Christina M

Practice Makes Perfect – Day 8

Today was the first day I got to see a patient for the second time, this one was getting a delayed reconstruction done. I was so used to just seeing a new face through every door every day, but seeing this patient again really reinforced for me just how much a personal and real connection means to these patients. They don’t want a doctor who just works in silence, never saying a word, they want a doctor who gets to know them and is enjoying what they do.

I got one of the nurses to give me a suture kit to practice with at home last night and it was much more difficult than the doctors make it look!! I had to get my mom to teach me proper technique, and I was able to get a few solid surgeons knots in. I started practicing with a 6-0 prolene which in layman’s terms is a really thin thread that I would not recommend first learning suturing with. I then switched to a 4-0 vicryl which had a thicker longer needle and a thicker string making it much easier to work with. All in all, this whole experience at the Cary Skin Center has only reinforced my wanting to be a doctor and I can’t wait to take the next step towards achieving that goal!!

A Mini Nurse – Day 7

Today I got to see some really neat reconstructions that I haven’t observed until today!! I saw a pretty large flap be put over a piece of open skin to help it heal looking as normal as possible. We had some lucky people get done after just one layer and a few that took 5-6. The patients are so great to talk to and I especially loved two specific families today that were really sweet and enjoyed talking to me to distract themselves from the surgery.

I have a running joke with the nurses that I should just come to work full time because currently I run layers up to the lab for them and if I came after WEP, they could teach me how to strip the rooms after patients leave. I honestly think that’d be a fun idea and I might look into it next summer!

All In A Days Work – Day 6

Today I decided to get the true experience of what the doctors and nurses go through and I woke up at 5am so I could get there by 6:20am. Boy oh boy was that quite the change for me. I must admit, I hit a bit of a wall about 3 hours in, but the interesting cases kept me going!

Now that I’ve been shadowing at the Cary Skin Center for a while, I’m able to help out a bit more because I know the routines and what needs to be done. Whenever there is only one nurse in the room for taking a layer, I run the layer up to the lab while the nurse blots, cauterizes, and bandages the wound. When we have a little down time, I run up to the lab, check for slides, and page Dr. Flynn if there are any for him. Whenever he clears a patient, I erase the layer number on the whiteboard and write “clear” in red. It’s been super fun and gratifying to help out everybody and I feel like I’m part of the staff!

I like to joke with the staff that because of HIPPA, most of my blog posts are “Today I saw people with spots on body parts and we removed those spots at their various locations” which is actually fairly accurate. Today was the first time it came to my attention that some older patients have cognitive problems and how scary it must be to have someone cutting into you and you suddenly forget where you are!

I included a fun little image of doctor humor, mocking the bad handwriting of doctors.

Oh The Stories You Hear! – Day 5

Today started bright and early, just like every other. Thankfully I’ve adjusted to the time shift though. The morning was quite the success. With multiple patients cleared in 1-2 layers and even more with lesions so superficial that no reconstruction was needed, I was done by 10:30. I had a 2 hour lunch break, so I went home to see my mom on her day off and talked with her for a bit before lounging on the couch to enjoy a single 42 minute Netflix episode before returning to work.

In the afternoon I met two patients who were great grandparents! One thing I love about all of the patients being around 70 or older is that they have so many interesting stories to tell!! Today I learned about the largest embezzlement scheme in Illinois, the Missouri University mascot is a tiger, standing desks are all the rage in corporate offices now, cow manure is worth quite a lot of money as fertilizer, and that people used to rub baby oil and iodine on their skin when they were my age and younger to try and get tan. It amazes me just how much I can learn from not only the brilliant doctors and nurses I follow around, but also these sweet and outgoing patients!

I also got to help out today a bit more and I was in charge of running the layers up to the lab to be frozen, sliced, and dyed for later inspection by the doctor. It wasn’t much, but I was glad to help out in any way I could!

One thing doctors need to think about even though they aren’t in an operating room is being sterile when doing a procedure such as a reconstruction. When doctors take layers and nurses assist them, they both use gloves from a box on the wall. These gloves are clean, but not sterile. When the doctors and nurses are doing reconstructions however, they take individually prepackaged gloves in their preferred size to put on for the procedure.

