women in medicine, about how they tend to choose specialties that are less stressful and less time consuming and how that was a shame because they are often more compassionate, less egocentric doctors. We talked about a big double standard women face in medicine - that we grow up being told we can do anything we want to do, but as we enter very demanding careers, we get the most criticism for abandoning our families. Men can work as much as they want and will never face the criticisms that women will. Dr. Moore told me not to let this criticism, if it affects me, faze me or keep me from working in the specialty that I am truly passionate about.
After we talked, Dr. Moore and I traveled to the Medical Center of Plano where he introduced me to his friend, Dr. Aldred, a pathologist. I spent some time with Dr. Aldred's pathology tech, Kristal, who showed me how she prepares the specimens extracted during surgery. She showed me a gall bladder, uterus, placenta, and colon that had been extracted from four different patients. She also showed me how they freeze specimens and make quick slides for the pathologists to examine. THis procedure is used if a surgeon finds something suspicious during the procedure and wants to make sure they can procede with surgery, make sure what they have found is not a malignancy or anything like that. Then Dr. Aldred showed me slides of different types of cancer - breast cancer, colon cancer, brain cancer, and lung cancer. Seeing these tissues up close was very interesting. I only wish pathologists saw patients - I'd love to do this as my career!
After meeting with Dr. Aldred, I went back to Baylor to see some clinical patients with Dr. Moore. He only sees patients in the office one day a week so we had lots of people to see. Mostly they were post-op patients coming for follow up imaging and to have their wounds checked. Everyone looked good! It was nice to be able to see the other side of medical practice. After being in surgery all week, it was nice to see some conscious patients. I also got to meet with one of his partners who is a cardiologist who specializes in imaging and heart disease in women. She actually did her fellowship at WashU! She showed me all the different types of imaging and their pros and cons. She also spoke to me about why she chose cardiology instead of cardiac surgery and about what it's like to be a woman practicing medicine, especially an Indian woman, who faced even more discrimination because of her gender within her culture.
I've absolutely loved my time with Dr. Moore! I'm so grateful to him for giving me this opportunity and so grateful to Mrs. Lyon for starting this program at Parish. It has taught me so much about medicine and I'm so lucky to have had this sort of exposure before I even start college!

Day 4

This morning I met Dr. Moore at the Baylor Heart Hospital where we dressed for our first surgery - another carotid endarterectomy. I've seen so many of these I feel like I could do it myself! umm not so much, but I did know exactly what Dr. Moore was going to do next this time and I've been able to compare and contrast the three surgeries. Today's surgery had many more complications than either of the other two. The man's carotid was buried very deep into his neck, which caused Dr. Moore to have to cut into a lot of the man's tissue (primarily adipose) and with that came a lot of excess bleeding. Also, he had a history of hypertension in response to anesthesia, so that was a complication that the anesthesiologist was continuously battling. The patient was initially placed under Dr. Moore's care to have a bypass surgery and a maze procedure (to correct atrial fibrillation that has not been receptive to medication) both of which were scheduled for today. However, because he is obese and has a history of heart disease, Dr. Moore suspected he may have blockage in the carotid. WHen this was confirmed with an ultrasound, his original surgeries had to be cancelled and the carotid surgery performed first since stroke is a major possible complication of open heart surgery. His other surgeries will be rescheduled for in about a week. Gonna be honest, I wish I could have seen the maze procedure instead :) Oh well, at least Dr. Moore caught it and the patient avoided major complications.

After the first surgery, we drove to Medical Center of Plano for a bypass surgery. During this surgery, I learned not only about the procedure from Dr. Moore, but also the anesthesiologist. He told me about what his responsibilities were during surgery, showed me how to put in a central line, and gave me a tour of the heart via ultrasound. I also learned about the importance of heparin (keeps blood from clotting, is injected at the beginning of surgery so the incisions don't clot before the surgeon can do major work) and protamine (reverses the heparin, injected at the end of surgery to help with healing). Also, he showed me how the heart-lung machine worked. Tubes from the machine are inserted into the aorta and right atrium. Deoxygenated blood entering the RA is picked up by the tubes and then transported to the machine to be repressurized and oxygenated. It is then pumped into the tube in the aorta to be transported to the body. It was really cool to see the heart almost deflates when the heart-lung machine is turned on - without the blood, the heart just shrivels up. The anesthesiologist was a really nice, informative guy and I really appreciated the time he took to explain everything to me.

