Today I was in clinic all day. And since it is my last week of Surgery II, I decided to try rectal clinic instead of Post Op. I had heard (from other students) that the Rectal surgeon on Coney Island is very good....and very quizzical when it comes to students. He not only pimps....he super pimps. He treats you as a resident in rectal surgery and fires question after question after question at you until your brain starts screaming STOP!!!! But, that is what made this clinic so much fun for me. Because he made me think....hard. And after only 2 hours, I felt like I learned and accomplished so much. So, let me briefly review the wonderful world of the rectum.
The first patient was an older male who was diagnosed with Carcinoid tumor of the colon that was resected. The doctor brought up his most recent labs which showed an elevated 5-HIAA. This is a marker for Serotonin, which is released from this kind of tumor. First question to me, what does this mean for this patient? My response: metastasis to a distant site. Good (first one down), now what sites are commonly involved? My response: liver and lungs. Very good (now I was feeling a bit cocky), now what 2 radiology studies, 5 blood tests, 3 clinical signs and one very important test will you order? OUCH!!! I got about half right, which isn't bad for my first try. By the way, the answers according to this doctor are: Radiology: CT scan, Octreotide Scan; Blood tests: 5-HIAA, Liver function tests, Serotonin, Chromogranin A, CEA; Clinical signs: Flushing, sweating, diarrhea; Important test: Colonoscopy.
The next few patients all had hemorroids, either internal or external. The external ones were easy to find...just spread the buttocks apart and you can easily see them. The internal ones were more tricky. A speculum type of device was placed in the rectum and slowly removed to show the presence of any internal hemorroids. I also got the wonderul opportunity to perform digital rectal exams on all of these patients.
On two of the patients I had the opportunity to perform a sigmoidoscopy. This is a device that allows you to see the mucosa of the rectum. And by blowing up a little balloon on one end, you can advance the device further into the rectum to the sigmoid colon, which is the most distal portion of the colon. Of course, I ran into a bit of a problem on the last patient. I tried to advance the scope and I ran into a big wall of pooh which allowed me absolutely no visibility. I had to retract the scope and the doctor informed the patient that he would need to come back again to have the procedure, but this time taking an enema prior to the appointment.
Overall this was one of the most challenging clinics I had ever attended and for a few moments I thought to myself "Hey, I could totally be a colo-rectal surgeon!!" :)
Tuesday, June 30, 2009
Tuesday, June 23, 2009
New things I learned on call.......
I had call last night (5 down, 7 more to go) and I learned some interesting things:
- Never try to interview a patient at 1:30am
- I never want to experience a chest tube placement
- I never want to live in a nursing home
- I am going to write a book entitled "Hernia repair: 101 Ways"
Because our night was very busy, our team did not get around to catching up with consults until almost midnight. At 1 am, my resident sent me to interview a patient on the floor with an abscess on her shoulder. So, I proceeded into the patient's room, turned on the overhead light and had the following conversation:
Me: Ms. BL, I'm sorry to wake you but I'm from surgery. I'm here to ask you about the problem you are having with your shoulder.
Ms. BL: WHAT??? You woke me up to ask me about pain. What the hell is wrong with you!!! I'm not talking to you now....get out of my room.....come back tomorrow morning!
So, I proceeded back down to SICU where I told my resident to please never send me to a patient's room again after midnight unless it was an emergency.
I fully recognize that sleep is very important for any person, especially those recovering from sickness or surgery. However, it is rare in the hospital setting to get any decent sleep at all. Nurses...doctors....therapists.....are constantly coming in and out at all hours of the day. I sometimes wonder if patients would recover faster with more sleep (interesting study idea).
Now on to the chest tube.....OUCH!! It started off okay, with some local anesthetic, 2mg of IV morphine and a small incision, but then the patient was having some pain and the resident was having a hard time getting into the chest wall. So, the senior resident turns to the patient and says "This is going to hurt", then proceeds to jab a blunt instrument extremely forceful into this guys chest and into his pleural cavity. All we heard was a loud "Pshhhhhhh" like if you opened a can of soda, and the patient started screaming in pain (although the word screaming does not do justice in fully describing what came out of this guys mouth)....and the screaming lasted for about 10 minutes after this fairly traumatic event. My first chest tube placement made me quickly realize that I never, ever want to go through that procedure....and, in the unfortunate circumstance that I do, I want to be completely knocked out.
