You could say this week had thrown me for a loop, diverging
from the sense of normalcy and workflow I’ve been trying to develop during the
past few weeks. Monday started off with the Plastics Conference/didactic
lectures. Unfortunately we had missed a portion of the first presentation, on
face lifts and other facial reconstructive procedures, on account of us being
unable to get into the surgical associates wing due to our lack of card access.
Luckily a fellow happened to be passing by, but am finding it frustrating how
we are supposed to just figure out on our own how to gain card access/or figure
out on our own how to setup these type of opportunities when we’re already
handicapped by our general lack of awareness… then again, things could be worse
(after hearing some of the experiences/difficulties of my peers). I digress…
the talk mostly consisted of the presenter, a senior surgeon, giving their
input/advice on the various surgical approaches/techniques for these types of
procedures in a dialogue between other surgeons/interns/med students/etc. and a
reliance of anecdotal evidence from decades of experience to support their
preferences for those methods. Helps me understand why some physicians may be
hesitant to adopt new technologies/methodologies to those already in existence/tried-and-true.
Fortunately, the mentorship in NY Presbyterian in general appears to be more
forward thinking. That surmised my clinical experience the first couple days,
as Dr. Spector was either out of the city or busy handling administrative
matters/not in clinic or surgery, sending us off to the lab to get ahead on our
respective research projects.
Although I got the general gist of what was expected of me
in lab, to forward our labs’ existing collaboration in whatever capacity I am
able to here in NYC, the general vagueness and the limited time available to us
over the immersion term makes establishing a solid game plan and obtaining the
necessary materials (e.g. assays) and training (e.g. confocal LSM in Microscopy
Core) a bit nerve wracking. Complicating our situation, this week had the rest
of Spector lab scrambling to finish remaining experiments or get trained
themselves as several of their senior students would be leaving the lab in the coming week(s), and
essentially a changing of hands over lab
projects/managerial responsibilities was taking place. Will likely be able to
go into more detail in the coming weeks as I’m solidifying what I’m supposed to
do/get rolling things rolling with experiments/etc.
Amongst the surgeries of the week, got to see the skin grafting/wound
closure of two patients from the previous week. These were slightly more
complicated cases due to the large surface area of tissue damage/degree of
necrosis. For one female patient, Dr. Spector elected to move directly towards
applying a split-thickness skin graft to her exposed calf after severals rounds
of tissue debridement, whereas with the other case he had initially laid a
foundation of Integra (skin substitute) the prior week before performing the
same type of procedure. His course of action for the later had been due to the
patient’s wound having regions of exposed bone. As such, the overlayed
skin-graft, being avascular, would have a low chance of integration in these
regions. The initial layer of Integra allows the development of a vascularized
bed, as cells migrate into the ECM construct, which drastically improves the
chances for the epidermal skin graft. The scoring of the skin graft serves to
both increase the surface area coverage and prevent subcutaneous pooling of
liquid between the graft-tissue interface.
Friday Dr. Spector was out again, however he was able to arrange
for us to shadow Dr. Sharif Ellozy from the department of Vascular/Endovascular
Surgery. One of the operations involved balloon angioplasty of occluded femoral
vessels, stenosed due to calcific plaque development or failure of previously
deployed stents due to re-stenosis of the surrounding vessel wall. After
accessing the femoral artery via ultrasound assisted catheterization, Dr.
Ellozy delicately manipulates the catheter/guide wire to snake his way through
the vasculature, with the assistance of CT contrast imaging. Although there are
surgical simulators to aide in training for these type of procedures, they are
still in their infancy, with most surgeons obtaining experience through years
of observation/hands on training. Recalling my undergraduate experience in
researching the topic of simulators for central-line insertions, and then
getting the chance to see how these procedures are performed in the OR
close-up, it becomes blaringly apparent to me how inadequate they are in aiding
in physician training and how there is a need for training tools which can
actually be useful for in preparing for the actual procedure. I feel there may
be somewhat of a disconnect between the companies which make these simulators
to what actually goes on in the OR, and that they’d benefit substantially from
this type of immersive experience… just saying…
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