Day 2 and 3

Day 2

My second day at the hospital was completely different than the first. I started my day off in a classroom full of all the surgical residents, but we quickly moved to the operating rooms. Since I´ve never observed a surgery in the U.S., I don´t know how the rooms are setup; but here the 5 operating rooms are all side by side connected by a long private hallway for the doctors and nurses.

The first surgery I observed was fairly simple. While only taking 20 minutes, the doctor removed a cancer of the skin from this bridge of this ladies nose. Since it was my first surgery I ever observed, I was thrilled. However, it´s the second surgery of the day that I will be remembering for a long time.

The second surgery started around 10 and would end 4 hours later after a number of complications. The patient was a 60 year old woman with a tumor the size of a melon near her kidney. The first hour of the surgery was going really well. They had had gotten through about 2 inches of fat and entered the abdominal cavity. However, at about 11.30, I watched as her abdominal cavity filled with blood. They had struck the inferior vena cava, the largest vein supplying the heart. I could tell that the doctor´s were generally concerned. Her blood pressure had gone from 150/100 to 60/40. That´s really low! The doctor´s quickly sealed the whole they had sliced and stabilized her with dopamine and a blood transfusion, and the surgery finished around 2. During the course of the surgery, the patient had lost almost a liter of blood. I don´t know what was more shocking, seeing a women´s abdminal cavity completely exposed with all the organs or knowing that she was close to dying right in front of me. You see it in movies and tv shows, but when the person is laying in front of you halfway between life and death, you realize that the stakes are high in medicine.

Day 3

The third day at the hospital took me outside the operating room to treat patients. Since I am currently doing a surgical rotation, many of the patients I see are pre or post operative and need wounds cleaned and redressed. Between the diabetic feet and the large surgical wounds, this job can be unsightly at times. I did not realize how bad it could be until I got to this 80 year old woman near the end of my third day.

When I entered the room, it appeared like another regular case with a simple wound on her foot. I peeled back the dressing from the day before letting the typical thick odor of rotting flesh escape. Underneath the wrap was a wound 4" by 2" and fairly deep. As I began scrubbing the wound with soap, large sheets of brown dead skin came with my rag. I finished cleaning and redressing her foot, when the doctor pointed to a much more sightly cut on her knee. I used a light alcohol rinse to sanitize the area. The moment I put the gaze to her knee, she screamed ¨Me duele...me duele,¨ which mean ¨It hurts me!¨Until this point she had been silent with her eyes closed. This sudden outburst caught me by surprise and I looked at the doctor. She told me I must keep going. This was the first time that I caused a patient unconsented pain. It was not fun.

Working in a hospital has made me realize how emotionally taxing this job can be. While amazing things happen in hospitals and almost all the patients leave better than when the entered, there is pain and death everywhere. A doctor was telling me how one day she saw 6 patients die! I have realized, not only how intellectually demanding being a doctor can be, but also emotionally taxing as well. Hospitals are wonderful places, but the reality is that people suffer and sometimes die in hospitals. Before my stay at IMSS, I was committed to being one of the doctors that was connected with the patients and pledged that I would never view them as just a number. I thought those doctors that did not connect were just lazy or uncaring, however, I realize now that they distance themselves from the patient not out of laziness, but as a way of coping. To become intimately connected with the lives of your patient can become extremely emotionally taxing when things go wrong.

I thought I was done with the 80 year old patient when the doctor pealed back her diaper, revealing a prolapsed rectum. My next job was to use our soap to clean the prolapsed rectum of this 80 year old woman. Clearly it was gross, but the gross feelings were muted by an overwhelming sense that I was doing something meaningful for this woman. While not technical or very remarkable, this 5 minute appointment with this 80 year old woman has been one of the most memorable moments for me and reaffirmed my excitement about service in the health care field. While death and pain are all around you, it is moments like these that make service in health care worth it.