Megan in Houston

Megan, a senior biology major in Dedman College, is participating in the eight-week Michael E. Debakey Summer Surgery Program in Houston, where she will work closely with a faculty mentor to learn more about careers in surgery.

My last week: Women in cardiothoracic surgery

As the last week at the VA Hospital is becoming a reality, so is the validation of what field of surgery I want to specialize in. In a specialty where males are dominant, I have somehow found my niche. When I entered SMU three years ago, I knew I wanted to become a cardiothoracic surgeon, and as I exit this program, I am more than sure that this is what I want to do for the rest of my life.

My final week was by far the best week that I had. I was fortunate enough to scrub in every day and complete new tasks that were given to me. On Monday, I scrubbed in on a triple coronary artery bypass surgery, and I was able to feel the blood pressure in the aorta before the patient went on bypass. I have held a heart that was not beating, however, this was the first time I got to put pressure on an aorta that was pumping blood throughout the entire body. This was so cool!

Megan6.jpg I also gained a new responsibility while harvesting the vein. The physician assistant allowed me to grab the vein from inside the leg using the proper clamp. The endoscope that is in the leg projects the image on a screen, and this is supposed to help guide you throughout the procedure. My goal was to use the screen as a guide in order to grab the vein. Let me tell you, that it is not as easy as it looks. The clamp was constantly going in the opposite direction of where I wanted it to go.

Fortunately, the PA gave me a hint and told me to look at the leg in order to find the direction of the vein and just stick the clamp in. After a few minutes of fiddling around, I finally got the vein out. I guess I should have played more video games as a child in order to master my hand-eye coordination.

(In photo: Megan with two of the three PA’s – Antonio (left) and Tony. Antonio let me grab the vein from the leg and had a lot of patience with me. He taught me a lot.)

On Tuesday, I scrubbed in on the most amazing procedure I have seen thus far. It was a three-part surgery consisting of a double coronary artery bypass, an aortic valve replacement and the repair of the ascending aorta. I have seen the first two procedures multiple times; however, this was the first time I saw a mechanical aortic valve placed in a patient. The aortic valve replacements that I have seen are tissue valves. Again, I was able to hold the heart in this procedure, which is always an amazing feeling.

However, the third part of the procedure I had never seen before, and I was left amazed. The patient had an aneurysm on his ascending aorta, which needed to be repaired. An aneurysm is a bulge that needs to be repaired once it gets to 5 cm. The surgeon cut open the aorta and then sewed in a new aorta. This aorta was tunnel-shaped and made out of a type of fabric. I got to hold the new aorta as the surgeon sewed it into the patient. I wanted to see this procedure, and I am glad that I was given the opportunity.

Just when I thought that this surgery could not get any better, the attending gave me an opportunity that I did not think I was going to get. Before scrubbing out, the attending told the resident to let me close the skin. I wanted to start jumping up and down! The resident taught me how to suture, and I was able to suture the skin. In fact, my sutures turned out better than the resident’s! That was something to laugh about since it took me 10 minutes to put in three sutures.

Wednesday was my last day at the hospital and I scrubbed in on a quadruple coronary artery bypass. I got to hold the heart three times during the surgery, but I was sad at the end because I knew that this was my final surgery. It was a bittersweet surgery.

Megan8.jpg As I look back on my eight weeks, I cannot believe how fast they passed by and how much I have learned. I am grateful to Baylor College of Medicine for accepting me into the DeBakey program, and I encourage pre-med students at SMU to apply to this program. It is truly a once-in-a-lifetime experience.

I am also very thankful to the cardiothoracic team at the VA Hospital for their willingness to teach me, for making me a part of their team, and for becoming my second family for eight weeks. They rock! It was really difficult to say goodbye to them on my last day. However, I am ready to begin my journey toward becoming a woman in cardiothoracic surgery.

(In photo: Megan with the three attendings – (from left) Dr. Cornwell, Dr. Bakaeen, chief of cardiothoracic surgery, and Dr. Chu. What can I say about three amazing surgeons who broadened my horizons?)

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Hard week in surgery

I have completed another week, and I am finally coming to the realization that my eight weeks are almost done.

This week was busy and pretty hard on the doctors. On Monday, we had one case that was a redo coronary artery bypass surgery. From the start, things were complicated. Seven hours later, surgery was over. However, complications set in, and I arrived early Tuesday morning to find both surgeons in front of the patient’s bed in order to make sure that he was stable.

You see cases such as this one on TV, but to witness it firsthand is completely different. Unfortunately, the patient suffered more complications and passed away the next day. It was not easy to see that room empty on Wednesday morning.

The rest of the week went smoothly. I scrubbed in on another coronary artery bypass surgery as well as an aortic valve replacement. On Thursday, I completed a CPR class and became certified. I learned how to perform CPR on an adult as well as an infant.

This class taught me the exceptions that can occur. For example, if you witness a child collapse you handle it a certain way, but if you come across a child who is unresponsive, then you must handle it a different way. This is done because you don’t know how long the child has been unresponsive and alone. It all makes sense, but of course, in emergency situations, we don’t always think clearly.

