Third Week of Internship

Most of us wake in the morning to a breakfast of cereal, toast and perhaps the occasional glass of orange or grapefruit juice. However, my morning is combined with the smell of human flesh being burned using a laser device. It becomes part of the daily cycle of entering the OR at 8:00 a.m. everyday. I mention this tidbit because most of the operations I have seen so far have been about removing certain body parts because they are dysfunctional or unusable.

On Monday, I observed a surgery performed by Dr. Jarrard W. Goodwin the Director of the Sylvester Comprehensive Cancer Center; he also actively practices in ENT surgical cases as well. The procedure was called a laryngectomy which is a removal of the voice box (right). This particular patient has a history of cancer, and radiation from chemotherapy caused scarring of the voice box. So, it had to be excised. This surgery lasted about four hours because it is harder than it looks. It involves carefully cutting the tissues that connect the voice box to the walls of the throat. Each section of tissue is precisely and slowly cut to ensure that there will be no problems upon removal. I would describe this surgery in the same manner as an artist paints something. The artist has to envision what method to utilize before he or she starts painting. A surgeon similarly does the same thing; he or she has to see what is the best route to take before beginning. I definitely saw this as a successful trait to harness, which is also something that has developed throughout my years at school: preparedness and evaluating the situation. Not only being ready but also having patience is essential in surgery. Dr. Goodwin did not at all try to rush the procedure or take shortcuts, even he will have to stay in there for four, five or ten hours. I saw that patience is absolutely a virtue, and it is too valuable to let go.

I also had the opportunity to view the removal of a benign tumor (left) located in the larynx also done by Dr. Goodwin. This procedure was shorter at a length of two hours. A benign tumor is nothing more than an abnormal mass of cells that do not move throughout the body in contrast to a malignant or cancerous tumor. Dr. Goodwin followed the same technique as was done in the laryngectomy; he cut section by section of tissue slowly and carefully. Before starting internship, I never knew that there were so many problems associated with the throat and its components. It shows how much you have to take care of all parts of the body and not just the ones talked about on television such as the heart, lungs, brain, etc.

Tuesday began with a similar removal procedure called a parathyroidectomy performed by Dr. Carmen Solorzano, Chief of the Division of Endocrine Surgery. The parathyroids are the glands responsible for the regulation of calcium in our bodies. This patient had a hormonal imbalance that caused calcium levels to be atypical. The only answer was to remove the glands completely and see if any results are obtained. I particularly found the parathyroidectomy to be fascinating because glands that are extremely small can grow relatively large when an imbalance occurs. Such a regulation in the body has massive effects; one must be careful in dealing with any imbalance as I had learned.

And the end of the day came with, surprisingly, not a removal but an insertion specifically a port insertion done by Dr. Dido Franceschi, Professor of Clinical Surgery. It is a procedure that is given to cancer patients in order to infuse chemotherapy. It is nothing more than cutting a few centimeters into the body cavity (usually on the chest) and placing the port with a tube running into the bloodstream. This port is the mechanism by which medicine will travel through the body during chemo.

Second week of Internship

You know that feeling you get just before a rollercoaster takes off or before entering a dark tunnel; feelings of anticipation, fear and even excitement that overwhelm your senses. My body surged with these emotions before entering my first surgery with renowned otolaryngologist and surgeon Dr. Roy Casiano, Director of the Center for Sinus and Voice Disorders at the University of Miami Health System. Specializing in ear, nose and throat (ENT), Dr. Casiano is highly remarked in the University of Miami Health System for his continuing excellence in this field. He has helped countless people with congested sinuses, unequal vocal cords and dislocated septa to name a few. Mrs. Cabrera asked him if he would be willing to have an intern shadow him this past week, and Dr. Casiano did not hesitate to include me. Although, he did make sure that I do not have problems with the sight or smell of blood because this week I would be entering the OR. Fortunately, I do not, but if I did, then my aspirations to become a surgeon would finish faster before graduating high school!

Dr. Casiano rotates between the different hospitals and clinics of the University of Miami Health System. On Monday we went to the University of Miami Hospital to see two patients with problems in the throat area. The first had a thinning of his trachea, and the procedure needed to evaluate this condition is called a bronchoscopy. Every patient has to go through the routine prep, which is placing the patient onto the surgical bed, putting pillows in the legs and arms to prevent blood clots, giving the correct anesthetic medications to numb the patient and placing heating blankets to keep his or her body temperature at normal. Also anyone inside the OR must have washed thoroughly in the scrub room and worn protective garments. What is interesting is that patient preparation is essential to the surgery; the doctor expects that everything be ready at a certain time and that no problems should occur. It is true that responsibility goes beyond the realm of turning in homework or performing well on exams. Besides the actual operation, preparation ensures that many things that can go wrong are eliminated before they happen.

The procedure begins using an endoscope, which is nothing more than a camera that is placed down the nose, throat and ears and viewed through a separate monitor. Basically the patient will need to undergo a separate operation to place a T-shaped tube that will open his trachea and allow air to pass freely. The second case involved vocal cords that were not separated; in other words, they were too close together which produces inability to speak and difficult breathing. The joint that attaches to one of the vocal cords had to be cut and moved so that space could once again be made. The only downside to this procedure would be that the patient may have a raspy voice, but it is a better trade off than living mutely.