While we were placing the chest tube, the paramedics bring in an 80-something year old female resident of a nursing home with a very visible, pulsatile abdominal mass. My senior resident asks the paramedics if she is responsive. The paramedics reply "The patient has been unresponsive for 2 days." What?? 2 days?? They go on to explain to my senior resident that that is the history the nursing home provided. 2 days?? That seems a little extreme to me. Who in their right mind would allow an elderly patient to be unresponsive for that amount of time. Can you say lawsuit??
Other than that, I also scrubbed in on 3 hernia cases, all involving the right inguinal region, and all of them completely different from each other. By the end of the 3rd surgery I realized several key things: the presentation (extent, location, etc) of the hernia can influence the surgery (where to cut, how long to make the incision, etc); each surgeon has their own way of starting a hernia, repairing a hernia, and closing a hernia (using a multitude of differing instruments, meshing, plugs, sutures, etc). I also quickly realized that I can easily pick out the layers of the hernia until they cut open the hernia sack.....then everything gets boggled up and I have no idea what layer is what (I only hope the surgeon knows ;)
Well, it is officially time for bed. Tomorrow is another OR day. Hopefully, I get the chance to see something new (please not another hernia :). Everyone have a good night.
- Never try to interview a patient at 1:30am
- I never want to experience a chest tube placement
- I never want to live in a nursing home
- I am going to write a book entitled "Hernia repair: 101 Ways"
Because our night was very busy, our team did not get around to catching up with consults until almost midnight. At 1 am, my resident sent me to interview a patient on the floor with an abscess on her shoulder. So, I proceeded into the patient's room, turned on the overhead light and had the following conversation:
Me: Ms. BL, I'm sorry to wake you but I'm from surgery. I'm here to ask you about the problem you are having with your shoulder.
Ms. BL: WHAT??? You woke me up to ask me about pain. What the hell is wrong with you!!! I'm not talking to you now....get out of my room.....come back tomorrow morning!
So, I proceeded back down to SICU where I told my resident to please never send me to a patient's room again after midnight unless it was an emergency.
I fully recognize that sleep is very important for any person, especially those recovering from sickness or surgery. However, it is rare in the hospital setting to get any decent sleep at all. Nurses...doctors....therapists.....are constantly coming in and out at all hours of the day. I sometimes wonder if patients would recover faster with more sleep (interesting study idea).
Now on to the chest tube.....OUCH!! It started off okay, with some local anesthetic, 2mg of IV morphine and a small incision, but then the patient was having some pain and the resident was having a hard time getting into the chest wall. So, the senior resident turns to the patient and says "This is going to hurt", then proceeds to jab a blunt instrument extremely forceful into this guys chest and into his pleural cavity. All we heard was a loud "Pshhhhhhh" like if you opened a can of soda, and the patient started screaming in pain (although the word screaming does not do justice in fully describing what came out of this guys mouth)....and the screaming lasted for about 10 minutes after this fairly traumatic event. My first chest tube placement made me quickly realize that I never, ever want to go through that procedure....and, in the unfortunate circumstance that I do, I want to be completely knocked out.
While we were placing the chest tube, the paramedics bring in an 80-something year old female resident of a nursing home with a very visible, pulsatile abdominal mass. My senior resident asks the paramedics if she is responsive. The paramedics reply "The patient has been unresponsive for 2 days." What?? 2 days?? They go on to explain to my senior resident that that is the history the nursing home provided. 2 days?? That seems a little extreme to me. Who in their right mind would allow an elderly patient to be unresponsive for that amount of time. Can you say lawsuit??
Other than that, I also scrubbed in on 3 hernia cases, all involving the right inguinal region, and all of them completely different from each other. By the end of the 3rd surgery I realized several key things: the presentation (extent, location, etc) of the hernia can influence the surgery (where to cut, how long to make the incision, etc); each surgeon has their own way of starting a hernia, repairing a hernia, and closing a hernia (using a multitude of differing instruments, meshing, plugs, sutures, etc). I also quickly realized that I can easily pick out the layers of the hernia until they cut open the hernia sack.....then everything gets boggled up and I have no idea what layer is what (I only hope the surgeon knows ;)
Well, it is officially time for bed. Tomorrow is another OR day. Hopefully, I get the chance to see something new (please not another hernia :). Everyone have a good night.
