My 2nd week

I want to write down my new experiences in week 2. These are new compared with my first week which was routine life of a radiologist. This week I got the chance to see several surgeries. Although two of them are related to radiology, they make me happy because hospital life in the surgery room or OR room are so different from that in the radiology reading room.

On Monday, Dr. Prince led me to an interventional radiology surgery room to see what happened there. Interventional radiology means that the doctors use X-ray to monitor the whole surgery process. In the control room there are several monitors which showed the whole procedure process. That day, the doctors were trying put an catheter into the patient's artery near the heart. The monitor showed the normal coronal plane picture of the patient's chest. The difference was a clear long wire near the heart. That is the catheter! Before I thought they used the X-ray imaging to see the body image all the time. But that would definitely led to enormous radiation. The doctor told me they just touch the panel once in a while to get one image. This is reasonable. I guess when to touch the panel requires the surgeon's experience because there are some important instants when the catheter reaches certain positions. It is hard to imagine how such procedure can be done without modern imaging technique. In fact, I was able to see how doctors deal with emergency in the surgery. Because of certain reasons, the patient's heart rate reached 140/m and the doctors immediately contacted the cardiologist. They had to stop the surgery in half way and send the patient to cardiology department. Everyone at that time was in a hurry but everything is in good order. Without an end, I finished my first surgery experience.

The second experience is hardly called a procedure. On Wednesday I saw how doctors inject contrast agents when scanning. This is not new to me in theory. Contrast agents is greatly used in vessel imaging. They can change the T1 and T2 time of the water so making vessels very bright which can not be seen in a normal MR image. I was excited to know I can see the injection by myself. And it was operated by Dr. Prince! To have a successful vessel image, timing is very important. When to inject and when to press the scan button are the key. Dr. Prince and another doctor ordered six syringes, each with 30ml Gd. Before the injection, they told the patient about the injection and what she should do during the process. Under Dr. Prince's instruction, the patient took a deep breath in, breathed out and held her breath. Then Dr. Prince and another doctor quickly injected the syringe. They had to be in pace so they watched each other. Then Dr. Prince pressed the button on the scanner directly in the scanner room. This is commonly done in the control room. So for the first time I know that I can press the scan button on the scanner too! The enhanced vessel image was pretty well. They found a blockage in the patient's right shoulder vessel. I have to say that a good timing is truly important, or the blood would have circulated too much. Then the image is ruined. Dr. Prince said MRI is an art. Yes, two different people can get totally two different images even most of the scan parameters are the same. That is why artiest can draw fantastic picture using the same pen. That is always true everywhere in the hospital: experience is top important.

My most exciting experience came on Friday. I was able to see my first real surgery: nipple reconstruction. Thanks to Bori, so I had the chance to know about the surgery time. Actually that was my first day to get in the OR room. I had no difficulty to ask for the scrubs. But it is a little annoying that we can wear nothing inside the scrubs because they are not short sleeved. By inspecting, I assure myself the scrubs are clean... they should be! I was a little late for the surgery and wandering outside the OR room. I really had no idea if I can be admitted in when the operation had already started. I nurse found my situation and kindly led me in to the room. At that time, the doctor was getting fat out of the patient's hip. Oh, I finally got to know how the fat is derived! It is more fierce than I expected. It made me feel that a human body can be so robust that a fierce way like that could do nothing to it. Back to the main topic. Getting fat is the first step. The fat are kept for further use. When the reconstruction is finished, the fat is injected into the breast to give a better shape. After fat is derived, the doctors moved to next step: cutting skins from the inner thigh. The doctor draw the desired shape on the skin and cut them down according to the shape. Then the cut was sutured together. This was how I got shocked again. The cut were both 1 inch wide, but the human skin is so elastic that they can just be pulled together and sutured. That means a one inch skin lost is compensated by suturing the other side together! Surgery moved on. The main step is to cut off the skin in the nipple area incompletely. That means the central part is still attached with the body. Then the peripheral part are sutured together to form the new nipple. Then the skin previously got from the sigh were sutured around the new nipple. So the whole surgery was almost done except that injecting fat in the breast. For a man watching surgery for the first time, plastic surgery such as nipple reconstruction can be a real shock. I know that any part of the human body can be opened, and skin can be used in any part for repair. The modern surgery and repair technique truly changed some people's life, making some impossible possible.