Atlantis Project 2011: Session 2

Yesterday, we had our class party to mark the end of our English course. We asked everyone to bring food, and they brought a lot of food! We had all kinds of sweets, chips, cakes, pies and pasta salad! It was delicious, and there was a TON left over!
A couple kids brought balls to play with, so we played games like volleyball, basketball and knock out. We had the party on a playground that is very near the place where we hold lessons, so it was very convenient. The three hours of class time that day went by VERY fast!
We also gave out evaluations at the beginning of the class and 100% of the students said they would take this class if it were offered next year!
The local newspaper also did an article about us on Wednesday. We had a picture and a blurb on the front page, and then another picture and a whole article on the inside. You can find the link here:
http://www.auniao.com/noticias/ver.php?id=24724
It's in Portuguese, but you can google translate it!!

The advanced group of students (me and Carissa's class)

The teachers of the camp (minus Matt).

Playing Knock Out

The food!

Here are a few pictures of our students in the classroom! Madeline came in and took a bunch of pictures one day during class. She got a lot of good ones!

This morning started out to be a day like any other. I woke up, got dressed, and walked to the hospital excited to see the removal of varicose veins in a 50 year old patient; however, when Dr. Timmy (the vascular surgeon I’ve been shadowing this week) saw me in the surgery room he asked me if I was prepared to perform the surgery with him. I thought he was joking and laughed it away but as soon as I stepped into the OR I realized that he was not kidding about having me scrub into surgery. He got one of the scrub nurses to take me into the wash room where she spent 15 minutes teaching me how to wash my hands up to my elbows. I never thought washing my hands would take 15 minutes, but the nurse showed me how to scrub my finger nails and the spaces between my fingers. She made sure I was scrubbed completely clean before she led me into a second room where I got to put on a scrub coat just like all the general surgeons. She helped me put it on because I was sterilized and was not allowed to touch anything except the patient and the sanitized green sheets around the patients. She helped me put on my gloves and tied my coat on me and at this point I felt really giddy and blessed that I was having an opportunity that not even medical students in America get a chance to be exposed to. When I walked into the operating room Dr. Timmy was waiting for me and re-explained the purpose of the surgery. He showed me the markings he made on the skin of the patient (something I saw him do yesterday) and he explained that he was going to remove every single one of the varicose veins. The biggest vein we had to remove was the great saphenous vein which extends from the bikini thigh region all the way to the ankle. After he explained everything and all the incisions the surgery began – and the people conducting this surgery were Dr. Timmy, a surgeon from Spain, a nurse, and me. The patient had varicose veins that covered both her legs completely so the doctors split up – one on each leg and I started out assisting the Spanish doctor while the nurse helped Dr. Timmy. I repeatedly told Dr.Timmy that I was not in medical school yet but he told me that he wanted to expose me to the medical world so I would work harder to get it. He said that he would have done anything to receive an experience like this when he was in medical school and he understood that the best gift he could give me was this experience so he told me to pay attention and start the surgery. The Spanish doctor started the surgery by making a small incision in the bikini area of the patient so that we could unveil the saphenous vein. During this process he held the scalpel and told me where to cut the patient (I surprised myself because my hands were not shaking as badlly as I thought they would be!) and then we started to dig through the tissue to find the point where a rubberband like vein existed. He then handed me strings that looked like sewing thread and scissors and showed me how to tie up the two areas of the vein so that we could cut it later. The surgeons always make sure to tie the regions that they want to cut before they actually cut it so that the blood does not squirt directly into their faces after they make the cut. After we tied the areas he gave me the scissors and said “corta” which means cut. I looked at him seriously shocked and he said be careful of the artery because if you accidentally cut it the blood will squirt directly on your face. So I prayed to the gods and made a cut exactly as he told me. The doctors were happy that I did that and began to trust me more during the surgery. To remove the saphenous vein, Dr. Timmy sent a long needle like tubing from the ankle and he pushed it into the vein until it ended up coming out of the bikini area of the thigh. He asked me to help him push the metal rod through the patient and this was an experience in itself. When the tubing goes through the patient you can see it move on the skin and it looks like there is a snake that is literally travelling inside the body of the patient. When the tubing popped up on the other side he had me cap it and then he told me to count to three so we could pull out the tubing. When the tubing was pulled out from the ankle the saphenous vein was wrapped around it. This was the first time I had ever seen a vein- I’ve read about veins, watched Grey’s Anatomy, and done my fair share of youtubing but seeing a vein outside the body is a unique experience in itself. The vein felt so rubbery and you could actually see the valves that were half closed and nonfunctional. He let me hold it and all the doctors were amused at how entertained I was by a vein that was seriously half a meter long. I could put my finger into the same tubing that held blood just moments ago and I felt so, so blessed to have that opportunity. Dr. Timmy told me to keep the surgery going and he asked me to pull out the veins with him. It was incredible because he knew exactly where each vein started and ended and would poke the skin at precisely the point where a tiny blueish-grayish vein would pop out. I was mesmerized and could not stop staring at how patient and quickly he worked. After all the veins were removed he wrapped up the leg with a compression wrap so that the bleeding would stop and then waited 5 minutes on each leg before he removed the wrapping and started putting tiny bandaids on each of the holes that he poked on the leg. He showed me how to put the bandaids using tweezer and told me to put them perpendicular to the wound. He gave me his bandaids and aided me as I put them on individually. Next, he asked if I wanted to suture the cut he made on the bikini to remove the saphenous. He did two sutures to show me how they were supposed to be done. First you have to connect the ends of the skin and then you wrap the suture thread around the scissors twice and pull to make a tiny knot. He made it seem so easy, but when it was my turn I couldn’t do it with the same technique that he did so quickly. It took me 30 minutes to get one suture into the patient the doctors were so kind that they didn’t even mind that it took me so long. They talked me through the whole process and wouldn’t let me give up half way. I had to make six knots on each suture and on the first knot I didn’t understand how the scissors opened (since it locked when you closed it) so the doctors made me step away and took a moment to show me how to squeeze the scissors so that it could unbuckle. It was only after the surgery that I realized that my white gloves were covered with blood and my scrub coat was covered with blood that squirted out when the doctor hit the artery instead of the vein. The surgery that started at 9 am ended at 1:15 pm and is an experience that I will remember for a lifetime. My first surgery was the removal of varicose veins and I think the experience made me feel more mature about the medical world. Surgery is an artform that requires patience but above all I think its something that requires humility and a lot of risk taking. It’s about breathing deeply and keeping your feet apart so that you don’t get a cramp in your neck from straining down so long. It’s all about the technique, but it’s also about keeping yourself sane by taking each cut one step at a time. It was in the OR today that I realized that being a doctor is more than merely cutting people open and saving lives. It’s all about the passion. After the surgery Dr. Timmy asked me to remember this experience when the path gets bumpy and when I have to spend late nights in the hospital during residency. He asked me to remember my joy in the OR when I have to study for my exams in undergrad. I think that’s why I am writing this long blog post, to remember forever my first day in surgery.

-Advaita