Dr. Casiano explained to me that some surgeries may have some kind of negative effect, and it is some time inevitable. Every surgeon has to let their patients know the risks associated with the procedure and obtain their agreement to the terms and conditions. I believe it gives the patient a sense of reassurance that even though something can possibly happen to them, they have the opportunity to make an educated decision as to what to expect. Part of surgery is not only bringing patients in and out like a load of cattle, but we have to remember that they are people. Compassion is a trait that every doctor must have and cannot expect to work successfully without it. I realized that the patients need someone they can confide in, and what better way then to trust you as more than just a person that is going to operate on you. This quality is something that I take to heart and definitely will use during my future as a surgeon.

On Tuesday, I witnessed a different procedure that moved from the head area to the left flank of the body. Here a section of fatty tissue with a melanoma was removed for the pathology to run tests on the specimen. By the way, these operations often remove and keep specimens to run tests, and bacterial cultures taken are used to see what medications the patients can use. It put into perspective when school has assigned science projects. Collecting data and later performing experiments to test a conjecture is at the heart of the scientific method; it helped me make sense of doctor’s idea of a diagnosis and if it proves false, then it has to be discarded or modified such as a hypothesis.

Wednesday, I went back into ENT cases and saw two patients with similar problems. Both had what are called polyps in the sinus cavities, causing them to have troubling breathing. Polyps are large masses of nasal tissue that form from an infection, chronic inflammation or even allergies in some cases. Thus, the surgeries involved using endoscopes to locate the polyps and remove them utilizing a microdebrider system. For just one nasal passage, it takes about two hours to complete. Imagine in a bilateral functional sinus endoscopy as was the case with the second patient. What I found the most interesting about these surgeries was the facility of performing the operation. In a nutshell it involves plugging in a camera and finding the polyps using a monitor, then removing them with the assistance of the microdebrider. Technology has truly given us the resources to enhance our capabilities and see beyond the norm for humans. I thank MAST everyday for enforcing us to embrace technology because it is honestly the future.

Lastly, I spent the rest of the week in the clinic located in the UM Clinical and Research Building (CRB) across the street from Sylvester. Dr. Casiano saw all kinds of nose and throat problems. I never would have guessed that these areas have so many widespread problems. The most common are when acid reflux causes damage to the throat and vocal cords. Others are more complex such as the polyps mentioned above and a deviated septum that blocks passage completely into a sinus cavity. One has to give it to the patient straight because it does involve his or her health; doctors cannot bend around the bush because they hate to be the bearer of bad news.

For the most part, this week has taught me the value of patients and the results they seek with surgery. They want to be able to breathe, swallow and hear again as was the cause with most of cases I viewed this week. Being an ENT is quite an interesting field, and it is not very known about in layman’s terms. The experience so far has been great, and I cannot wait to see what is in store for me next week!

First week of Internship

As I watched episodes of hit TV hospital shows such as Grey’s Anatomy and ER, I began to realize how the life of a surgeon is portrayed as dramatic and serious. This has some validity because surgeons do in fact hold the life of their patients in their hands and have the skills to continue or end it. I have always been fascinated by medicine and the important role it plays in society: keeping us healthy and alive. Specifically, surgery compelled me to want to enter the medical field in the future. Surgery is a difficult practice that takes many years of study, hard work and determination. But the challenge has always appealed to me. And through my internship project at the University of Miami Health System, I will experience the daily routine of real surgeons and not the ones that Hollywood created. Made up of different hospitals and affiliates, this system is one of the leading organizations in South Florida dedicated to providing quality health care and a focus on teaching future medical leaders.


My internship began on June 11 in a general orientation at the University of Miami Hospital (above). There, I let the coordinator know about my interests in medicine and my goals to become a surgeon. The rest is history because I was immediately placed in the Sylvester Comprehensive Cancer Center (left), across the street from the Hospital, to intern at its surgical floor. My mentor is Maria Cabrera RN (below) the director of Surgical Services. She is a registered nurse oncologist with over 30 years of experience, a Masters in Nursing from NOVA Southeastern University and a Masters in Arts from the University of Miami. Exceptional interpersonal skills and strong mentoring capabilities are some of her notable abilities that I witnessed. I knew just from her education and experience that she is the best person to be mentored by and learn about the surgical department for this hospital. She has abilities that every leader needs, and if I become a chief resident, then these are valuable "treasures" that I cannot let escape.

My first week started on June 15 learning the ropes of how the department operates. Basically, everyone is required to be on time, and surgeons should be prepping for the first surgery in the morning. Scheduled cases are located on a big whiteboard that is changed as they progress. My duties this first week were to do some clerical work such as filing, copying, faxing, etc. and observe the routine of the department. As I began to see, the floor is always bustling with energy; nurses, doctors and administrators "run" around, making sure everything is in tip-top shape before the patient is operated. I was also given a tour of the floor and a typical operating room (OR); they are quite similar to ones shown on television I have to admit! I also found out that it takes about one hour to inform, move and prep the patient for surgery. While most of these tasks may have seemed boring, I find them sort of important. Anybody wanting to enter a professional field has to be punctual, keep their records organized and know the "lay of the land" or departmental arrangement. These are skills that at first glance are common sense but are constantly ignored, as Mrs. Cabrera mentioned. Finally there is no time to dawdle; patients are waiting to be treated, and you cannot let yourself get in the way of why you became a doctor, no less a surgeon. It made me realize that there is more to being a surgeon then just cutting up organs, for lack of a better expression.

During that week, Mrs. Cabrera mentioned that I would be able to start shadowing physicians the following week, which is, consequently, this week. Be sure to look at my next entry for details about me entering the OR. I would also like to mention that I am not allowed to give any patient names or other identification because of patient confidentiality. I will only describe the surgical procedures needed to cure them.