18NellL – CA Work Experience Program

Day 8

Today was my second and final day at the Triangle Veterinary Referral Hospital. It was a very slow day from an observers standpoint. There were no surgeries and no consultations that we were apart of. After we listened to the updates from the overnight patients, we just walked around all day watching what we could. A lot of new dogs and cats came in today with a variety of different problems. It is really sad to see how sick animals can get. Luckily, no animals were euthanized today, which is good considering how I started my day yesterday. Just before we left a dog came into the ER and everyone was frantically running around to try to understand what was wrong with the dog and trying to help it. Turns out the dog wasn’t in as bad of shape as the owner had claimed it to be. When things started to settle back down again, we headed out around 2pm.

Day 7

Today was my first day at the Triangle Veterinary Referral Hospital. I arrived at around 8am and met up with Katrine and Madi S. shortly after. The first thing we did was join everyone in rounds by listening to the updates about the animals who had stayed overnight. Our first consult of the day was for a dog in very poor condition. The dog had an equivalent of stage 4 cancer which was restricting it from going to the bathroom. The dog hadn’t eaten or drank anything in almost a week and was vomiting multiple times a day. The family decided to put the dog down that day to end all suffering. It definitely was not a good way to start my first day, but it is apart of the job and is good to experience. Our next consult was much much better. The dog was very upbeat running around the office, but unfortunately was healing from some fractures that had occurred the week before. While the doctor talked to the dog’s owner, we got to sit and play with the dog which was a good turnaround from the last appointment.

We then watched an amputation surgery. I know this sounds very sad, but we were reassured that the dog would feel significantly better after having the operation. After lunch, nothing big happened we just wandered around seeing all the little things going on around the office.

Day 6

Today was Claudia and my second day with Dr. McElveen, but also our last. Yesterday, we saw the clinic side of Dr. McElveen’s job, and today we got to see him perform two procedures. We arrived at the Duke Raleigh Hospital around 7am, but didn’t go into the first surgery until around 8am. The first surgery was around an hour long and he performed the whole thing through the ear canal which was very impressive considering how small it is. Here are some magnified pictures of the prosthesis placed behind the ear drum.

The next surgery we watched was after lunch and lasted again, about an hour. This surgery required the patient to be under general anesthesia because a large incision was being placed behind the ear. After this surgery, Claudia and I headed back to the office where we were yesterday and worked with the audiologists for a couple hours. We both saw two patients. The first was coming in for a “check up” because they had recently been fitted with a sound arc (a device to help you hear). The second patient was in because his hearing aid had gotten wet and he needed to get loners while his were being fixed. After these two patients, Dr. McElveen came back from another surgery that he performed while we were working with the audiologists. We thanked him, said goodbye, and ended our day around 4:45pm.

Day 5

Today, we were at a different location. Claudia and I were shadowing Dr. McElveen at the Carolina Ear and Hearing Clinic. Dr. McElveen is specialized in ENT (ear, nose, and throat). This was a completely different experience because not only does Dr. McElveen have a different specialty, but he also doesn’t work at the hospital unless its doing surgery. Today, we worked at his office where we met with patients all day. We arrived at 9am and worked until 4:30pm with an hour long lunch break at around 1. We did a mix of seeing patients with Dr. McElveen and seeing patients with his nurse. In the afternoon, he allowed Claudia and I to meet with two new patients of the clinic by ourselves. We were allowed to fill out their chart and ask them questions just getting as much information about why they’ve come to see Dr. McElveen. We then ran over everything with the nurse to make sure we had filled it out correctly, then presented like residence would to Dr. McElveen before he went in to see the patient. I don’t think ENT is something that I am very interested in, but I did enjoy seeing a completely different aspect of medicine. Another difference in Dr. McElveen’s practice and the hospital, was that Dr. McElveen still had patient files, like the one below, whereas the hospital had all its records on the computer.

Day 4

Today, we arrived again at 8am and quickly moved to the OR to watch a robot surgery which was being completed by Dr. Boulton, who by this point we knew pretty well because we had sat in on many of his long surgeries. This patient needed a bypass surgery but refused to have a sternotomy (opening of the chest). This surgery with the robot was less invasive and involved sticking the arms of the robot through the ribs, which also has complications like an open heart surgery. Dr. Boulton controlled the robot from a machine in the corner of the room. We watched what was happening on a television that was showing what the camera was seeing inside the body. Below is a picture of the robot used in the surgery. It definitely took up most of the room.

This surgery lasted from about 8:30am- 1:30pm. After a quick lunch, we visited the patient whose surgery I watched on the very first day in the morning. That was the only patient that I had seen multiple times and gotten the most information on during my whole experience at WakeMed and it was very cool to be apart of that experience. We then learned a little bit more about EKG’s and looked at the EKG’s of many random patients in the hospital at that time just to see all the information you can learn about a patient just from their EKG. Dr. Hamrick then had another surgery, but it was one we had seen many times, so we sat in on that for 20 minutes, then called it a day.

