Author: teja_wasudev

Today was very fun! I learned about kinds of skin cancer and how to remove them. I shadowed Dr. Housman at her practice, which mostly removes skin cancer embedded in people’s skin.

The cancer these people had was called Basal Cell Carcinoma and Squamous Cell Carcinoma. These cancers aren’t fatal if they are removed when they are first noticed on the skin. So, no chemotherapy is necessary for these types. The way that Dr. Housman removes the skin cancer is really fascinating. She uses Mohs Micographic Surgery method. She explained to me the very specific and detailed steps, and how successful this surgery is on getting all of the cancer removed.

Dr. Housman let me assist on two procedures after I had seen a few! I helped blot the blood away on the patient’s skin when she or the surgical assistant was stitching up the wound, I handed tools to the person stitching, and I held the extra suture out of the way while she was stitching. I had never done something like that before, so I am very thankful I got that experience!

On 6/1, I drove all the way to Lillington but it was worth it. I got to shadow Dr. Lewis who is a cardiologist. I followed her in the clinic and met many people, who were mostly very old. I met an 86-year-old man! The patients mostly lived in the country, so many of them suffered from old tobacco farm smoking or secondhand smoke. It was cool to see how history can impact people’s lives and health today. The most exciting part of my day was seeing how a nurse practitioner and another nurse run a stress test on a patient in real-time. The patient had to walk on the treadmill as fast as she could with monitors on her chest. She was experiencing chest pain, so that’s why the doctor ordered her to take a stress test. Immediately after she couldn’t walk on the treadmill anymore, she went over to the chair and the nurse did an ultrasound on her heart. The nurse looked at all different angles and from the final ultrasound pictures, she could look at her heart function before and after exerting herself. She explained to me the anatomy shown at different angles and what they were looking for in a healthy heart. The patient luckily had healthy heart function!

After all the appointments were over, Dr. Lewis explained to me how she reads cardiograms. Earlier, I had listened to a lady’s heart that had every other beat too early. She showed me how that is represented in a cardiogram. Below is an example of what that can look like (the arrow points to the early beat).

On 5/31, I shadowed Dr. Schweitzer. He works at a Duke Orthopedic office and does clinic and surgery. I saw him on a clinic day, so I got to see various patients. The patients that came in were all adults and some of them were seeking post-surgery care. The most common case we saw was people with bunions. I learned that bunions are genetic, but they can be obtained. There were patients getting a consultation because their bunions were becoming unmanageable, so surgery was scheduled. There were other post-op patients recovering from bunion surgery and making sure everything was healing well. Dr. Schweitzer showed me various MRIs of bunions, and here is an example.

The MRI on the left is of a normal-looking foot. The bones are straight and the big toe isn’t overlapping with the neighboring toes. The MRI on the right is of a foot with a bunion. Bunions cause pain when walking and standing, trouble with proper fitting shoes, and swelling. Bunions decrease quality of life, so many people need surgery to fix them. It is a long process because bunions usually occur in both feet.

I also met patients who had arthritis in their joints and needed ankle replacements. I learned about this procedure and realized how common it is, especially in older adults.

Many patients don’t know about the disease or illness they are facing, so most doctor’s offices have pamphlets so that patients can educate themselves. They were also very helpful for me so I could learn more as well!

Today was my last day at Wakefield. Today, I saw a lipoma removal, a mass removal, a gallbladder removal, a hernia repair, and an attempt at getting a sewing needle out of someone’s foot. During the first few surgeries, the anesthesiologist explained to me some of their responsibilities during surgeries. They first have to find out if the patient is allergic to any anesthesia and know not to use it for the surgery. Then, while nurses and surgical techs position the patient for surgery, they place a breathing tube strategically to make for the best airflow. Most of the time, the breathing tube has to go directly to the lungs so that they can have total control of the person’s breathing. The picture below is where anesthesiologists keep their supplies and do nonsurgical work.

