Surgery

The past two weeks have been the most intense of this semester. We had a test last Friday for Behavioral Medicine, one on Monday that covered Rheumatology, and one on Thursday for Surgery. The Surgery exam was originally scheduled for Tuesday, which would have made it way more intense, but it ended up getting moved to Thursday...what a relief.

Last week we had a bunch of lectures for Rheumatology. We covered topics like Lupus, all types of Arthritis, Sarcoidosis, Fibromyalgia, Spondyloarthropathies, and Gout. We had a CPX, which is when we see patient actors, one day. We have 15 minutes to get a focused history, physical exam, and give a brief treatment plan or discuss further diagnostics. I enjoy doing these and seeing how much (or little) I actually know.

We had a few Behavioral Medicine lectures mixed in as well as our usual Friday surgery day. For surgery we spent half of the day in the SEAL (Surgical Education and Activities Lab) which is usually used for the surgery residents at Duke. We used the lab last Friday and this Friday. It has a large room with four computerized laproscopy machines which simulate laproscopic surgery procedures; four manual laproscopy stations; two computerized machines that simulate bronchoscopy and endoscopy; and a very expensive, life-like dummy for emergency training. It is going to be very difficult to explain how everything works, but I will do my best.

Sim Man-

Sim Man is a life-sized, life-like, dummy that can breath, blink, sweat, talk, has a heart beat with pulses, his pupils dilate, and has vessels for IV's. He is hooked to a monitor that will give you anything you would need to know for his current state, including labs and imaging studies. We saw Sim Man in groups of about eight and were given a scenario, we then had to work through it deciding what was happening and what needed to be done. It was very interesting, and very hard to explain in any more detail. Let me know if you have questions about him. By the way, you can have your very own home Sim Man for a very reasonable $85,000.

Sorry for not getting a picture of his face.

The Laproscopy machines have three ports for two instruments and one camera. We worked in pairs having one person run the camera, while the other used the instruments. The instruments are two handles with scissor-like handles that are used to grasp or clip. We chose specific modules to practice with like anything from suturing, to a cholecystectomy.


What I called the manual laproscopy stations have the same set up as the computerized ones, only no computer. You actually have real tools and manipulate actual objects. First we moved little blocks on pegs (again hard to explain and I didn't get a picture), and then we clipped a circle out of the center of a 4x4 gauze. The gauze was suspended in air by all four corners and we clipped a circle out of the center. Very hard. The surgery residents have to do all of this stuff in a specific amount of time. I don't remember the exact time constraints, but it didn't seem possible to accomplish.

You can see the instruments in the ports on the right and left of the gray thing (what would be the body in real life). Under the gray thing is a table with whatever you are working on placed on it.
This is the monitor that you use to see what you are doing. Here is my suspended gauze with the circle drawn on that I needed to cut out using tiny scissors on the end of a long stick (a very crude description).
And here is my finished circle. Not bad, huh?

The machine for bronchoscopy and endoscopy was very strange. On the top of a table-like thing was a face (as if it were coming up out of the table) and on the end was a pair of cheeks (bum cheeks, that is). We had to "drive" a scope through the nose or anus to view the colon or trachea and lung. For the bronchoscopy, the machine would cough if the scope touched the walls of the trachea. For the endoscopy, the machine would moan if you touched the sides of the colon.

This week we started the Endocrinology unit. We have discussed Diabetes, in length, including Type I and Type II and all the pharmacology that goes along with it. I thought the Pharm was going to be fairly easy, but I was wrong. Insulin is not the easiest thing to dose and teach a patient how to use. We also had lectures on pituitary disorders and parathyroid disorders.

All of the test went okay. The surgery was the most intense going into. It covered a lot of material. The pharmacology for the Behavioral Medicine exam tripped me up. All in all I did alright.

This coming week is our spring break. It will be great to have the time off and spend some time with my family.