We did not have any cases on Friday, but we had two consults, which turned into surgeries for next week. This adds to the cases we already have planned for next week, so I am taking it easy this weekend in order to be ready for a full week.

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New and exciting surgeries

What a great way to end the week. On Friday, I scrubbed in on another coronary artery bypass, and not only did I get to hold the heart but I helped the physician assistant harvest the vein from the leg. I have seen it done every time there is bypass surgery, but I have never been able to help out as much as I did.

After the PA pulled the vein from the leg, he needed help tying off all the small holes that the vein had. That is where I came in. After he clamped all the areas, I got to hold the clamp as he tied off the vein. Now this doesn’t sound like a tough job, but once he was done tying he taught me how to properly release the clamp from the vein. Let me tell you, this is not as easy as it looks. It took a couple of tries, but I finally got the hang of it and was able to unclamp with one hand.

Megan7.jpg I also observed a new surgery that week. On Monday, there was a mitral valve repair that turned into a mitral valve replacement. The repair did not take and the problems were too severe, so the surgeons replaced the whole valve. The mitral valve that they used was a mechanical valve.

(In photo: Megan with the two residents and mentors Dr. Suarez (left) and Dr. Bezzina.)

This was the first time that I saw a mechanical valve being placed in a patient. So far, I have seen aortic valve replacements where they put in a tissue valve. With aortic valve replacements you can insert either a tissue or a mechanical valve, but I have only seen tissue. This was a new and exciting procedure for me.

I did get to help out on one other task. On Thursday, a post-op patient had a lot of mucous in his lungs and could not cough it up. If left untreated this could lead to pneumonia, so the doctors had to perform a bronchoscopy. In this procedure, a camera is inserted into the patient through the nose and the mucous is flushed out and removed. I was able to help the doctor through the procedure and learn something new at the same time.

It has been six weeks, and every day I learn something new. Even if I have seen the surgery before, there is always a new piece of information that the doctors teach me. I have learned so much, and I am eager to learn more.

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Before, during and after surgery

It has been a while since my last post, and I have a lot to talk about.

My fourth week was a short one due to the Fourth of July, but it was still really exciting. I scrubbed in that Wednesday on a triple coronary artery bypass surgery and got to hold the heart again. This was one of the longer surgeries that I scrubbed in on; it lasted almost seven hours.

Megan4.jpg This past week was my fifth week, and I was able to scrub in on an aortic valve replacement. I have observed this surgery on the monitor multiple times, but this was the first time I was able to witness it up close.

(In photo: Megan with her favorite scrub nurse Luchie.)

I was able to feel the calcified leaflets of the aortic valve as the surgeon removed them from the patient. They were as hard as a rock. It really makes me wonder how anything that hard can allow blood to be pumped at all in the heart.

This surgery presented me with another task that I did not expect. The patient formed a hematoma (a pool of blood under the skin) after the surgeon placed a line in his femoral vein. The surgeon allowed me to apply pressure to the hematoma in order to help it go down. It actually worked and the hematoma went down! I was told that I have the magic touch. Even with the hematoma, this surgery only lasted about four and a half hours.

During clinic on Monday, I had a reunion with a former patient and his wife. This patient had coronary artery bypass surgery the first day I arrived, and I met his wife in the intensive care unit. She was a little bit stressed out and just needed some emotional support during this tough time. I helped her as much as I could, and her husband was finally discharged.

On my way to clinic I saw them coming out of an exam room. It was the one-month post-op appointment and everything was going smoothly. The patient’s wife looked so much more relaxed, and the patient himself looked as good as new. They were both so happy to see me, and we hugged just before they left.

This touched me in a way that I have never felt before. Just being there for them was the best thing I could have done. Being here this long has allowed me to be with the same patients before, during, and after their surgery. This is what I call a once-in-a-lifetime experience!

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Fixing a human heart

Oh my gosh, I held a human heart on Tuesday! Let me back up a bit. On Monday, I observed the removal of a thymoma, which is a tumor on the thymus. I could not believe that the tumor was bigger than the actual thymus. Even the surgeon was amazed by the size.

Tuesday was the most amazing day for me this week. I scrubbed in for the first time with my mentor, Dr. Bakaeen, on a quadruple coronary artery bypass. I was excited just to scrub in and see the procedure up close.

However, Dr. Bakaeen had a different plan in mind for me. After the patient went on the heart-lung machine and the heart was stopped, Dr. Bakaeen turned to the scrub nurse and asked her to hand me the special glove. I pretty much knew what that meant for me and my heart started to race. Once I put the glove on Dr. Bakaeen grabbed my hand, correctly positioned it on the heart, and told me to hold it steady in order for him to graft the new vessel. Holding the heart in my hand was such a breathtaking experience. I left the operating room with a huge smile on my face.

I also scrubbed in on a triple coronary bypass this week. This time I was able to hold a clamp steady as Dr. Bakaeen tried to maneuver around the tight space. The procedure took a bit longer than expected but everything turned out fine in the end.

