Author: aidan_sher

The schedule on my final day at WakeMed allowed for a good amount of time to visit patients. The morning was procedure focused until around 11:00 before transitioning to a hospital visit day.

For the most part, the procedures were fairly typical colonoscopies / EGDs that were screenings done due to patient age. However, I was able to watch my first EGD that involved removal of a foreign object. This patient, due to psychiatric disorders or otherwise, had stuck 4 unraveled paper clips into his abdomen. Two of these paperclips had penetrated and become stuck within his stomach. So, a procedure had to be completed to remove these paperclips since they were causing considerable discomfort. A different set of forceps than the one normally used for biopsies was used to grab onto the paperclips.

Afterwards, we visited Dr. Lawal’s new patients in the hospital. Today was a rare case. He had 4 patients at one time who were afflicted with colon cancer. The first was a younger patient who had colon cancer than had spread to the liver. First, a colonoscopy must be done to view the nodule/mass before using chemotherapy. The rest of the patients were much older and also had colon masses that had metastasized elsewhere. One of the patients, although they acted quite normally and were quite active, had a tumor in the brain in addition to the colon. A colonoscopy needed to be conducted before evaluating the tumor. Although I definitely feel for the patient and the difficult stage they are going through, I was also conflicted by my interest in seeing new things.

Overall, this week was a great learning experience for me. I certainly know more about the colon and GI tract now than I did before and this has certainly shaped my future intentions to work in medicine.

The above image is of a CT scan of one of the patients. You can see that the large white nodule on the right side of the scan is a colon mass. This mass is cancerous.

Here is an image of a colon mass. This was taken during a colonoscopy procedure.

 

Today’s schedule was more similar to last week than any of the days this week. This was because Dr. Lawal had many procedures today. There were so many cases that my day ended more than an hour and a half later than usual. This can also be attributed to two cases which took quite a while longer than expected.

The first of these two cases involved an individual who had taken a Cologuard test. This is a test tjat can be administered at home that indicates (with great accuracy) whether you have colon cancer or many polyps or not. This individual had received positive feedback from the test, hinting at the possibility that the individual has cancer. While colonoscopies normally take around 25 minutes to complete, the colonoscopy of this individual took an hour. This was due to the extremely high prevalence of polyps: a total of 23 were removed and even more were left untouched (since they looked hyperplastic). Luckily for this individual, there were no cancerous growths; however, rhe individual will need to return in 1 year to get reassessed.

The second case that caused delay was an EGD of a very old individual afflicted with dementia. The issue involved the transfer of anesthesia to the patient. The problem was eventually found to be involving the IV. It took 3 attempts to place an IV so that it was functional and after that the operation proceeded smoothly.

Tomorrow I will be staying late once again. But, I should be able to see more patients in the hospital tomorrow since Dr. Lawal has a lighter procedure load.

Above are images of equipment and diagrams used today.

 

Today had a very similar schedule to yesterday. There were several procedures that needed to be completed (although there were less than yesterday) before Dr. Lawal took me around the hospital. Most of the procedures in the morning were EGDs which are a shorter procedure (around 10 minutes) compared to the colonoscopies (around 25 – 30 minutes). One of the patients had extensive family history of colon cancer, so extra careful study of the colon was done. One of the polyps that was found is called a pedunculated polyp, which is a polyp that has a stem that connects to the lining of the colon. I have an image of this polyp attached.

Afterwards, we visited a few patients in the hospital. The first was an alcoholic who was beginning to develop complications in his liver. With extensive drinking, the liver, which detoxifies blood and the body, begins to fail and stop working optimally. This patient was experiencing this and had extensive water buildup in his abdominal area. There were around several liters of water that needed to be drained. Also, with dysfunction of the liver, water begins to buildup in the legs of the individual. This can bee visualized through pressing down firmly along the patient’s leg. If the depression remains, there is water retention. With continued abuse of alcohol, symptoms can worsen, even resulting in complete failure of the liver. Another patient we visited was having acute abdominal pain. Previous surgery had placed a stent that allowed flow of fluid from the pancreas to the small bowel. While the stent is supposed to fall out, this did not occur and there was considerable buildup of debris. This lessened the possible flow of pancreatic fluid to the rest of the body leading to pain.

Tomorrow, I will be doing this same thing, but I will be staying later so I can see more patients.

This week, Dr. Lawal has a “service” week. The daily schedule on a week like this encompasses a morning filled with procedures followed by patient visits in the afternoon. These patient visits involve meeting with them in the hospital to check in with their symptoms and treatment. Interestingly, today there were numerous procedures done, all focused on EGDs (esophagogastroduedenoscopy) which involves inserting a scope down the esophagus and into the stomach. Attached are pictures that depict healthy and unhealthy portions of the esophagus and stomach. A condition I was introduced to today was esophageal varices, swollen veins along the lining of the esophagus. If the varices become too invasive, small bands can be placed around some of the tissue, cutting off blood supply and preventing extensive bleeding (or perhaps the esophagus even bleeding out). I specifically thought our trip to the intensive care unit was the most interesting. I had never been in an environment like this before and being introduced to the different technology and care provided to patients was reassuring. I am excited to meet more patients outside the OR, so hopefully I will get more exposure to them tomorrow.

Today was a slightly shorter day since Dr. Lawal had a meeting. I have slowly adjusted to the routine that they have in his office and I am finally able to find my way around the hospital myself (it’s like a maze). As Dr. Lawal had less procedures, I was able to see first-hand the less “fun” parts of the job: desk work. I learned the different tasks that needed to be completed by the doctor, whether it is discharging patients or setting them up for future procedures. Additionally, as Dr. Lawal had to interview a potential job candidate, I was able to meet other doctors at WakeMed. For instance, I met a doctor who focuses on imaging lungs. He specifically tackles lymph nodes around the lungs and tests for the potential for cancer. That was very interesting! Tomorrow, Dr. Lawal is off work, so I will see if I can work with another doctor or take the day off.

As Dr. Lawal is focused on procedures this week, we had another day filled with procedures. At 8:00 a.m. I showed up at his office where we briefly covered the first patient of the day. Then, he consulted with the patient before we headed to the endoscopy room. Over the course of the day, there was less variety in the procedures done; however, I was still able to learn a lot under Dr. Lawal’s mentorship. I have gained a greater understanding of the medical vocabulary and spotting certain phenomena on the camera footage. For instance, today, I learned about liver cirrhosis and its potential effects on other organs of the body. At the end of the day, we consulted with patients in the “clinic”. This resembles a more typical visit to the doctor. Tomorrow should be another packed day with several procedures. I am excited to see what’: in store for me tomorrow.

Today was my first day as an observer at WakeMed. I am shadowing the gastroenterology department. This week Dr. Lawal is focusing on procedures, whether it is colonoscopies or treating infections. I was able to witness many of these operations and while I am unable to discuss details, I can attest that a wide variety of cases were done today.  So far, the experience has been fantastic. I have learned a huge amount concerning gastroenterology and Dr. Lawal is always ready to answer any questions I have. In addition, the other doctors such as anesthesiologists and physician assistants are keen to help out. I hope to learn more tomorrow.