I realized today that the tone of the operating room is set not by the surgeon or the anesthesiologist, but by the circulator nurse. This nurse's job is to advocate for the patient, to care for him or her before, during, and after the procedure, and to make sure everything is safe and sterile. If the circulator nurse is tense and uptight, then the entire room reacts to his or her energy in the same way. But if the nurse is relaxed and respectful of everyone, that becomes the tone of the room. Today we were lucky to have two really great circulator nurses. They cranked up the music and talked about fun things while still making sure everything was safe, the counts were right, and the patient was healthy. It really made the atmosphere more enjoyable and everyone felt more relaxed.

Day 3

Today I learned that technology isn't always so helpful...

Dr. Moore had a patient at Medical City Dallas, so I met him there this morning. When we entered the OR, his partner had already begun work making the initial incisions on our patient for the day - an older man with a history of heart disease who needed an aortic aneurysm repaired. This surgery was to be performed in a much less invasive manner (endovascularly) than the traditional route of an incision directly down the chest, cracking the ribs, etc... Two relatively small incisions are made on either side of the groin. A tube called a stent graft is then inserted through an artery up towards the aorta. Once in place, the tube is inflated and used to support the weakened wall of the aorta. Technologies such as X-Ray, angiogram, and ultrasound are vital to this procedure, which is where our troubles happened today. First, the machine that injected the contrast dye (for angiogram) wouldn't inject the dye. Surgery had to be completely stopped until the tech could go get another machine. Then the live X-Ray couldn't be focused on the area that the doctors needed to see. These mishaps only added to the tense feeling in the operating room. This surgery is very dangerous - if the aneurysm is to rupture, the patient could die within seconds.

I know that I really love medicine, but this project has shown me that I don't think surgery would be the specialty for me. These doctors have incredible attention to detail and patience - two qualities I would not characterize myself as having. Plus, they are pretty ambidextrous and I can barely even eat with my left hand :) So I think when I'm a doctor, I'll leave the surgeries to my colleagues and I'll handle the other stuff.

Day 2

Alright so, another bright and early day with Dr. Moore at the Baylor Heart Hospital. When I arrived at the hospital, we immediately dressed for surgery and began the same procedure from yesterday (removing blockage from the carotid artery). I learned today that most patients with carotid artery disease do not experience symptoms until it is almost too late. These types of blockage are usually only discovered if they are found when doing testing on another area or after the patient experiences a stroke or other serious neurological complications. I also learned that there is another type of procedure, called angioplasty, that is minimally invasive; however, it has not yet been approved for patients who do not display symptoms because of unnecessary risks. A diagnosis of carotid artery disease can be confirmed using an ultrasound, which measures the velocity of blood flow. If the artery is blocked, the blood will flow much faster through the area because of the smaller diameter of the vessel.

After this surgery, Dr. Moore took me into the OR of one of his friends who was broadcasting his surgery via webcam to a group of visiting surgeons observing from a big conference room in another part of the hospital. They all came to see this surgeon do a minimally invasive mitral valve repair. Throughout the entire procedure, the doctor was on speakerphone with the director of the conference, who was conducting a Q&A between the surgeon and the members of the conference. In this surgery, the doctor made a very small incision on the left side of the chest (as opposed to cracking open the entire chest, like in traditional valve replacements). He then used probes to repair the patient's own mitral valve (connects left atrium to left ventricle) instead of removing the valve and replacing it with a synthetic one. During this surgery, the patient is put on a bypass machine, which takes blood to a maching, instead of heart and lungs, to be pumped and oxygenated. When the patient is both put on and taken off bypass, the operating room is very tense. In the end, this patient came out just fine. Because she is very young, the surgeon expected that this valve malfuction has been congenital, but she will make a full recovery and live as if she had never had the leaky valve.

