The Volcanoe/Ruins

In 1943, a volcanoe erupted and buried a town at its base. The only building left standing was the town´s church, which is now covered in 20 - 30 feet of lava rock. As we walked from the town to the ruins of the church, we got glimpses of the churches one remaining tower. When we arrived, I was struck the amount of rock that now covered the church. Between the 30 feet of lava rock that now buried the church and missing church steeple, the force of the eruption was very clear. All in all, it was great to get out of Morelia and see some of the diversity of Mexico´s rural scenery and culture.

Video (1 of 2)
http://youtube.com/watch?v=ISj9X-EY8Gc

Video (2 of 2)
http://youtube.com/watch?v=ISj9X-EY8Gc

Uruapan National Park

Last weekend I left Morelia to go to Uruapan National Park. The park is supplied by a natural spring near the entrance. As we travelled through the park there were another beautiful waterfalls draped by beautiful tropical foilage. While we did not see much wildlife, there were these gorgeous white butterflies. Near the end, there was a clavadista diving from a tree. It was very Mexican. All in all, the walk took about an hour.

Despite enjoying the park, I left the park a little unimpressed. I think we are spoiled by beautiful scenery in the Northwest and the park here seemed almost like an imitation of what we have in the Northwest. I´m so used to our parks, being largely untouched by man and left in it´s completely natural state. However, the National Park at Uruapan had man-made waterfalls beside the scenery. It felt like they were trying to compensate for the nature. It was still beautiful, and I enjoyed the time there, it just made me appreciate more the beauty of the Northwest.

Check out two videos of the Park. The first is at the base of a waterfall. The other is of a clavadista diving from a tree. Enjoy!

Video (1 of 2)

http://youtube.com/watch?v=3eMUKXcUVt4

Video (2 of 2)

http://youtube.com/watch?v=yZdG97WuHbs

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.

Fútbol

I have been to two Monarch soccer games during my time here. Soccer to Mexicans is what the NFL is to Americans. The fans are passionate and hate seeing their team lose. The stadium reminded me of Reser, but only a lot older.

Throughout the game, venders sell a number of items from beer to noise makers. A popular snack during the game is garbanzo beans with salsa and limes. They sell them unpealed, so you have to removed the shell in your mouth like sunflower seeds. I thought I would give them a try. Needless to say, it can become very messy.

The first game I saw was with my host dad and his two sons. The game was a tie at 0 - 0. The second game I went with some friends. Unfortunately, Morelia let San Lois score in the first 2 minutes, and the game ended on a 1-2 loss for the Monarchs. Overall, I love sports, but watching the fans and being in the culture of the stadium was equally as fun.

Kidney Transplant

While the surgeons do many technical operations here, this one might be the most spectacular. It requires two teams of 4 surgeons and 2 different rooms. And, as an observer of the surgery, I had the privilege of watching each part and moving room to room.

The surgery began in the room with the nephrectomy of the donor. It was a very clean surgery, taking only 30 or 40 minutes. I had been so accustomed to surgeries where large tumors were removed after traversing 3 inches of fat. This was nothing like that. Simultaneously, in the room next door, the surgeons removed the diseased kidney from the recipient and were preparing the site for the transplant. When both rooms were ready, the kidney was removed. According to the doctor, the kidney can go a little over an hour without oxygen before the risk of failure begins to climb. The clock was ticking... First, the kidney treated with an electrolytic solution called Bretschneider solution. After about 15 minutes of treatment, the kidney was moved to the other room and placed in the recipient. First, the surgeons attached the renal vein and followed with the renal artery. Without a blood supply, the kidney had turned almost white. The moment all the blood vessels had been reattached, the doctors released the clamp on the renal artery and vein, and the kidney quickly turned a dark red. It was the moment of truth for the surgeon. It told them that everything was connected right. The surgery finished up with the connection of the ureter, which delivers urine from the kidneys to the bladder. Despite being only one vessel, this part actually took almost an hour. Since the ureter, like the blood vessel, must be hollow to function properly, it took a lot of precision. All in all, the surgery took about 4 hours.

X-ray of the ureters of the donor.

Nephrectomy on donor.

Nephrectomy on donor (part 2).

Kidney in electrolytic solution being prepared for the transfer to recipient.


The kidney being moved to the recipient from the solution.


The surgeons connect the connective tissue to the new kidney.

After the clamps were released on the blood vessels, the kidney fills with blood and turns the healthy red. It was the moment of truth for the surgeons.

The surgeons are preparing the ureter on the kidney to be connected to the ureter of the recipient.

Pátzcuaro

This past weekend I left Morelia for the first time since I arrived over a month ago with 4 friends. It was great to finally get outside of the 5 mile radius around my house. We travelled to two places during the day.

First was the island of Janitzio, which is known for its famous monument of Morelos, a founding father of Mexico. Once we arrived, we hiked along the narrow and winding cobblestone streets to the base of the monument, which towers over the island at the summit. For $0.60, we got to go inside. Inside the monument is a spiral staircase with five with five levels. Each level has separate murals that capture the life of Morelos. When we reached the top, we could see a 360 degree panorama of the whole island and the lake.

While the monument was amazing and it was great to see the history of the Mexican independence captured through murals, it was actually the climb up to the mountain that I found most memorable. The streets are untouched by modern life. They are narrow and windy and crowded with little tiendas. It was like walking back in time - even many of the woman are dressed in the traditional clothing. I tried to capture this through the photos and video, but I don´t think they do it justice. It honestly felt a little surreal.

The second place was the city of Patzcuaro. This city, like Morelia, was established after the Spanish conquest and has many of the same features as Morelia. I didn´t find it as photogenic as Morelia, so I don´t have any pictures. However, in Patzcuaro, we had deep fried quesadillas and icecream. It was delicious!

Like always, I still miss you guys, but I am settlled in and having a good time. Feel free to leave a comment. I actually read them.

Video 1 (On the boat)
http://youtube.com/watch?v=rfr9yDGO8IA

Video 2 (At the statue)
http://youtube.com/watch?v=WGDSUgvPZCE

Video 3 (In the streets)
http://youtube.com/watch?v=IM548m7l0bc

Lobectomy

For the past week the doctors have been waiting to operate on this patient with lung cancer. Monday, they finally lowered his blood pressure enough to operate, and they let me in on the surgery to observe. Anytime you enter the theracic cavity, it is a high risk procedure. There is a reason you have ribs protecting this area of your body, so I was pretty excited to be able to watch.

As you can see from the CT scan of this man´s lung, his left lung had a tumor the size of a softball. (On the CT scan the left side is black and normal, the middle white blog is the heart, and the right white blob is the tumor). In order to get to the lung, the surgeons had to operated on the man´s side and remove a rib to gain access to the lung with cancer. This was one of the most fascinating parts for me. The surgeons used a tool that looked like a gardening tool to snap off a rib in two places. When the surgeon actually made the cut, the sound of the ribs breaking resembled the sound of branches being cut, but with a little bit more crunch. I posted a picture of the rib after it had been removed.

Next, the surgeons opened up a bigger space by using a tool that worked like a jack to separate the ribs. After this, they entered the lung tissue and were able to remove the defective lung. At one point in the surgery, the surgeon stopped and let me take a picture of the hole in this man´s chest. While I don´t thinks it is visible in the pictures, I could actually see part of the man´s heart through the whole in his lungs. All in all, despite losing a lot of blood (over a liter) and needing a couple blood transfusions, the surgery went pretty smoothly.