Hello everyone! This week started off slow and relaxing because Monday (6/12) was Philippines Independence day, so we got the day off! We used this as a day to explore Santo Thomas, and get some shopping, and laundry out of the way. On Tuesday we had our first day on the chemo unit! We mostly observed and got to see what a typical day is composed of there. The unit is all outpatient so first, patients typically come in, get their vital signs taken (manual BP readings!), and height and weight recorded. Then, they get a primary IV line put in, and they start running D5W to hydrate the patient before starting the chemo therapy. While the patient is getting hydrated, the Chemo Pharmacist is getting orders from the physician for what medications to prepare for each patient.
The process of mixing chemo drugs is very complex because of how toxic the medication is. First, the pharmacist puts on full PPE (KN95, hair net, double gloves, full sterile gown, and shoe covers). Then, they check what medication the patient is getting, and calculate the dosage. Then, they fill a 50 cc syringe with air to use during the drug mixing process. After that, they turn on the fume hood before opening any of the medications, creating a vacuum to not let any chemicals from the drugs spread in the air. Next, they open the medication and push a protector into the vial. This traps all the air and medication in one place so it can be discarded all together without contaminating anything else around it. Then, an injector in attached to a syringe, and that snaps into a port of the protector, and the medication is drawn up. Lastly, the syringe is connected to an infusion adapter that is attached to IV fluids, then the medication is pushed into the compatible fluid to dilute the drug, and then it is safely ready to be given to the patient. I have attached a picture below of the protector, injector, and infusion adapter.
On Wednesday (6/14), we got to assist the pharmacist in mixing chemo meds, and monitoring the patients. Wednesday was the units busiest day, they saw over 20 patients! I got to give patients IV push, and oral pre-medications. These were anti-nausea, anti-histamine, and a diuretic to help ease the chemo side effects. Before this I was unaware that chemo patients were given a diuretic. But, this is administered because chemo creates fluid retention and edema, so this drug is given to help the patient excrete extra fluid and salt out of the body. But, because of the diuretic patients can become dehydrated, which is why D5W is given pre-chemo, and drinking lots of water in encouraged. The diuretics also cause patients to get up and go to the bathroom a lot, which can cause other health problems, such as additional fatigue, and fall risks because of trying to navigate the IV tubing, and poll. So, it was important to assist and watch patients coming in and out of the bathroom. Additionally, I got to give subcutaneous shots to a couple patients, who received that type of chemo instead of IVF (IV fluid).
Thursday (6/15) was a very exciting day! We went up to observe in the OR because no chemo patients came in that day. In the OR we got to see a Arteriovenous fistula (AVF) created, and a total thyroidectomy! An AVF is a surgically created connection of an artery and vein, this was done on this patient for dialysis access. But, during the surgery a 6.2 magnitude earthquake hit Batangas! This resulted in the operating table, and equipment shaking violently. But, everyone was safe where we were, and the shaking only lasted a couple minutes. But, that was definitely an experience I will never forget! Then, later in the day we got to see a total thyroidectomy. This is when the surgeon takes out the entire thyroid gland. This surgery was also full of excitement because the power went out in the middle of the operation! And, everyone that wasn’t sterile had to pull out their cellphone flash lights to help the surgeon see what he was doing. Luckily, a couple minutes later the power came back on, and the thyroid was successfully removed.
On Friday (6/16) we were back on the chemo unit. I helped take vitals, give medications, and monitor patients. There were only 10 patients that came in that day so we were done by noon. But, it was one of the chemo nurses birthday so she brought in a Lechon (whole, roasted piglet) for everyone to enjoy! After the birthday feast we went back up to the ER to watch a laparoscopic cholecystectomy, which is the removal of the gallbladder. Thankfully no power went out during this operation! Then, Sam got to assist a surgeon in the excision of a patients back mass. And, then once we were done we left from the hospital to catch a bus to Manila!
We got to Manila around 8pm on Friday night, and we met up with other IWU Freeman Asia interns! We all went out to a nice dinner and had a great time. Then, on Saturday (6/17) we explored SM city Bicutan, and hung out in the pool till the sun went down.
Finally, on Sunday (6/18) Sam and I took the bus and jeepney back to Santo Thomas. And now, it is time to prepare for a week on the hemodialysis unit!
Thank you for reading, stay tuned for next week!
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