4 Surgeries

Here lies my rather lengthy tale of the surgeries I observed today. I focus a lot on the actual procedures as I thought it was fascinating. I liked the opportunity to write it down to help me think about it and the amazing bodies God has given us as well as the ability to operate on them. I'm going to try and report this as accurately as it happened, but given the fact that I'm not a doctor and am human, I'm sure mistakes will occur. Here is the gist of it anyways.

I entered the OR with Marc and Chris; they like working together. The first case was a (rather large) woman and she had a tumor on her right cheek. It wasn't complicated or big, so we think she was a paying patient (also judged by her rather largeness - if she could afford that much food, she could afford surgery). I was watching as they prepped her and was doing all right. Chris cut an incision over the tumor with the scalpel and then used a tool called a Bovie (ever heard of it?) to cut deeper into the tissue and to create a skin flap under the incision to get room to work with. The skin actually separates rather nicely from the other tissues and so this gives a large area to work with even though the incision is small.

It was somewhere around here where I started feeling really hot and soon after started having blackness crowd into my vision. I got a bit dizzy and said "I'm not doing so good" and made my way towards the door but another Chris got a chair and gave me some things to put in a plastic bag just as a stupid thing to keep me busy and occupied. What surprised me was the dizziness came on fairly quickly and I wasn't really thinking about it. I didn't think "wow this is disgusting' or anything like that, I was watching pretty interested because I love learning stuff and seeing stuff, and then I was gone. I didn't faint, but it was pretty darn close.

I got up after a bit and then watched maybe 20 seconds before deciding to call it quits for a while. I drank lots of water and walked around the hospital a bit looking for people for different things. When I came back I felt a lot better and waited for the next one. The surgeries actually went pretty quick today, but the time between the surgeries was at least an hour.

The next one I watched was of a baby, I think I heard 18 months. I think the condition is called hydrosephalis or something like that but basically there is fluid in the brain. Chris did most of this surgery too and after the baby was prepped and I well hydrated and taking deep, steady breaths, Chris made a "C" shaped incision on the right side of the baby's head. After making the incision he used the Bovie to separate the skin and tissue from the skull so when he peeled the skin back the bare skull was exposed.

As Chris did that, Marc was checking out the shunt and figuring out how this particular one worked and operated. He also filled it with a saleen solution and checked the pump on the shunt and got it ready to be inserted.

After the Skull was exposed Chris made an incision at the base of the shoulder and neck and another in the abdomen. Once these incisions were made and ready for later, Chris drilled a hole in the skull. It was maybe a quarter inch in diameter. I wasn't really looking at it for a size comparison, but I think that's about what it was. The first drill bit was really dull so he changed it and tried again. It was no time at all and he was through the skull.

This next part was so cool. The shunt itself was about the length of a pen but much thinner. There were little perforations along it's length and a tube opening at the top to attach to the pump and tube already strung through the baby's body. Lining up the shunt from the hole in the baby's right side of the skull to the left eye, Chris simply pushed it into the brain. After a couple centimeters, fluid started coming out of the top and I think he went another centimeter beyond that and the shunt was in place. There was a metal rod inside the shunt and he pulled that out and fluid poured out like a hose. Marc was clamping it shut a bit to slow the flow of the fluid so it wasn't too drastic of a change for the baby's body. The shunt was cut to size so it was a little past level of the skull, a 90 degree elbow was put on top of it, and the pump tube attached to the elbow. The pump tube is what made use of the other two incisions to get the tube from the baby's brain to the abdomen. This was really cool because as soon as the pump was attached, they tried it and pushing the pump caused fluid to come out of the end of the tube, so it worked.

Using a guide sort of like people sometimes use to guide feet into shoes (bad example of what it looked like but half way decent for how it worked), he started from the skull incision and worked the tube and guiding tool under the skin layer and down to the incision at the shoulder. That was pretty weird watching this thing push under the baby's skin from his skull to his neck. After the shunt was pulled that far they situated the pump for the shunt against a bone and got ready to make the next pass. Chris then made his way from the shoulder incision to the abdomen incision. After pulling the shunt tight from the skull, there was about two feet of tubing left. They conveniently just shoved the tube into the abdomen cavity of the baby so it would be there when he grows.

After that it was pretty basic as they closed the wounds up. The stitching is actually pretty simple and I was surprised at how much they could pull on it and get it tight. The human skin is pretty tough and can take a lot. I also noticed none of the incisions tore or anything like that, again showing how tough the skin tissue can be because at times they would move and pull on it quite a bit. To drain the fluid in the baby's head someone just needs to push the little bulb pump under his skin by his ear and the fluid should drain into his abdominal cavity where the body clears it out. It was a pretty spectacular surgery.