Wednesday, June 17, 2009
No sleep = severe crankiness
I have been blessed to recognize, since early on in my life, that sleep is a very big priority for me. I try to get at least 7 hours of good sleep a night. 8 hours is the very best, allowing me to perform at my maximum intellectual level. So what happens when I am on call and the resident sends me to bed at 4:30am and I have to get up at 6am for morning rounds??? Lets just say I am not very pretty (in any sense of that word).
Example: during morning rounds the Chief resident pointed to me and asked me a question. It took me a whole 10 seconds (of complete silence and everyone staring at me) to realize first, that he was pointing to me. I said "are you directing the question to me?" and he said "Yes". And then, after pausing for another 5 seconds, I said "What was the question you asked?" He then gave up and pointed to another student which I was entirely happy about. The funny thing about this whole conversation.....the Chief was also on call with me last night and was fully aware that my sleep was non-existent (as was his), so why he even thought of pointing to me in the first place was something I contemplated for almost 10 minutes after this whole exchange (which of course led me to miss the presentation of the patients in rooms 225A, 225B, 226A, and 226B). So, to start a list of sleep deprived issues...so far I have decrease in responsiveness, confusion, pre-occupation on things that are not relevant at that specific time....oh, and lateness, considering rounds started at 6am, and I arrived at 6:24. Although I could also classify that as an inappropriate behavior and non-caring attitude considering the fact that while I was in the call room staring at my watch thinking to myself that I'm late, I was also saying "I don't really give a shit, I was on call last night!!!" Of course if you truly know me, you realize that none of the above really even come close to describing me, which leads me to the conclusion that without sleep, I am a totally different person. So the moral of my story....sleep is very important for me!!
Last night we had alot of surgeries.....a small bowel obstruction, an abdominal bleed on a patient who had surgery to remove the gall bladder 3 days ago, and an appendectomy. I got to scrub in on the last case which started at 2:15am. The funny part....putting the foley catheter in. I asked the nurse if I could do it...she said yes, but insisted on "watching me". So, I put my sterile gloves on, cleansed the area and proceeded to place the catheter. The nurse then says "Are you sure you aren't in the vagina?" In my mind the answer to that was "If you knew me, you wouldn't have to ask me THAT question!!!" but what came out of my mouth instead was "I am positive I am in the urethra." Sure enough, urine was seen in the catheter tube (damn I know my anatomy :)
I also got to place some stitches in the patient. I used a subcuticular stitch: the stitch is placed just below skin level ( in the dermis) and is continued throughout the lesion. When finished, tension can be placed on the ends to bring the skin edges together. No visible suture marks are seen. I am still working on my surgeon's knot for tying purposes so I didn't have a chance to do that. But I'm confident I will have it down by next call!!
Well, that is it for tonight. I have breast clinic all day tomorrow and then Head and neck on friday. I hope everyone has a great night!
Example: during morning rounds the Chief resident pointed to me and asked me a question. It took me a whole 10 seconds (of complete silence and everyone staring at me) to realize first, that he was pointing to me. I said "are you directing the question to me?" and he said "Yes". And then, after pausing for another 5 seconds, I said "What was the question you asked?" He then gave up and pointed to another student which I was entirely happy about. The funny thing about this whole conversation.....the Chief was also on call with me last night and was fully aware that my sleep was non-existent (as was his), so why he even thought of pointing to me in the first place was something I contemplated for almost 10 minutes after this whole exchange (which of course led me to miss the presentation of the patients in rooms 225A, 225B, 226A, and 226B). So, to start a list of sleep deprived issues...so far I have decrease in responsiveness, confusion, pre-occupation on things that are not relevant at that specific time....oh, and lateness, considering rounds started at 6am, and I arrived at 6:24. Although I could also classify that as an inappropriate behavior and non-caring attitude considering the fact that while I was in the call room staring at my watch thinking to myself that I'm late, I was also saying "I don't really give a shit, I was on call last night!!!" Of course if you truly know me, you realize that none of the above really even come close to describing me, which leads me to the conclusion that without sleep, I am a totally different person. So the moral of my story....sleep is very important for me!!
