Week 2: Scrubbed, Gloved, & Inside an Abdomen

The title says it all for this week as we had a nice four hour orientation for scrubbing, gowning, and gloving - I'm all for the dry scrub 3M Avagard (Chlorhexidine Gluconate 1% Solution and Ethyl Alcohol 61% w/w) method that's five times faster than the traditional wet scrubbing. I got to use our training the next day when I shadowed my mentor who was operating in the morning on a lower back fusion case. Apparently the patient got into the hospital at 6:00 am in the morning, and when I arrived at 8:00 am he had finally been sedated, and was just beginning to get prepped and draped. The first incision occurred shortly thereafter but by 11:55 am when I had to go, the orthopedic surgeons still hadn't had a chance to go in yet as the general surgeons were still trying to prep a window to the patient's spine - untangling a lot of anatomy that was in the way of the vertebrae. Some impressions and lessons learned from this experience observing first hand surgery for the first time include:

• How long surgery actually is, especially when you're scrubbed in with your arms against your chest for four hours under bajillion candlelight inferno lamps with no way to touch your face or wipe the beading sweat off your brow.
  
• How less blood there really is in surgery (if you're not severing arteries and viens), I guess that's why they call it an abdominal cavity.
• How unique and different an individual's anatomy is, ie. making a routine procedure a lot more complicated.
• How un-surgical surgery can be as this procedure resembled more cut and clamp, pull and shove, slash and sew (don't get me wrong though the surgeons still have to be extremely careful especially to the spinal cord, nerves, arteries, and veins coming off the spine.
• How anesthesiologists seem to have a boring role: four hours of watching a monitor on the other sides of the drapes, reading a book, and being a more or less passive to the team and the procedure.
• How few knives there really are, in buckets of sterile equipment I counted 2 scalpels, 1 pair of scissors, and a snippet thingy - a lot of the cutting was done with electro-cauterization using a bi-polar and another doohickey (I'll get these names down in the future)
• How dissimilar cadavers are from live patients, cadaver::cooked turkey as live patients::meat aisle displays - as gross as that may sound, I was surprised how familiar I was to gore just from my exposure of being comfortable handling, cutting, and cooking red meats.

So my first exposure to surgery thus far has been a good one. At the end of my observation, to
"get some blood on my hands," I got to reach inside the patient's abdomen, feel his aorta and vertebrae, and even got to stick a marker in the disc between L4 & L5 to see on the CT scan. Definitely a novel experience. For now I'll definitely have to continue considering some sort of surgery as a possibility, especially to compliment my type A personality.

We actually started some team based presentations and studies this week as we have already been assigned a team service project that we need to design and perform to the community by mid-December. We also studied the assigned topic of "Self-Directed Learning" or autodidacticism and presented a 40 minute presentation Friday along with the other team focuses of "Communication," "Time Management," and "Negotiation."

A highlight on the week perhaps was Mayo CEO Dr. Cortese's visit to our class to present Mayo's proposal to a solution on the health care crisis. Part of his commentary is available online, but of his ideas many are quite practical that I'd readily agree with. Some of these ideas include implementing a pay for value system, which amazingly enough - a shout out to those Utahns out there, is exemplified best in Intermountian Health Care (IHC)'s system of practice offering both system and also its own insurance. Also of note is IHC's handling of patient care, employing 5 endocrinologists to oversee 25,000 diabetic patient needs but not by seeing a single patient, but rather being in charge of allied health teams to direct individualized care for each of the 25,000 patients in a home care setting.

Dr. Cortese also listed many other facets of a true health care system that can be developed for the first time, one thing of note to have parallel private and public life-long insurance programs with no exclusions and the option to switch in and out of either plan at any time. An interesting argument to this end is right now the policies designed - including Medicare - offer no incentive for insurance agencies to invest in the long-term health of patients as they see no benefits after 65, passing on all early healthcare investments to saving Medicare dollars in later life. If insurances were required to insure for life, they would likely invest more for long term health and for prevention as they would likely see a return in lower end-of-life health care costs.

Finally the creation of a universal electronic patient record that could be shared and transferred to all is another factor that he mentioned in his system. As health care becomes a larger political issue you can be sure to see Dr. Cortese in front of Congress and on the news promoting Mayo's official perspective on the solution to health care. The amazing thing to all of this is that Mayo doesn't just talk the talk, they also walk the walk, and are currently implementing all these changes as far as they are able into the Mayo Clinic as an example of a working model. So if anything Dr. Cortese did raise my interest in health care policy - something that will definitely be a hot button issue in the next few decades as baby-boomers strain the system to collapse.

To wrap the week up on a fun note, we had lunch at Charles Mayo's historic mansion at Mayowood, lunch with our third-year advisers in the Kahler Hotel, and started a new class: Dynamic Physician Skills which has us working already on a project for December studying emotions which my group has been assigned fear. We're also reading Paul Ekman's book Emotions Revealed: Recognizing Faces and Feelings to Improve Communication and Emotional Life

Finally as an ode to last week's title, a little snippet of our team purple's photo scavenger hunt product is here below. Week 3 starts tomorrow with Basic Life Support training, and ends in the hospital for a night's stay!