Immersion Week 2: More Productive

Summary: Week 2 of immersion was a lot more productive than the previous week. During the week I shadowed Dr. Vahdat during her patient meetings and was able to see two new patients being admitted into her ongoing clinical trials. I was also able to get into the OR and shadow Dr. Otterburn.  Lastly, I was able to observe screening and diagnostic breast imaging.  

The OR was an interesting experience. I was able to observe Dr. Otterburn perform several procedures. First, was a patient who had multiple abdominal disruptions from a hernia that stemmed from her past pregnancies. That, according to Dr. Otterburn, was a straight forward procedure and required the hernia to be repaired and the abdominal was to be tightened to strengthen the impacted area. Second procedure of the day was a breast reduction for a patient that had suffered from back and shoulder pain for quite some time as a result of her large breasts. I have to say that this procedure, for lack of a better word, was brutal. The procedure required that the nipple, areola and accompanying tissue pad to be separated from the lateral and medial halves of the breast. A large amount of skin and breast tissue/fat is removed from each breast. All together over two pounds of tissue was removed from the patient’s breasts and the resulting shape and size was quite different from the initial starting point. The last procedure I observed was a joint procedure and required a bilateral mastectomy, resection of sentinel node, and reconstruction using tissue expanders. The first surgeon performed the mastectomy and sentinel node resection and then the plastic surgeon placed the tissue expanders and internal bra. After my first day in the OR I have a great respect for the amount of focused that is required from the surgeons. First, they are expected to have a vast library of surgical knowledge available at moment’s notice all while performing the procedure, educating students, prepping future patients, and working 12+ hour shifts.

The breast imaging experience was 180° different than the OR experience. The radiologist and residents were locating in a dark screening room analyzing patient mammograms and sonograms. The patients were seen by the nurses and techs and the resulting images were sent to the screening room for interpretation. Observing the images with a radiologist I realized that the amount of focus required is astonishing. The radiologist is looking for abnormalities in the breast tissue which are sometimes more obvious, but also must scan for calcifications that can be a strong indicator of cancer. The calcifications are often millimeter in size in a large area of breast tissue that is the same color. It is a stressful job because the radiologist doesn’t want to miss any potential signs of cancer, but also must be careful not to cause anxiety for the patients with false positives.

Next week, I have scheduled more time in the OR with Dr. Talmor, a plastic surgeon. Also, I have time scheduled to observe ED medicine. I would also, like to continue the progression of disease and shadow a pathologist who is responsible for screening breast tissue that is biopsied.