Day 3

Today was a more low-key day. We started at around 8:30am by looking at some crazy x-rays from a patient who had fidgeted with their pacemaker (which lies under the skin underneath the collarbone) and caused the wires, which were attached to the heart in specific locations, to become coiled up and removed from their original positions. This can be very bad, especially if the patient is relying on this device to keep their heart beating. After looking at these x-rays, we watched 4 very quick procedures in the cath lab. The cath lab is where minimally invasive procedures are done with catheters. The first procedure was placing a micra pacemaker in a patient. A picture of this pacemaker can be seen in the post from day 1 (it is the very small device next to the larger one). The second procedure was called a linq. It is a 10 minute procedure in which the patient is awake the entire time. This particular patient was young and had a stroke. The doctors didn’t know why, so they completed this procedure which inserts a small device right under the skin and detects when the heart is having irregular rhythms. It then sends data to the doctor to look at in the morning. The third procedure was replacing the battery in a pacemaker that a patient had. The batteries themselves cannot be replaced, the entire pacemaker has to be replaced for a new battery. In this surgery the leads were unscrewed from the old pacemaker and screwed into a new pacemaker with the new battery. The next procedure was similar to the first procedure we saw on day 1, where a regular pacemaker with wires/leads were placed into a patient. After this 4th surgery, we took a quick lunch break then watched our final surgery of the day which was seeing if a patient needed a stent or bypass surgery. To do this, the patient is lightly sedated and a catheter is brought into the heart through an artery in the arm. Contrast is injected and x-rays are used to see where the blockages are. The picture below is an example of what a blocked artery looks like. This picture is from the internet and not from the actual patient we saw.

After this procedure we called it a day at around 2pm after having two back to back long work days (as high school students).

Day 2

Today we started again at around 8am. After getting into scrubs and getting our official ID badges, we headed into surgery.

I saw two surgeries today, both performed by Dr. Boulton. The first one was another valve replacement, but it was a little bit more invasive than the TAVR I saw twice yesterday. The patient went on general anesthesia and the chest was opened by sawing through the sternum and exposing the heart. The aortic valve was being replaced so the patient had to go on bypass. This is when a machine works as the heart and lungs so that the heart can stop beating while the surgery is taking place. This procedure lasted about 2 1/2 hours. After the surgery ended, we took a quick lunch break, then headed back to the OR to watch another of Dr. Boulton’s surgeries. This second surgery was a triple coronary artery bypass. Again, the patient was placed on general anesthesia and the chest was opened to expose the heart. The coolest thing about this procedure was the heart never stopped beating as it was being operated on. The artery used for the bypass was harvested from the leg which I also got to see. This surgery lasted about 4 1/2 hours, and we stayed for the whole thing. In both of Dr. Boulton’s surgeries, he wore a camera on his head so that when he looked down, everything that he saw displayed on a screen which we could see from inside the OR. After this surgery ended, we called it a day and left around 5:30.

Day 1

This morning, we met Dr. Hamrick in the Heart Center at the WakeMed Hospital in Raleigh. After a brief introduction, we quickly got into scrubs and headed in to watch a surgery that he had at around 9 am. Before going into the O.R. (operating room), Dr. Hamrick gave us a quick overview of his surgery and basically how the heart works. This surgery was adding in an additional lead/wire to an existing pacemaker/defibrillator that this patient had in order to increase the amount of blood that is pushed out of the heart with each squeeze. We were allowed to stand in the OR to watch the opening and the closing of the incision, but we could not stand in the OR during the operation due to radiation from the x-rays. The nurses and other people in the room were so good about explaining everything to us and answering our questions in ways that we could understand. The company that made this specific pacemaker had a representative in the OR to code it specifically to the patient. This representative showed us the pace maker that this patient had, but also showed us a newer pacemaker that had just been developed.

After the surgery, we updated the family, did some rounds on patients, then we went into another doctors surgery which was called a TAVR. This is a minimally invasive procedure which replaces the aortic valve in the heart through a catheter. The replacement valve takes the old valves place and the old valve is not removed. After this procedure we did more rounds with a different doctor, Dr. Wood. We were then given a tour of the ER by a nurse, then we watched a stress test. Normally, these are completed by putting the patient on a treadmill and watching their EKG (electrical activity of the heart) and their bpm (beats per minute). This particular patient was very old and too fatigued to be able to go on a treadmill, so they did it chemically where a medication is introduced to the body which makes your blood pressure drop and your bpm to increase almost as if you’re exercising. After this stress test, we watched another TAVR, then called it a day around 5pm.