Scrubbing in this week allowed me to see what it is like standing over the operating table. Adrenaline rushed through my body and allowed me to focus on my task. Even though I was nervous, the heart did not slip once. Once the surgery was over, I was still filled with joy and happiness. I forgot that I had been standing for four hours and that I skipped lunch. None of that mattered to me. All I cared about was the heart that I helped fix. My task may have been small, but I felt like I contributed something. This is the feeling that I want to have every day as a surgeon.

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Thoracic surgeries

Thoracic surgeries were the focus this week. I observed an aortic valve replacement and a CABG on Monday, but the rest of the week we barely focused on hearts.

On Tuesday I observed the removal of an esophageal diverticulum. A diverticulum is a sac or pouch that arises from an organ, in this case the esophagus. I watched as the surgeon removed the diverticulum and sent it off to pathology. I could not believe how thick and large it was. Even pathology did not know where to start examining the diverticulum! It was about a four-hour procedure, and the patient is doing well.

Wednesday was the day of all days for thoracic surgeries. There were two different procedures taking place, but I decided to observe a left upper lobectomy. In this case, the patient had lung cancer and the surgeons had to remove his entire upper lobe on the left side. When the lobe finally came out, I started inching closer to it just to get a better look.

Megan5.jpg I also learned more about the training that residents go through in order to become certified. I volunteered to be a victim for ATLS training. This type of training places doctors in difficult trauma positions, usually with limited resources, in order to see if they take the proper steps to save the patient.

(In photo: Megan with nurse practitioner Casiano. He thought I talked funny because I have a New York accent!)

I was a pregnant woman involved in a car accident and I listened as the doctors attempted to pass the test and save my life. This was a once-in-a-lifetime experience and I was able to gather useful information that will help me pass this test in the future.

Amid all the surgeries this week, I also removed sutures on my own for the first time. My mentor was kind enough to allow me to remove sutures from two different patients during clinic.

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Views of heart surgery

Megan2.jpg Today concluded my first week as a DeBakey Summer Surgical Student. Once we completed the morning rounds, the medical student and I were assigned to remove chest tubes from two patients.

I observed the removal from the first patient, but on the second patient I was given the opportunity to assist in the removal. I got so excited when the medical student told me to glove up. She handed me the scissors and told me to cut the knot on the sutures. Then, with the assistance of the resident, I pulled out the chest tubes from the patient. It was so amazing! I could not believe that I was given this kind of opportunity during my first week.

I also observed two more surgeries this week. Another aortic valve replacement and a coronary artery bypass graft (or CABG). During the CABG I was able to stand next to the anesthesiologists, so I had an up-close view of the procedure. I could not tear my eyes away from the surgery. I was a mere foot away from the operating table!

Megan3.jpg I watched as the surgeons bypassed four arteries on a heart that was still beating. This is called an off-pump procedure and is becoming a more popular way to bypass arteries.

In just a short week I have observed and learned a lot of new information. I have witnessed the risk of major heart surgery and the various complications that can arise. Even if the procedure goes smoothly in the operating room, no one can predict what will occur afterward. Emotions run high in the surgical intensive care unit, and doctors try to do the best they can when things don’t always go as planned.

For me, I enjoy getting to know the patients and being there for them and their families. Each patient has a unique story behind them, and just by talking to them for a few short minutes, you can learn something interesting about them.

(In photos: Megan with the five other students assigned to the VA Hospital – two on the vascular team, two on the general surgery team and one on the neurosurgery team. The photo above left shows us “thinking like surgeons.”)

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Learning something new every day

Today was my second day, and boy did I see a lot. I started my day in the operating room observing an aortic valve replacement. I watched as they opened his chest, stopped his heart, inserted the new valve, removed him from bypass and closed him back up. I could not believe that stitching him back up took almost an hour. The surgeon’s work was truly meticulous.

After observing, I learned how to properly scrub in for surgery. This is one technique that you need to perform properly so your patient does not get infected. I ended my day learning how to take an H&P (history and physical).

The medical student on cardiothoracic service was kind enough to let me shadow her while she examined the patient. She even let me listen to his heart murmur! Even though it has only been two days, I have learned so much. The attending, residents, PA’s and medical students are all willing to help me, and they explain everything using pictures, which makes it much easier to understand. I am very excited to learn more and observe another surgery.

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First day as a surgical student

Megan1.jpg Yesterday was my first day as a DeBakey Summer Surgical Student. The DeBakey Summer Surgical Program is a program that is designed to give students a hands-on experience with surgery. There are about 24 students participating in this program, and each student is assigned a surgical faculty mentor in a specific surgical field. I have been assigned to a cardiothoracic surgeon at the VA Hospital.

(In photo: Most of the 2010 DeBakey Program students. The ones in green scrubs (including myself) are from the VA, while the others in blue scrubs are from the other hospitals.)

After a few hours of orientation, we went our separate ways to our assigned hospitals in order to find our mentors. I introduced myself to my mentor and headed straight for the surgical clinic. The clinic is where the doctors see patients before and after surgery. I was introduced to attendings, residents, physician assistants and a medical student.

By the time I arrived at the clinic, there were already a bunch of patients to be seen. The first patient I saw had esophageal cancer and I was able to see the blockage in his esophagus on the endoscopy photos. I could not have had a better first day.

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