Week 4

On Monday I attended the pediatric ICU (PICU) rounds where I observed a wide variety of patient cases. Some of the patients were very young babies with heart defects, two with Tetrology of Fallot and one with a single atrium and ventricle and arteries/veins attached in the incorrect places, all recovering from complicated surgeries. There was also a 5 year old boy with a broken arm, and another 21 year old in organ rejection from a recent kidney transplant. One case was a mystery: a 15 month old boy having seizures with an unknown cause. An extremely sad case was a 12 year old girl previously with leukemia, suffered rare complications from a brain hemorrhage and is now a quadriplegic.

I was also giving the opportunity to observe Dr. Mark Schwartz, a plastic surgeon, in the OR where he replaced a faulty breast implant with a breast tissue expander. Here, his team cut an incision and first removed the old saline implant and the capsule formed from the implant. They inserted the new expander, filled it with saline to match the patient’s other breast, and then closed the wound. The patient will have the tissue expander for about a month and then will undergo another procedure to replace it with a more permanent implant.

Additionally, this week I was able to see cardiothoracic surgery with Dr. Leonard Girardi. The procedure was a triple bypass with at least one being a coronary artery bypass surgery (a “cabbage” procedure). This middle aged woman has suffered a heart attack and narrowing blood vessels, so the surgery was to restore and improve blood flow to the heart. A physician’s assistant removed a single vein from the patient’s left calf. A cardiothoracic fellow performed a lot of the other prep work until Dr. Girardi arrived. With all of the doctors and anesthesiologists in the room it became too hard to see anything inside the patient. I did hear that the patient’s mitral valve was experiencing regurgitation due to the injury in her heart, so the doctors placed a small white thing around the valve to help close it. Overall, it was a frustrating experience to not know what was happening in the surgery and also not being able to see much of anything.