- A schedule is only a guideline for surgeons. How else would they manage being in multiple places at once?
- The only way to learn to stand for 12+ hours is to actually do it.
Monday afternoon, Terence and I spent the first hour of our planned meeting time with Dr. Spector trying to locate him, only to find that he had been in and out of the clinic because he was needed in a few surgical cases. Little time was wasted once we finally made contact. We joined Dr. Spector and his physician’s assistant Kelly in clinic as he consulted a patient needing surgery for abdominal hernia. Like Terence mentioned in his post, Dr. Spector was straightforward in explaining that two possible surgical approaches to repairing the hernia, which would be decided between intraoperatively. We also saw an in-office botox injection procedure, during which Dr. Spector explained to use the origins of its use while carefully avoiding hitting major nerves and muscles. A few patients later, we followed Dr. Spector throughout the hospital to obtain scrubs, see his office, and finally, his research lab. He headed back to the OR, leaving us with his research team, who introduced us to a few of their projects. Terence and I left lab with some project-related reading, and advice to survive rounds and surgery the next day: eat a big breakfast.
Early Tuesday morning, we met Dr. Spector’s surgical team for rounds. With the post-operative patient list and the day’s schedule in hand, they moved efficiently from room to room, monitoring wound healing, changing dressings, and taking note of any particular follow-up needs. One hour and a quick breakfast later, we were in the OR for “a production” of a case: mandible reconstruction with fibula free flap. This surgery took about 14 hours to complete, involving multiple surgical teams, OR nurses, and anesthesiologists, as well as a level of coordination, attention to detail, and endurance that I can only hope to reach some day.
Keeping our distance from the sterile field, Terence and I watched as the head and neck team worked to remove a tumor-bearing portion of the patient’s mandible, and Dr. Spector’s team worked to isolate and remove the fibula free flap. The key difference between a flap and a graft is that the former has a blood supply, and the fibula is a popular choice due to the tibia’s ability to adapt to greater load bearing. This surgery was computer-assisted, meaning the patient’s CT scans were used to specifically plan the locations of cuts to the bone that would best recapitulate the native geometry of the jaw. Patient-specific (3D-printed!) cutting guides were fit to the bone and used to ensure precision of cuts, and the fibula flap was reconnected to local vasculature under microscope (using a nifty microvascular coupling device for venous anastomosis). Re-establishment of blood flow was confirmed by a Doppler device. Regrettably, neither Terence nor I was able to endure the physical challenge of standing in the OR through the end of the procedure; I think I can safely say that the life of surgeons is not for me, but I have endless admiration for the work that they do.
Wednesday consisted of rounds and another complex, all-day surgery: laryngopharyngectomy with anterolateral thigh (ALT) free flap. The patient’s esophagus had to be removed in this case and was reconstructed by essentially creating an inverted tube using half of the ALT flap. The other half was used to fill in for missing skin on the patient’s neck. The ischemia time for the flap is always noted in the OR, and Dr. Spector later explained to me that onset time is largely dependent on the metabolic needs of the cell types within the flap. Compared to intestinal tissue, which is sometimes used to replace esophageal tissue due to its peristaltic capacity, ALT flaps are able to withstand greater periods of time without oxygen, making them an ideal tissue source for reconstructive surgery.
On Thursday morning, we returned to Dr. Spector’s clinic. We saw a patient with trigger finger (treated with catabolic steroid injection), learned that BME strategies to reduce friction between prosthetics and stumps has the potential to greatly improve the lives of amputees, and were informed that direct silicone injections into tissue are not safe but cannot be resolved efficiently with surgery (note: when surgeons do not recommend surgery, they are doing it at no benefit to themselves). We also watched a cyst removal procedure, and received some valuable life advice from the patient in the process. Our afternoon was spent in the OR, moving between a few smaller cases than in the days prior. We saw an abdominal hernia repair surgery, split-thickness skin grafting procedure (using a dermatome and meshing device), and placement of tissue expanders (to be later replaced by implants) after a total mastectomy. Finally, we spent some time in lab discussing possible directions and approaches for the projects that Terence and I may be involved in this summer.
After our Friday morning immersion meeting, we spent some time in lab, still getting a handle on the work that people have been up to. Lab meeting started later than originally scheduled because Dr. Spector was needed in the OR again, but it was a nice overview of what has been happening in lab and Terence and I left with a better idea of the projects we will be helping out with for the next six weeks. I may also be helping with a tissue IRB that will allow Dr. Spector to send tissue samples to other labs such as mine (i.e. Fischbach lab in Ithaca), so he and I ended lab meeting by going off to meet another surgeon who will be involved in writing it. Unsurprisingly, we could not locate this (probably) very busy surgeon, and we will need to follow up on this at another time. I successfully found my way back to lab (navigating between different buildings and wings can be extremely confusing), where Terence and I talked with the research team a bit more before heading out for the weekend.
In our first week, we have already seen a wide range of cases and conditions, and I think this variety will keep things interesting throughout our term. Similar to Terence, I have found that the lab environment is more familiar and comfortable, so I am glad we will be spending some time there as well. Despite how tired I have been feeling at the end of each day, I have learned more than I could have imagined, and I am grateful to have this opportunity to learn from Dr. Spector and his team. Looking forward to what our next six weeks will bring!