The very last case of the day was removing a sewing needle from someone’s foot. A woman accidentally stepped on one and it went deep into her foot. Most of it came out but a small part broke off and is still very deep in her heel. The podiatrist tried for a long time to get it out, but the needle piece was too deep. He used an x-ray machine to see the needle piece, and though he knew the location, it was still too far in her foot. Unfortunately, the needle will not eventually travel up to the surface but will likely stay there forever. He also said it will likely not cause her pain or even feel it but because they just performed surgery, the area will be tender for a while.

On 5/26, I went back to UNC REX at Wakefield to shadow Dr. Dorfman and his colleagues. Today was super interesting because I saw a tympanoplasty which is a surgery to repair a ruptured eardrum. I watched Dr. McElveen take a skin graft from near the ear and use that graft to help heal the hole in the eardrum. The first picture below is a close-up of the skin graft.

The second picture is of the eardrum after it has been covered with the skin graft and another layer of tissue to secure it. It is not completely in place because this photo was taken mid-operation, so there is still a gap.

What was even more exciting was watching a vitrectomy. A vitrectomy is when the surgeon removes the vitreous in the eyeball and replaces it. He also did a membrane peel to remove scar tissue over the patient’s retina. This surgery was performed by Dr. Thordon. He was kind enough to let me observe through the microscope while he operated. It was very important for me to remain extremely still since I was right next to him and was looking through the same double microscope. To be able to do this, I had to wash my hands and arms with a special solution, wear a gown and gloves on top of my scrubs, only touch the sterile objects in the room, and be aware of the non-sterile objects so as to not contaminate. I was nervous because of all of the protocols and being so close, but it was a surprisingly quick surgery.

Lastly, I saw Dr. Dorfman perform a septoplasty which straightened the patient’s septum. The patient had a hole in their septum, so this made straightening it more difficult than normal.  He also opened up the patient’s sinuses to reduce infections.

This was my second and final day shadowing Dr. Grace. Today was another clinic day where I saw more patients with misalignment, cataracts, chalazion, and tear duct issues. I saw mostly toddlers and infants, who tend to need more eye care than teenagers and middle-aged adults. Dr. Grace taught me more about eye anatomy and common eye diseases.

Many eye abnormalities don’t need treatment, such as the pupils being two different sizes or if one eye drifts to the side, if they don’t impair the patient’s vision. It is often best to not treat an abnormality if it isn’t causing problems with vision because surgery, glasses, or patching could make it worse. I also learned that issues in the eye could just be symptoms of a larger systemic problem. An example of this is diabetes, where high blood sugar levels can cause cataracts to form in the lens. A less extreme example is allergies, which can inflame the insides of the eyelids or cause tear ducts to clog.

On 5/24, I shadowed Dr. Grace during her clinic appointments. Before this, I did not know much about ophthalmology, so I learned about the most common issues patients come in for. I learned about chalazion, strabismus, cataracts, tear ducts, and more! The most exciting part of my day was when Dr. Grace and I went to Duke University Hospital for an emergency visit for a baby with issues with her tear duct. One of her tear ducts was producing excess tears and mucus. After examining the baby’s eye, Dr. Grace concluded she has an infection and will need IV antibiotics to treat it. After the hospital visit, we went back to the clinic and saw more patients! Dr. Grace explained to me the importance of asking patients the questions in the image below and collecting important medical history to help diagnose the patient accurately.

Today, I shadowed Dr. Dorfman, Dr. Bloeden, Dr. Vig, and Dr. Day. I was able to see two ear tube operations, two gallbladder removals, and two hernia repairs. I have never observed a surgery before, so being in the OR taught me many things. My favorite part of today was seeing two different methods for hernia repairs. Asking the doctors why they choose their preferred method over the others taught me how creative surgery can be. I learned not just from the surgeons but from the nurses as well, who explained different steps of the surgery and important procedures. I felt very lucky to be able to see ENT operations as well as general surgery. I am excited to come back later this week!

I will be shadowing at various doctor’s offices for the next two weeks! I am very excited about this opportunity to learn about a doctor’s usual workday.