Oh My Melanoma! – Day 4

*Alarm blaring at 5am* – That is how I started my morning. Dr. Ingraffea normally starts his day at 7:30, but on Fridays he starts at 6:30, which unfortunately for my sleep pattern, means I too had to start at 6:30. He starts early on Fridays because that is the day he does surgery on melanomas. He told me I could come in at 7:30 if I wanted, but I figured I should go through what an actual doctor does on a regular basis, and besides, I would never pass up the opportunity to see surgery on a melanoma!

For basal and squamous cell carcinomas, it takes the lab about 30 minutes to stain the mohs layers, but for a melanoma, the layers go through a specific staining process to contrast the melanocytes from the background tissue. This process takes an extra 45 minutes, so Dr. Ingraffea really hopes he can get out the melanoma in one layer, or at the most two. Thankfully both melanomas were cleared in 2 layers at the most.

One of the patients was quite the bleeder, due to a specific known medical reason, so we were expecting it and had extra gauze ready. This patient’s reconstruction took much longer than others because we had to continue cauterizing the blood vessels to minimize bleeding. Dr. Ingraffea let me put on some surgical gloves and retract the skin as he cauterized the bleeders. It was so cool to be up close and actually getting to be a part of the surgical process!

Most cases were finished fairly quickly, which is exactly what I liked to hear on a half day! We did have one case that seemed like nothing but ended up taking 6 layers to clear and that is why mohs surgery is so important and useful!!

After work was done, I was able to make it to Cary Dermatology again and hang out with Hannah and Oyinlola for a drug rep hosted lunch. (We had Boston Market and it was delicious!!)

Catch 22 – Day 3

Today I shadowed Dr. Summers at Wake Orthopedics to see what a day in the life of an orthopedic doctor was (at least when they’re doing clinical work). Before I came to shadow, Dr. Summers told me to review the muscle groups of the general areas he sees the most, shoulder and knee, and sure enough, 90% if not more of the patients today were for the shoulder and knee.

The morning was mostly smooth sailing except for one difficult patient who was requesting some things the doctor just could not give her and feel medically ok with doing. I know that sounds vague, but for obvious reasons, I can’t really explain further. I must say though, the most informative part of my day was actually learning how to read an MRI scan. I had always seen them on the computer screens in those medical tv shows, but it just looked like a bunch of black and grey blobs everywhere. By the end of the day I was able to spot some of the tears in ligaments in the knee on the MRI scan without Dr. Summers having to specifically point it out, which was a major accomplishment in my opinion. Because I got to work in Cary today, I was actually super close to my mom’s workplace and got to drive over there for their potluck lunch and visit Hannah! It was great getting to see a friendly face after so much time working and so little time to hang out with people. We had an amazing lunch and then it was back to the races.

The reason I named this post “Catch 22” is because that was a phrase that can sum up a lot of the patients’ stories. For many of them, their problem was caused by a lifestyle choice, and by fixing their lifestyle choice they could fix the problem. The catch 22 though, is that the problem often inhibits them from being able to make that lifestyle change, therefore leaving them between a rock and a hard place.

I did very much appreciate by time in orthopedics, although brief. It sparked a new interest I never really knew I had!

All About the Nurses!!

Today I got to work a bit before Dr. Ingraffea and I got to hang out with all of the nurses for a bit and ask them some questions about their job. I got to follow one into the room as she prepped the patient for the doctor to come in and understand the hard work that goes into a doctors visit. I must day, nurses don’t get enough credit for all they do to keep the office running so smoothly! Once the doctor got in, we had a well paced day with a lot of interesting cases! Of course I cannot really disclose the information about the cases, but there were a lot of long cases and I got to look in the microscope and see where the cancerous cells were on the skin. Some of the patients were brand new and this was their first skin cancer, some past patients came for another removal, and there were a few there for a post-op check up, so I got to see all aspects of the job in just one morning!

Day One is Done!

Having to get up at 6am was quite the change after getting to sleep in for almost a week. I had bought some scrubs to wear as I shadowed at the Cary Skin Center, and let me tell you, they’re quite comfortable!! I made sure to bring my hydroflask to stay hydrated throughout the day, but it was definitely difficult because of the fast paced environment. I was brought to the lab and was taken through the process of preparing, slicing, and staining the slides for the doctors. It was quite an interesting process and it was crazy how thin they could slice an already thin layer of skin. Dr. Flynn used a different technique from the other doctors to remove layers. He uses a thin double edged razor which creates thin layers. I saw a lot of basic reconstructions on the face. My feet sure did hurt by the end of the day, but I absolutely loved it!