I'm not entirely sure if it happened in that order of shunt, pump, threading through the body, but that's the gist of it. That was surgery two of four.

I saw an X-Ray for the third surgery when we first got to the hospital in the morning. It was a chest X-Ray and you could see the esophagus and as it went to the stomach it was almost completely closed due to muscle tissue and scaring around the esophagus. The esophagus was a white tube maybe an inch in diameter coming up to a hazy looking circular shape (the stomach) and before it got to the stomach the white looking esophagus came almost to a complete point showing it was blocked off. I watched as Marc explained what was going on to the doctor in a book and got a pretty good understanding of what would happen.

The surgery started with us walking in on a young man (teenager maybe) naked on the table. They prepped him with sterilizer stuff and covered every part of him not being operated on with robes. This surgery started with an abdominal incision 6-8 inches long right in the middle of the stomach where there isn't any muscle to cut through. This surgery reminded me the most of deer hunting as I could see some of the organs and thought "hey, I know what that one is." Working within this incision Marc was looking for the esophagus and soon enough they found it. They were using these "L" shaped tools to hold the organs and skin back and also pieces of sterile cloth to get a better grip on the skin and organs. Once they found the esophagus they got around it and put a rubber hose underneath it. This they clamped to the cloths covering the boy and this kept the esophagus from falling down again.

From here they used the Bovie to cut the tissues and muscle around the esophagus starting all the way at the stomach and extending about 6-8 centimeters up the esophagus. Marc said the biggest failure rate on this operation was not clearing close enough to the stomach. Marc actually worked a bit on the stomach making sure there wasn't any muscle tissue in the way that would grow again and cause more problems. What surprised me here was how much Marc was showing with this guys stomach cut open. He was moving around organs and at one point actually had the stomach out of the body completely to show things and it was cool. When they sewed up this guy they first sewed the tissue under the skin and then sewed the skin shut so it was a double stitching (I think). Marc let the doctor from HEAL finish up the stitching and he's pretty confident it will be a successful surgery and this boy who hasn't been able to eat for a long time will be able to have fluids for a week, soft food for a week, and then real food for the rest of his life. Having just come from dinner, I think that's pretty darn incredible.


The fourth surgery was a long time in coming. The surgeries take less time than the turn-over between patients here and really we waited well over an hour, and possibly two for this last surgery to get under way. This final surgery was on another boy who had some lumps on his neck. Marc found out right before the surgery that he was being treated for TB so the lumps were probably expanded lymph nodes (which they were) and that at least answered one question. For this surgery, Doctor Luke (a doctor here) was doing it and Marc was assisting. This was a good one to watch because there weren't a lot of people and I could see everything great, but was much less dramatic than the last two.

An incision was made and the hunting with the Bovie began. As lymph nodes were identified Luke would cut the tissues around them and Marc would position it for a good cut until the whole node was free. This surgery was a bit cautious because of nerves in the area but they determined there weren't any in the immediate area and went along fine. They removed 4 nodes and there were more smaller ones, but they were too difficult to get at or were too small to worry about. They might shrink a bit as the TB gets better, or stay that size, but it shouldn't matter.

The coolest part about this surgery was watching them stitch the wound back up. Marc was showing Luke how to make a hidden stitch and once it was done, there was no stitches showing and it was a pretty smooth wound. The boy is young enough that he will have a scar, but it won't be that bad at all.

Overall, I was surprised at a couple things. I always knew they had to do something to stop the bleeding as they operate and the Bovie does a great job of that. The Bovie is an electrical instrument that has different settings for cutting tissue and coagulating blood. A metal plate with some sort of jell is placed under the patient to create a circuit and this is how all work inside the body was done today.

I was also surprised about how little blood there was overall. When they made an incision it was usually in a safe place to do so and not a lot of blood was there.

I was again surprised at how hard they would pull when they were stitching the wounds shut and how hard they could be on the skin and tissue. Looking at a deer I can kind of understand it, but I thought our skin would be a bit weaker than that, and it might be, but it didn't really look like it. They were always clamping and puling on it and it was fine.

All in all, it was pretty cool. I might try and catch a couple more, but the next couple days might be busy for me too so I'll wait and see what happens. I could always watch Joe too when he operates, I just have to remember to breath and drink lots of fluids.