Leave ’em in Stitches: Angeli in SLMC Week 1

:) For my “summer” clinical elective, I chose to rotate outside the confines of UP-PGH and into the halls of St. Luke’s Medical Center-Quezon City. Hopefully, I’ll get to see the Global City hospital too! Looking forward to making the most of these four weeks!

Day One: Monday, June 29, 2015

Orientation. Breast Center. Post-OP Conference: Colorectal CA. Hospital Tour. :)

I spent the morning with my off-campus preceptor, Dr. Macel Pagdanganan-Garcia, head of SLMC-QC’s Breast Center. I accompanied her while she did consults (A lot of patients with various complaints of the breast – mostly masses and pain! A lot of them discovered masses by accident; I got to do PE on some of them, getting to appreciate breast masses of all sizes and character), as well as observe a core needle biopsy procedure. Tita Macel was such a sight to behold during her consultations, keeping a smile and an ever pleasant attitude while dealing with patients. It goes to show that attitude goes a pretty long way. Even when you’ve got the skills and the smarts, if you don’t have the right attitude, you’ll never be an effective doctor. Also, Tita Macel takes great lengths to give proper patient education, an important component of the treatment process.

I also got to attend this week’s Post-Op Conference, featuring a case of colorectal CA, with the report focusing on the pros and cons of neoadjuvant chemoradiation therapy. Apparently, studies do not really show any significant difference between giving neoadjuvant and adjuvant chemoRT when it comes to overall survival rate. 

And to cap off my first day, I got a special tour of the hospital from one of the surgical residents. Napagod ‘ata kami pareho. Haha! Bonus ride home from my favorite surgical resident, Kuya Ernest (siyempre biased ako. haha!)!

Day Two, June 30, 2015

Low Anterior Resection, Diverting Loop Ileostomy, Appendectomy, Assisting the Institute Head. Inverted-T Sutures.

My first OR day and what a day it was! I was expecting to just observe for my first few days, but I was instead suddenly tapped to assist the man himself, Dr. Menandro Siozon, the head of SLMC-QC’s Institute of Surgery. A case of rectal adenocarcinoma and the patient was set to undergo low anterior resection. I was probably just as nervous as the patient about to undergo surgery. :)) My first OR at SLMC, and it was with Boss right then and there?! Boom tachycardia!

But it turned out to be quite the experience! :) I held those retractors with pride as I got to observe my father’s own mentor work his magic. Boss was in such a good mood that day! He gave informative tidbits here and there, pointing out the important anatomical landmarks and describing what he was doing (while sneaking in a little dance and song number, haha!), lucky for us of the assisting team, residents and clerks alike. Boss even let me palpate the tumor. That crazy thing was located in such a low segment that it took quite a while before Boss could find it. Definitely not an easy procedure to do!

Boss left the residents to close once he got the resection, the ileostomy, and the appendectomy done. Our residents were awesome! We (me and the other 2 clerks assisting, Lara and Dante) were taught how to do the inverted-T stitch used subcutaneously to close the surgical site before placement of the staples. The whole operation took us 6 hours! Di ko inexpect na ipags-scrub ako! Akala ko talaga mago-observe lang ako!

Day 3, July 1, 2015

Mastectomy. Sentinel Node Biopsy. Oh look, the lymph node turned blue! And the radioactive detector is beeping like crazy! OR Book Nerd Talk with the Residents. :)) 

Today, I got to observe Dra. Macel do a mastectomy with axillary lymph node dissection + sentinel lymph node biopsy. To identify the sentinel lymph nodes, the nodes where the cancer will first drain into/spread, a blue dye (either methylene blue or isosulfan blue) or/and a radioactive substance is injected. Pretty cool to see the lymph node take on this color blue! Using the radioactive detector probe was a lot like treasure hunting with a metal detector. As the probe was swept through the breast tissue, it makes these sounds that indicate it has picked up the location of the sentinel lymph node! A pretty fun OR with a pretty fun OR team! Everyone’s so nice! :))

Day 4, July 2, 2015

Low Anterior Resection (again!). “Ah, sa puwet po pala pinadadaan ang stapler!”. Bonus Anesthesia tidbits from the AROD. :) 

Got to accompany my monitor, Surgery Chief Resident Dr. Gilmyr Maranon on one of his OR assists today, low anterior resection on another rectal CA case with Dr. Gerry Caburnay as the main surgeon. Seems like I’m seeing all the really big cases first. :)) Look at them bowels! The whole procedure took quite some time, really not easy to do. In contrast to Dr. Siozon’s case, this one didn’t require an ileostomy, and instead of using surgical ties, they used staples for the anastomosis. As a sort of bonus, especially since I spent my time in their space of the OR, observing the field whilst standing on top of a stool platform, the Anesthesia resident on duty taught me a bit about their work, monitoring the vital signs, IV fluid, blood replacement, as well as the medications given. Hoorah, hoorah!

Day 5, July 3, 2015

Endoscopic Thyroidectomy. Minimally Invasive Surgery. Kain Pa More! :) 

So, I’m supposed to assist Dr. Siozon in his distal pancreatectomy OR today, but the operation got cancelled, so I spent my lunch hour chillin’ with Lolo Boss, the consultants, the fellows, and the residents in the OR doctor’s lounge, snacking on chicharon, mango cookies, biscocho and butterscotch. “Kuha ka lang, Angeli. Wag ka mahiya!” Oh wow. Can definitely get used to all the food :)) Bawal ata magutom dito. Haha!

Come 1PM, I got to observe Dr. Domino’s endoscopic thyroidectomy (or is it lobectomy, since only the right lobe was removed? ah bah! technical terms! :)) ). He and Dr. Tamayo, the anesthesiologist,  are actually Dad’s frat brothers, and they gamely shared stories about my dad. The minimally invasive surgery approach is done through a small axillary incision, and another one just below the breast, incisions just big enough for the instruments to pass through. It doesn’t produce much of a scar as compared to the open technique. What’s more, it produces a faster recovery time post-op, i.e. lesser hospital days, faster discharge. But from what I understand, it is somewhat more painful (higher pain score ratings) post-op because of the dissection done in the subcutaneous tissues, which is where the nerves are. MIS looks so cool, but also pretty difficult! :) Must need tons of practice to be able to manipulate those instruments with such dexterity!

endoscopic thyroidectomy
Here I am with Dr. Domino and Dr. Tamayo, with the fellows doing the last of the suturing behind us. Kitang-kita sa shot! Pretty cool to see how this procedure was done. The advances in Medicine are so awesome! :) Now, if only we can make them widely available for everyone in the near future. (the instruments and machinery alone make this procedure really expensive) #HealthForAll  || My thanks to Intern Ate Iris for taking this photo! :D

I keep forgetting to take pictures! :)) Maybe next time I’ll be able to include more. 

My first week with the SLMC Institute Surgery definitely felt like some sort of homecoming for me. I was literally born in this place. :)) I really appreciate how welcoming everyone has been. Hooray for learning! Excited for everything else in store for me for the next three weeks. Yay~! :)

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