Tag: MohsSurgery

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.

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.

*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!!)

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!

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!