Last night we had alot of surgeries.....a small bowel obstruction, an abdominal bleed on a patient who had surgery to remove the gall bladder 3 days ago, and an appendectomy. I got to scrub in on the last case which started at 2:15am. The funny part....putting the foley catheter in. I asked the nurse if I could do it...she said yes, but insisted on "watching me". So, I put my sterile gloves on, cleansed the area and proceeded to place the catheter. The nurse then says "Are you sure you aren't in the vagina?" In my mind the answer to that was "If you knew me, you wouldn't have to ask me THAT question!!!" but what came out of my mouth instead was "I am positive I am in the urethra." Sure enough, urine was seen in the catheter tube (damn I know my anatomy :)
I also got to place some stitches in the patient. I used a subcuticular stitch: the stitch is placed just below skin level ( in the dermis) and is continued throughout the lesion. When finished, tension can be placed on the ends to bring the skin edges together. No visible suture marks are seen. I am still working on my surgeon's knot for tying purposes so I didn't have a chance to do that. But I'm confident I will have it down by next call!!
Well, that is it for tonight. I have breast clinic all day tomorrow and then Head and neck on friday. I hope everyone has a great night!
Friday, June 12, 2009
Week 3 done....
Wow, I am really proud of myself. Not because I have successfully completed my third week of surgery. No. More important is that I have kept up blogging with my incredibly crazy and hectic schedule!!
So, as mentioned above, today was the end of week 3 and of Surgery I. On monday, I start Surgery II. I'm looking forward to breast, rectal, and head/neck. Hopefully, I get to see some great surgeries and more importantly, I hope the surgeons are willing to teach us (because I am so willing to learn).
Let me recap this past week. I did make it into the OR on several occasions this week. I saw a carpal tunnel release, multiple phlebectomies (to remove varicose veins), but by far the best procedure is what I saw on Thursday. A debridement and skin graft on a diabetic patient. This patient had a partial foot amputation. They needed to trasplant skin from his thigh to his foot, hoping that the new skin will take and therefore relieve him of a stumpy red foot with no skin. The grafting was interesting. The plastic surgeon informed us that they use a similar device that the cow hide industry uses to shave off the epidermal layer of skin. It looks like a giant metal razor. Then the skin is place on a platform with lots of holes and is pressed in another machine. This makes the skin come out looking almost like an accordian, with the purpose being to allow the skin to stretch more so less skin needs to be harvested. By far the most stomach turning moment was when the surgeons had to debride the patients foot. They needed to rid the foot of any non-viable skin/tissue thereby allowing the new skin to be grafted to healthy, blood rich tissue. Basically, they scraped the foot with tools; and the blood and tissue that flowed off the table and onto the floor made the OR look like a horror film. I swear it looked like a gallon of blood on the floor!! It was both gross and interesting at the same time. If not for the surgical mask covering my face, everyone in the room probably would have seen my mouth wide open and fixed (as if the wide eyes didn't give me away)!! Overall, the surgery was a success and now we get to follow the patient to see if the grafting took and if someday he will be able to walk.
Other than that, I had call on Wednesday night. Only one trauma: an 18 year old patient who was hit by a car crossing the street to school. His head hit the windshield and he had a huge hematoma on the top of his head, but other than that, no injuries - he is very lucky. We kept him overnight to evaluate his mental status. We had lots of consults all night long, and the night was officially annointed Bleed Night. Everyone was bleeding...consults for upper GI bleed....consults for lower GI bleed....even a consult for epistaxis (nose bleed). I have never seen so much blood come out of any oriffice before. The only plus of the whole night was I got to perform my first rectal exam.....and then, about 20 minutes later, I got to do another :)
Overall, call went well although I was exhausted thursday night and basically just came home and slept. I have also found that call night messes royally with my circadian rhythm. I found it incredibly difficult to wake my ass up this morning. But once I was up, I was okay. The best part....lecture was cancelled today so I was out of the hospital by 3:15pm!!! I came home, ran in the park for 45 minutes, ate dinner...and now, I am just relaxing with a Caribe and waiting for the Penguins to hoist the trophy!!!! GO PENS!!!
Everyone have a wonderful night!
So, as mentioned above, today was the end of week 3 and of Surgery I. On monday, I start Surgery II. I'm looking forward to breast, rectal, and head/neck. Hopefully, I get to see some great surgeries and more importantly, I hope the surgeons are willing to teach us (because I am so willing to learn).
