Aussie/Thai Boy 101: WEEK 3: SURGERY

So I am just about to finish the 3rd week of my internship…

This week I was in the SURGERY Department at McCormick Hospital, and thus far, it has been an amazing learning/growing experience for me. Despite only being 4 days in, I’ve already got to see a ton of different surgeries, including:

Tumor/cyst removals from breasts and ovaries
Cesarean section (birth)
Hip fracture surgery
Tracheostomy
Various endoscopies - ureteroscopy, colonoscopy, etc
Circumcisions
Penis reconstruction surgery
Cataract & other eye surgeries
Appendectomies
Kidney stone removals
Excision lipomas
ETC

But before I go into any more detail about my week, I have to remind everyone that, despite this being a great opportunity for me to see surgeries and to gain clinical experience, it is also a sad and serious time for many of the patients. Therefore, I will remain respectful to all the patients I’ve seen this week in the operating room (OR)… There will be nothing unprofessional or disrespectful in this blog, like names or pictures of the patients… just simple descriptions of the surgeries I’ve seen and the knowledge I’ve gained because of them. These surgeries serve as a way for me to grow as a premedical student and to prepare myself for a career in healthcare. I only wish all the patients I saw this week full and speedy recoveries.

With that being said, this has been great. I’ve really learned a lot about surgery and myself and have gained guidance of what area of medicine I want to pursue and what kind of doctor I want to be.

Before this week, I wanted to be a GP (General Practitioner). I really never considered surgery because I didn’t know if it was something that I could handle… But after this week, I know it is something that I can handle and could be very good at. I mean… there were still times during the week when it got VERY intense and I cringed… But for the most part, I was able to handle it with stride, and over time it really didn’t shock me anymore. So now, I am kind of leaning towards becoming a General Surgeon rather than just being a family doctor. Being a surgeon requires precision, hard work, diligence, confidence, and most of all a strong knowledge of anatomy & physiology… all of which I know I could attain and be very well at. I mean… I won’t actually know for sure what area of medicine I want to pursue until I get to rotations in medical school, but I could definitely see myself doing it in the future. I have a newfound interest for it.

I’ve also learned a ton of general knowledge about surgery in general… terminology, acronyms, techniques/procedures, etc. Plus, it is always busy, which I love… going from room to room, surgery to surgery… AMAZING! I get to see how the daily life of a surgeon really is…

I must say, however, that the best part of the experience is the first-hand experience. It’s always intense and in-your-face… I’m right up there, side-by-side with the surgeons, watching them perform. I’m never in the corner! One time during one of the more serious surgeries, I backed away for a moment from the operating table because I thought I was too close… Then suddenly one of the nurses grabbed my arm and pushed me forward right next to the patient, saying “You belong here.” Haha, never in the US would I ever have been that close to any of these surgeries, but here I was right under the operating lamps with the doctors and nurses.

And just like the last couple of weeks in pediatrics and internal medicine, no one asked who I was or what I was doing in the operating room. Everyone treated me like a doctor and never questioned me. Thai people don’t care about privacy in the same way we do in America… so it really doesn’t bother them if I watch doctors perform surgeries on them. Essentially, the surgeons just told me I could watch any surgeries I want with any doctors I want, so I get to see a lot of surgeries that I would never get to see in US without permission from doctors and patients and patient’s families, etc. The only negatives are that there are no heart surgeries at McCormick… It would have been nice to see a brain or heart surgery because they are pretty rare, but I’m very happy with what I have gotten to experience thus far.

Here is just a breakdown of some of the more MAJOR and INTERSTING surgeries I got to see in the last 3 days…

Day 1

Excision Biopsy (Bx) Right Breast Mass
i.e. I got to see them remove a benign tumor from a woman’s right breast.

Appendectomy
Surprisingly, this only took like 15 minutes… And the doctor who performed it was amazing. He walked us through the procedure (in English), showing us everything we needed to know about the procedure - where to begin cutting, what structures were important (appendiceal stump and appendiceal artery), where to make excisions, what sutures to use, etc.

Penile Reconstruction Surgery
This would normally be considered a plastic surgery in the US, but here in Thailand, a General Surgeon performed this operation… What happened is that here in Thailand, there is a belief among men that they can enlarge their penises by injecting them with stuff like silicone, etc. Well, this man tried to make his penis larger by injecting his penis with olive oil. It worked initially (making the penis larger), but not in the way the man wanted. The olive oil formed tissue around the penis, making it enlarged and deformed. Now, the man wanted the doctor to remove the excess tissue and make his penis normal again… This was kind of a “different” surgery, but it was a good experience to watch nonetheless… VERY intense and bloody. They essentially had to cut his penis in the way that you would peel a banana, so that they could reach the excess tissue and cut it off. It took something like 3 hours, but they accomplished it. The only funny thing about the operation, however, was that the nurses didn’t really know what to call it, so on the schedule of surgeries for the day, they simply labeled it “circumcision/excision.” Hopefully the man learned his lesson and will not be injecting his penis with anymore materials.

Day 2

Ureteroscopy
i.e. I got to see a surgeon find and remove kidney stones from a young man’s ureter. It’s amazing how something so small can cause so much pain...

Open Reduction Internal Fixation (ORIF) Cortical Bone Perfusion (CBP) Fracture (Fx) @ Right Femur
This was probably one of the more intense surgeries I watched. It took about 3 hours and involved adding a metal rod to a guy’s fractured hip (femur). The young man had been involved in a motor biking accident and had fractured the upper femur (in-between the greater and lesser trochanters). Well, the doctor had to make a 12” cut about 2-3” deep to fix it. He also had to add a permanent metal L-shaped plate which he screwed to the bone, so it could heal. About 1.0 L of blood was sucked out the guy, not including the tons of towels soaked in blood, but I’m glad the guy is on his way to recovery. I’m also pretty amazed by just how many tools, equipment, etc. the doctor used for fixing his leg… There were screwdrivers, hammers, screws, metal clamps, spatulas, and tons of other various metal rods. It did give me a newfound respect for orthopedic surgeons and the amount of knowledge and precision they must have when operating… maybe I’ll become an orthopedic surgeon one day…? We shall see…

Day 3

BK (Below the Knee) Amputation
A woman suffering from diabetes had to have her right amputated. Sadly, her left leg had already been amputated, so she no longer has any feet. This, by far, was the most intense surgery I’ve seen. I cringed many times, especially when the surgeon cut the bones of her leg in half, but it was an experience that I needed to see if I expect to be a surgeon one day. For the surgery, they essentially cut the lower part of her leg in half. Firstly they cut through tissue and muscle, suturing (tying up) nerves, arteries, and veins as they went along, until they reached the bone. Then finally they cut the tibia & fibula in half and sutured up the leg. It took about 1.5 hours.

Cesarean Birth
A woman, who has already had 2 children via c-sections, gave birth to another baby via cesarean. For once, this surgery was not a sad, bloody one. It was a happy occasion… bringing life into the world. There was lots of blood, however, and it was definitely intense. The doctor essentially mounted the woman, stuck her whole arm in, and yanked the baby out. It was probably one of the coolest things I’ve ever seen… Being a midwife is definitely an interest of mine and maybe something I shall pursue it in the future. P.S. The baby was happy and healthy… YAY!