Finally, I saw Dr. Moore put an emergency patient who had just had a heart attack on the bypass machine and graft blood vessels from his leg and put attach them to the patients heart to divert blood from the blockage that had caused the heart tissue to starve.

All this excitement before lunch!

So far my senior project has shown me how important it is to be able to make clutch decisions under high pressure. With a patient's heart in their hands, this would be no time for surgeons to panic. THey always keep level heads when the situation gets tense and are able to decide what is best for their patient. I have also been able to see how vital technology is in the world of medicine. Today a group of surgeons were able to further their education without having to crowd the busy operating room. And the electronic bypass machine essentially became the patient's heart and lungs so that she could have a valve deep within her heart fixed. finally Dr. Moore is able to pull up every scan and image ever taken of his patient while he is elbow deep in the chest cavity. Modern technology has revolutionized medicine and all this progress has happened in just a few short years!

Pics to go with today's post

This is an angiogram of the corotid artery. The blockage on our patient today was in the bulb (where the artery forks) and into the internal corotid.

This picture just shows the parts of the heart and shows the direction of blood flow.

My 1st Day on the Job

Just to start off, I'm not a very good 21st century learner. It's not my forte. So if you all can just bear with me as I attempt to enter the age of technology, I will try my best!

Today was my first day with Dr. Moore, cardiothorasic surgeon. I met him in his office at the Baylor Heart Hospital of Plano, where he informed me about our surgery for the day. We looked at the patient's imaging, and he walked me through her procedure. After, we drove to the Medical Center of Plano where we first met with his post-op patients. The first was a woman who was 4 days out from an open heart bypass surgery. She was doing well so Dr. Moore removed the wires attached to her heart (implanted during surgery in case she experienced arrythmias and needed an external pacemaker). The next patient was a man who was also 4 days out from the same procedure, however was not doing as well. He had not yet been released from the ICU. Upon reviewing his films, Dr. Moore diagnosed him with non-cardiac pulmonary edema (excess fluid and swelling in the lungs) and prescribed steroids. We then went down to the surgical floor where we went to view one of Dr. Moore's friends performing a bypass surgery. He intended to perform this surgery with the heart still beating, without having to divert the blood to a machine. When we entered the room, the patient was in distress - his blood pressure was skyrocketing. But the anesthesiologist got it back under control and the surgeon could procede. This surgery was performed by removing healthy blood vesseld from the leg and implanting them around the heart so that the cardiac blood supply could be diverted around the blocked vessels. All went well until the doctor put the heart back into place (it had been lifted out of the chest so the backside could be exposed) - the patient began to experience V-Fib (severely abnormal heart rhythm). Just like in Grey's Anatomy, the surgical team charged the paddles and shocked the heart back into normal rhythm. The patient came out just fine. Next Dr. Moore's surgery began. His patient needed to have blockage removed from the right corotid artery, near where the artery branched into the external and internal corotid arteries. During this procedure, Dr. Moore made an incision below the patient's jawline, careful to avoid major nerves. He then exposed the area just above and just below the blockage, restricted bloodflow to the area, and cut the artery. He implanted a stent to divert the blood from this artery to continue blood flow to the brain (though this is helpful in recovery, it is not necessary because the left corotid artery can compensate for blood flow lost from the right corotid artery). Dr. Moore then picked out the blockage and then placed a patch (made from the pericardial tissue of a cow) over the cut artery. The patch is used to keep the artery from collapsing in on itself. This patient also came out fine, with no major complications. We had to watch her for a while because of the high risk of stroke after this surgery.

I really enjoyed my time today with Dr. Moore. It was nice to be able to contrast two different methods of correcting blockage in arteries. On the smaller vessels, like those surrounding the heart, the surgeon cannot just cut into the vessel to remove the blockage, like he can in a larger artery. Tomorrow, Dr. Moore believes we will have both an open heart surgery and another corotid artery procedure. He also hopes later in the week I will be able to meet with a pathologist and look a different cells and cultures underneath microscopes. We will see!