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Warning: This blog contains a graphic image of surgery

Hello Everyone!

This week Sam and I moved around various units. We were supposed to be in ICU, but Monday-Wednesday there were no patients. Monday we continued to work on our case study presentation. Then, Tuesday and Wednesday, we observed in the OR. Some notable surgeries that we watched were a total thyroidectomy and an excision of a submandibular gland. A total thyroidectomy is when the surgeon takes out the patient’s whole thyroid gland. This surgery is very interesting to watch in the beginning but it gets tedious because the surgeon has to cauterize and tie off veins since excessive blood in the neck could be damaging to the patient’s airway. Excision of a submandibular gland is a common surgical procedure to remove one or both of the salivary glands under the jaw. This patient specifically got their gland removed because they had a blockage in their duct.

On Thursday, we got to see a total hysterectomy which was fascinating to watch. A total hysterectomy is when the uterus, ovaries, cervix, and fallopian tubes are removed. We got to look up close and dissect the organs afterward which was very interesting. It was surprising to see how small the uterus was, it was about the size of a fist before it was cut open. One of the previous weeks in the OR we saw a dilation and curettage which is a procedure to remove tissue from inside your uterus. So it was fascinating to see the inside of the uterus and make the connection of where someone would remove tissue for this diagnostic test. The surgeon also showed us the cervix, and it was crazy to see how small the cervix and its opening are on a non-pregnant woman because it is hard to imagine it can open up to accommodate a fetus during childbirth.

On Friday, Sam and I were in the ICU. We started the morning learning about all the medication in a “crash cart”, and working on medication calculations. Then, we were each given our patient to monitor, take vitals, feed, bathe, turn, and any other care they would need. My patient required vitals to be taken every hour, strict NPO, and urine output monitored every hour. My patient had a Glasgow Coma Scale of 15 which is super high, and abnormal for a patient in ICU. The GCS assesses a person based on their ability to perform eye movements, speak, and move their body. These three behaviors make up the three elements of the scale: eye, verbal, and motor. A person’s GCS score can range from 3 (completely unresponsive) to 15 (responsive).

After our duty on Friday Sam and I made a trek to the Manila Airport to go to Palawan! Palawan is a popular beach island in the Philippines. We got in late Friday night. So, Saturday morning we woke up bright and early to seize the whole day in El Nido, Palawan. We met up with ALL of the IWU Phillipine interns and went on an island-hopping tour. The tour was amazing, we got to explore 5 small islands, go snorkeling over coral reefs, and kayak in the Big Lagoon. The Big Lagoon is a famous body of water with caves you can explore and swim in.

Sunday, Sam and I headed back to the airport to trek back to Santo Thomas.

Thank you for reading! Talk to you next week!

Hello Everyone!

This week Sam and I were stationed in the Hemodialysis unit. Hemodialysis is the process of purifying the blood of a person whose kidneys are not working. On Monday (6/19), we observed the nurses and dialysis techs perform their duties. First, I observed the nurses access the various access ports. There are four types of ports used for dialysis, AV fistula, AV graft, sub-clavicular catheter, and inter-jugular catheter. Depending on what port the patient had the nurse used a different technique of connecting the patient to the dialysis machine. With an AV fistula, and AV graft a large gauge IV is inserted into an artery and vein. The sub-clavicular and inter-jugular catheters are permanent catheters that stay under the skin, and the nurse just aspirates the arterial and venous port and then connects the patient to the machine. The dialysis machine was very overwhelming at first, it just looked like a mess of tubes going in every direction! The machine works by two tubes that are connected via your hemodialysis access (large gauge IV). Then, Blood flows from your body into the machine through the arterial access port. Next, Your blood enters the dialyzer, where it is filtered. Your blood goes through another pressure monitor and an air trap to make sure it’s safe to go back into your body. Your cleaned blood returns to your body through the second tube attached to the venous access site.

On Tuesday (6/20), we observed more, and here are some of the things I learned. Dialysis patients come in every other day for the rest of their lives! And, each treatment is 4 hours! I can only imagine how interruptive this is in your life. It would be very hard to keep a job where you need a minimum of 4 hours off every other day. Additionally, I had one patient tell me his daughter lives in Sacramento, California but, he’s never been able to visit her because he has to adhere to his dialysis treatment. Another thing that surprised me was how young so many patients were. In the States, I’ve only witnessed dialysis patients that were 50+, but here patients started as young as 17. One, of the nurses mentioned that they had a 3-month-old dialysis patient, but they have home care so I didn’t see them. In an oddly common occurrence on Tuesday afternoon, the power went out again! This resulted in all the machines stopping and sounding alarms for what felt like an eternity! Luckily, the power eventually came back on and the patient were all able to complete their treatments.

On Wednesday (6/21) I was able to cannulate a patient! Personally, I felt that it was much easier than inserting a normal IV. The process of doing this is auscultating the fistula. A working fistula has a very unique sound called bruits (it sounds like a train horn). Then you feel the artery for thrills, thrills feel like a small motor vibrating. Next, you feel the venous port for a bounding pulse. Then, you clean the site with alcohol and insert the large IV in the artery, followed by the vein. I was only able to cannulate patients with fistulas because the graft was too delicate and required a skilled nurse. I was also able to connect a patient with a permanent catheter to the machine, but that was a much simpler process. It was pretty similar to connecting a patient to IVF.

Thursday (6/22), and Friday (6/23) were the same as the other days. Overall, I learned a lot about dialysis, and I’m very grateful I got the opportunity to see this specialty.

On Friday (6/23) Hunter (another IWU intern staying in Manila) came down to visit Sam and me. We all went to a local bar with live music called The Neighborhood and had a very fun time.

On Saturday (6/24) we all went to Tagaytay. Tagaytay is a cute, mountain city that overlooks the Taal volcano. We went to Skyranch which is an amusement park and we went on the Ferris wheel to get the best view of the volcano! Then, next to the amusement park is a famous statue of a pair of praying hands so we checked that out. And, then we went to a very nice steakhouse for dinner. And definitely, the highlight of my week was seeing someone in an England Football jersey!

Sunday (6/25) we accompanied Hunter back to Calamba so he could take a taxi back to Manila. And, then we headed back to our apartment to get ready for the week!

Thank you for reading, talk to you next week!