Week 4 - Bo

I went to the ICU (Intensive Care Unit) this week. The team I followed has one doctor, one new fellow and a 2-year resident. Their routine work in the morning is to go around each patient room and record the patient's state of illness. The resident was in charge of reporting the patient's previous records. She had a stack of cases and read them out to the doctor. The doctor took notes on the form of each patient and the team examined the physical state of the patient and added them in the previous record. They also wrote down what the patient's relative told them when they accompanied the patient. The fellow told me they would discuss these records in the afternoon and gave further treatment of next day. In most ICU rooms, there are 3 patients. Most patients I saw were children, with age ranging from several months to 7 years. These children were most in a relative steady state. They did have some tubes attached to them, but not as many as I thought. Actually, I saw some ICU room on the TV before, which seemed to be really "intensive", single room, many nurses outside and tons of different tubes and measurements. The fellow told me that the ICU have different form in different hospital. Here, in Presbyterian, the care in this floor is not that intense.

I went to see a new plastic surgery this week. However it is different from what I observed before. In the OR room, two surgeries were carried out together. One surgery was to cut the skin of the wrist while the other was a throat tumor removal. It was to see clearly what was going on of the throat tumor removal. What I can saw is the throat and half face of the patient was opened. The incision was quite big. That is why the plastic surgery was needed. Dr. Spector carefully cut a patch of skin off which did not quite took time. But he also had to cut two arteries attached with that patch. This process took a while and seemed to be a little bit difficult. That patch was used later to help suture the big incision on the neck. Arteries were necessary to be connected to the original ones in the neck. I watched until noon. By then the wrist skin had been successfully cut off but tumor removal was still in process. I was told that the whole surgery took 12 hours altogether! So the tumor removal part was very hard. And this is the longest surgery I have heard since the summer immersion.

A very interesting and thought-provoking case happened on Thursday. I went to see a lung cancer biopsy procedure with Charlie and Michael. Apparently it was a routine but not hard procedure. But we encountered a patient who was 1 out of 2000. She seemed very painful and uncooperative. She wanted to quit in half of the biopsy for many times. Dr. Cham soothed her and even injected another dose of anesthetic. During this injection, the patient screamed and tried to prevent the doctors. This was a rare scene that a patient can be so uncooperative. But finally Dr. Cham injected the biopsy deep enough to reach the mass center and got some sample. The sample was tested immediately in side the scanning room. In about 10 minutes the result came out, validating that the mass was indeed a tumor. What makes the patient felt so painful is the long process of biopsy because each time the doctor could only move the biopsy forward a little and came out of the scanning room to position where it was through CT. This process had to be taken out for 6-7 times. So maybe a robotic arm fixed on the CT machine would be more helpful. In this case, the doctor doesn't have to come in and out the scanning room. He just need to use the robotic arm, so the movement and relative position of the biopsy can be displayed on the CT image while he moved the robotic arm. Positioning won't be problematic as now.