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!