Another Tumor...

The day after the kidney transplant, I scrubbed in to my second surgery with Doctor Garcia. The patient was a middle aged man with a tumor the size of a volleyball on his right inner arm. During the course of the surgery, the doctor showed me different important nerves and arteries of the upper arm as he cut away the diseased tissue from the normal tissue.

The first nerve we reached was the ulnar nerve. After watching several surgeries, I was always amazed that the doctors were able to identify the nerves from connective tissue, because the look so similar. When I asked the doctor how he was able to do it, he explained that the cauterizer they use to cut through tissue will illicit a electrical impulse along the nerve and cause a muscle contraction. After this happens, the surgeon knows they are in a region with a nerve.

An hour later and after much more cutting, we reached the brachial artery. It is often crucial that they find arteries before cutting in order to avoid excessive bleeding. The doctor explained to me that they can identify arteries because they actually move with the beat of the heart. In the case of this patient, the artery was in a fairly tough to reach area as it ran through the middle of the tumor. After they had successfully removed the brachial artery from the tumor, the doctor actually showed me the phenomenon of the artery moving with the beat of the heart.

In the final stage of the surgery, the surgeon uncovered the median nerve of the upper arm. The tumor was finally completely removed after 3 hours of sugery. Before the surgery ended, the gaping hole left by the tumor had to be closed. In a surgery like this, some care must be taken in making a cut to allow enough skin. At the beginning of the surgery when the surgeon initially cut, I noticed that he didn´t cut an area as large as I had expected. In the end of the surgery, there was barely enough skin to cover the huge hole left by the tumor. The preservation of the skin is a component that´s crucial to the surgery, but something that never occurred to me until this surgery.

This surgery was incredibly interesting because I got to see and touch the intricate parts of the body in a live patient. I don´t anticipate having this kind of experience again until the thrid or fourth years of medical school.