Let me recap this past week. I did make it into the OR on several occasions this week. I saw a carpal tunnel release, multiple phlebectomies (to remove varicose veins), but by far the best procedure is what I saw on Thursday. A debridement and skin graft on a diabetic patient. This patient had a partial foot amputation. They needed to trasplant skin from his thigh to his foot, hoping that the new skin will take and therefore relieve him of a stumpy red foot with no skin. The grafting was interesting. The plastic surgeon informed us that they use a similar device that the cow hide industry uses to shave off the epidermal layer of skin. It looks like a giant metal razor. Then the skin is place on a platform with lots of holes and is pressed in another machine. This makes the skin come out looking almost like an accordian, with the purpose being to allow the skin to stretch more so less skin needs to be harvested. By far the most stomach turning moment was when the surgeons had to debride the patients foot. They needed to rid the foot of any non-viable skin/tissue thereby allowing the new skin to be grafted to healthy, blood rich tissue. Basically, they scraped the foot with tools; and the blood and tissue that flowed off the table and onto the floor made the OR look like a horror film. I swear it looked like a gallon of blood on the floor!! It was both gross and interesting at the same time. If not for the surgical mask covering my face, everyone in the room probably would have seen my mouth wide open and fixed (as if the wide eyes didn't give me away)!! Overall, the surgery was a success and now we get to follow the patient to see if the grafting took and if someday he will be able to walk.
Other than that, I had call on Wednesday night. Only one trauma: an 18 year old patient who was hit by a car crossing the street to school. His head hit the windshield and he had a huge hematoma on the top of his head, but other than that, no injuries - he is very lucky. We kept him overnight to evaluate his mental status. We had lots of consults all night long, and the night was officially annointed Bleed Night. Everyone was bleeding...consults for upper GI bleed....consults for lower GI bleed....even a consult for epistaxis (nose bleed). I have never seen so much blood come out of any oriffice before. The only plus of the whole night was I got to perform my first rectal exam.....and then, about 20 minutes later, I got to do another :)
Overall, call went well although I was exhausted thursday night and basically just came home and slept. I have also found that call night messes royally with my circadian rhythm. I found it incredibly difficult to wake my ass up this morning. But once I was up, I was okay. The best part....lecture was cancelled today so I was out of the hospital by 3:15pm!!! I came home, ran in the park for 45 minutes, ate dinner...and now, I am just relaxing with a Caribe and waiting for the Penguins to hoist the trophy!!!! GO PENS!!!
Everyone have a wonderful night!
Sunday, June 07, 2009
2 weeks down.....10 to go!
Tomorrow starts week #3 of surgery, and my last week of Surg I. I should explain a little on how this surgery rotation is set up. In 12 weeks we do the following:
3 weeks of Surgery I: comprised of general, vascular, plastics
3 weeks of Surgery II: comprised of general, rectal, breast, Head and neck
1 week each of: Orthopedics, Anesthesia, Specialty clinic, Urology
2 weeks of Surgical ICU
After this week I move into Surgery II. Of course Surgery I and II have the most time committment since we have to be at the hospital at 6am. To do that I have to get up at 4am so I can make my 5:05am Q train to Coney Island. If we are not on call, we are able to leave after lecture at 5pm, and then I usually get home around 6-6:30pm, where I have dinner, check some email and then get into bed by 8pm to rinse, lather and repeat again!!
Of course, a call day means a 36 hours stay in the hospital. For instance, I have call Wednesday night which means I go in at 6am on Wednesday and I get out of the hospital on Thursday at 5pm!! Very, very long night and day. Its actually not all that bad if you are able to sleep a little, but even then the night of post call, you just crawl into bed at 6pm and go to sleep :)
So how is surgery going so far?? Its okay....I have found that there are good days and bad days and it really all depends on who you are working with that particular day. If you have a great attending/resident, your day is awesome in that you are able to learn so much. If you have an attending/resident that just doesn't seem to care about you/doesn't want to teach you anything, then its a pretty shitty day. I will say this....the residents work hard and are on call every 3rd night. I don't know how they do it and quite honestly, that schedule alone turns me off from being a surgeon. I love medicine and it will be a big part of who I am....but, there is also so much more to me than that and I have so many other things that I love and want to do.
So, for the next 10 weeks I will learn as much as I can about surgery. Because I know that after August 14th, I will probably never be in an operating room again. I hope everyone has a great night. Take care!
3 weeks of Surgery I: comprised of general, vascular, plastics
3 weeks of Surgery II: comprised of general, rectal, breast, Head and neck
1 week each of: Orthopedics, Anesthesia, Specialty clinic, Urology
2 weeks of Surgical ICU
After this week I move into Surgery II. Of course Surgery I and II have the most time committment since we have to be at the hospital at 6am. To do that I have to get up at 4am so I can make my 5:05am Q train to Coney Island. If we are not on call, we are able to leave after lecture at 5pm, and then I usually get home around 6-6:30pm, where I have dinner, check some email and then get into bed by 8pm to rinse, lather and repeat again!!
