Week 2-3: Get used to O.R.

I have to admit that the experience in O.R. was not a complete pleasure for me. In the first five minutes of the first orthopedic surgery I observed in my life, I felt my breath was taken away as if some tough hands holding my throats after seeing the skins being cut open, observing the layer of tissue exposure, and smelling of the burn flesh under cauterizer. I left O.R. as quickly as I could once I got permission from a circulation nurse and squatted in the corner. Surrounded by the noise from nearby O.R.: hammers hitting the metals, saws chopping the bones, and blood splashing everywhere, “Orthopedic surgeons are like carpenters” I talked to myself, “that sounds much better.”

My mentor Dr. Michael Cross was attending a conference in Hawaii for the entire week, which set my second week in HSS free. I spent the first two days in the O.R., mainly observing two types of highly standardized surgeries: total knee replacement (TKR) and total hip replacement (THR).  A TKR is a complex procedure that requires accurate and skillful remove of the diseased portion of the bone. The surgeon always starts making an 8 to 10 inch incision across the front of the knee to gain access to the patella. After rotating the patella outside the knee area, the distal femur part will be cut precisely using special specimen to fit the femoral component of the artificial knee. The next bone being resurfaces is the tibia to fit the metal part and UHMWPE plastic tibial components. The tibial tray is secured into place using bone cement within 15 min curing time. The last part is the re-adjustment of the patella to ensure a proper fit with the rest of implant. The entire surgery usually takes about 2 hours, consisted of half an hour anesthetic, 1 hour surgery, half an hour closure time.

Getting a little bit bored about seeing same type of surgery all day, I started shadowing Dr. Jason Spector, a plastic surgeon in New York-Presbyterian hospital since the Wednesday of my second week. With Terence and Aaron, we observed some body reconstruction surgeries like breast reduction, facial reconstruction, etc., and debridement and grafting surgeries. Observing the later types of surgery was another strong impact to my tolerance: seeing pounds of flesh missing from patient with wide open wound left. For a female patient that severally injured in a bus accident, , Dr. Spector decided to postpone the split-thickness skin graft after several time of tissue debridement due to the large surface area of tissue necrosis. As a temporary treatment, wound-size sterilized foam was placed first before Integra (artificial skin substitute) to protect the wounds being exposure to infection. Unlike orthopedic surgeries possess many carpenter characteristics, plastic surgeon are more like tailors as their job always involved in obtaining an autograft split –thickness skin to patch the wounds by suturing.

The most exciting part of the week was to participate into an online meeting with Dr. Spector as well as other doctors and engineers on the Thursday afternoon. The goal of the meeting was to determine the personal treatment plan for a patient that requires mandible reconstruction with free fibula flap. The engineer team provided patient’s 3D scan data in a shared screen; therefore in real time, doctors can decide the location and orientation of the autograft fibula part to fit patient’s size and the implants. The entire experience greatly enhanced our sense on how engineering collaborated with hospital to improve doctor’s ability to perform accurate surgery and to benefit patients as overall results.

Dr. Cross came back on the Monday of the third week, and shadowing him in O.R and rounds became the major duties of the week. Unlike other surgeons that usually spent 2 days per week for clinic and the rest in O.R., Dr. Cross has only 1 clinic day per week, which means he need to talk to more than 50 patients within 10 hours.  Clinic day is always exhausting but it is my favorite part since the conversation between the doctor and the patient contains huge amount of information from every single aspect and Dr. Cross always give instant response to my questions. Also, seeing patient’s gratitude towards doctors for saving their lives really inspired my passion to the research. I am unlikely to be a doctor being loved and admired by the patient, but I could be a doctor of philosophy that contributes to the patient life quality improvement.

On Thursday I went to the arthroplasty conference in the morning. Two experienced doctors from HSS had a debate on anterior THR V.S. posterior THR. Two procedures are very similar in long term recovery results. Anterior THR has minimal advantages in short period in term of hospital stay time and pain management record, while posterior THR, which is the traditional method that have been performed for more than 40 years, is more approachable to new doctors and toxin free. This topic still remained as an open question and only time will tell the difference. Yet many patients are more prone to the anterior THR only because it is a “newborn” technique. I understand it is human nature to admire fancy and advanced things. Especially when as in lack of expertise, people are more likely to be attracted by the shallow advertised appearance. In those cases, instant and effective communication between the expert and the populace become the key to the problem.

Overall, in the past two weeks I have been fully immersed into this immersion program and get used to the environment. The next job is to explore more surgery types and start research on a more specific orthopedic topic.