Down in the OR

I spent Monday morning in the OR. I have worked in scrubs for many years, but for some reason, OR scrubs to fit funny. People that work in the OR all the time seem to have figured out how to make them work, but I always feel goofy.

Our first case was a power port placement for a woman with rectal cancer. This is a port placed beneath the skin and threaded to a central vein to allow better access for chemotherapy. With central access, versus peripheral, you can give more medication in a given time frame and harsher meds because they get diluted so much faster due to the amount of blood in the central vein.

The second case was an inguinal hernia repair. This old man was very frail and it took Dr. Robles quite a while to fix his abdominal wall tears. Apparently, this was a recurring hernia and the patient didn't want to get it repaired and it just became a big mess. Surgery doesn't make me squimish, but I definately had no idea what I was looking at most of the time. Lesson of this surgery (from the surgeon's opinion): Get all hernias repaired as soon as diagnosed, otherwise they become a pain in the a$$ for the surgeon.

The third case I watched was pretty quick, but rather interesting. He was doing a bilateral temporal artery biopsy to determine if the patient has temporal arteritis. So the surgery involved finding the temporal artery, right near the ear, and cuting a little piece out. The most difficult part of the surgery: the lady kept moving her head. She was anesthetized, but it wasn't general anesthsia, so she could still move and squirm a bit. Temporal arteritis is an inflammation of the arteries in your head that stem from arteries in your neck. One of the common symptoms is headaches, and one of the large concerns is that it will cause a stroke. The treatment is prednisone and due to the negative side effects of long term steroid use, you want to make sure arteritis is causing the problem before prescribing the meds.

It was an interesting day. I really like surgery actually. I think if I had been a doctor, I might have wanted to be a surgeon. This month is going very well. I really like the people I am working with and I definately feel like I'm making a meaningful contribution to patient care. I did miss rounds this morning though. I went to look for Dr. Patel at 8:10 and he had already rounded on his 2 patients! Oh small hospitals -- the census got down to 7 today!