Of course, a call day means a 36 hours stay in the hospital. For instance, I have call Wednesday night which means I go in at 6am on Wednesday and I get out of the hospital on Thursday at 5pm!! Very, very long night and day. Its actually not all that bad if you are able to sleep a little, but even then the night of post call, you just crawl into bed at 6pm and go to sleep :)
So how is surgery going so far?? Its okay....I have found that there are good days and bad days and it really all depends on who you are working with that particular day. If you have a great attending/resident, your day is awesome in that you are able to learn so much. If you have an attending/resident that just doesn't seem to care about you/doesn't want to teach you anything, then its a pretty shitty day. I will say this....the residents work hard and are on call every 3rd night. I don't know how they do it and quite honestly, that schedule alone turns me off from being a surgeon. I love medicine and it will be a big part of who I am....but, there is also so much more to me than that and I have so many other things that I love and want to do.
So, for the next 10 weeks I will learn as much as I can about surgery. Because I know that after August 14th, I will probably never be in an operating room again. I hope everyone has a great night. Take care!
Tuesday, June 02, 2009
LOBECTOMY!!!
This morning I had the excellent opportunity to scrub in with Dr. S and see a right middle/lower lobectomy. This female patient was diagnosed with a carcinoid tumor.
So last night I prepared for this surgery by digging out my old anatomy books and looking up the relevant physical structures. In terms of cutting into the thoracic cavity, I reviewed which structures would be cut (skin layers, subcutaneous fat, muscles, intercostal space). I then reviewed the lung anatomy, artery and vein supply, the trachea, the lymphatics and other structures nearby (heart being the biggest). This morning I arrived early to look into the history of my patient. 57 year old female with 40 year history of smoking tobacco (and some occasional crack). I looked up her chest CT scan and saw where the tumor was localized (right posterior lower/middle lobe). And I was all prepared to answer any question that Dr. S asked me right?
Well, I got the first one; "What muscle is this that I am cutting through?" My answer: Latissimus Dorsi! Correct!!!! And I got the next question right; "What is that muscle's nerve supply? Long Thoracic Nerve! Correct!! But then it was downhill, because the next question was "Do you know the history of the first lobectomy/pneumonectomy?? And I said No. And so began Dr. S's hour long explanation into the history and its importance. I actually enjoyed it tremendously because it gave you an appreciation for how this procedure developed. So now I know that the first pneumonectomy was performed in 1933 by Dr. Graham on a Dentist from Pittsburgh who traveled to Barnes Hospital in St. Louis to have the procedure done. And I should mention that the Dentist was a smoker.....and so was Dr. Graham!!!
By the way, for those who can stomach it....the following University of Michigan video is very similar to the procedure I saw. Enjoy!!!
http://anatomy.med.umich.edu/surgical_videos/pneumonectomy.html
Have a great night!
So last night I prepared for this surgery by digging out my old anatomy books and looking up the relevant physical structures. In terms of cutting into the thoracic cavity, I reviewed which structures would be cut (skin layers, subcutaneous fat, muscles, intercostal space). I then reviewed the lung anatomy, artery and vein supply, the trachea, the lymphatics and other structures nearby (heart being the biggest). This morning I arrived early to look into the history of my patient. 57 year old female with 40 year history of smoking tobacco (and some occasional crack). I looked up her chest CT scan and saw where the tumor was localized (right posterior lower/middle lobe). And I was all prepared to answer any question that Dr. S asked me right?
Well, I got the first one; "What muscle is this that I am cutting through?" My answer: Latissimus Dorsi! Correct!!!! And I got the next question right; "What is that muscle's nerve supply? Long Thoracic Nerve! Correct!! But then it was downhill, because the next question was "Do you know the history of the first lobectomy/pneumonectomy?? And I said No. And so began Dr. S's hour long explanation into the history and its importance. I actually enjoyed it tremendously because it gave you an appreciation for how this procedure developed. So now I know that the first pneumonectomy was performed in 1933 by Dr. Graham on a Dentist from Pittsburgh who traveled to Barnes Hospital in St. Louis to have the procedure done. And I should mention that the Dentist was a smoker.....and so was Dr. Graham!!!
By the way, for those who can stomach it....the following University of Michigan video is very similar to the procedure I saw. Enjoy!!!
http://anatomy.med.umich.edu/surgical_videos/pneumonectomy.html
Have a great night!
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