Starting off this week, I spent a day working on my project
related to Bloom’s Syndrome. Beyond that however, I got an amazing opportunity
to witness a grafting surgery for a patient with a tumor in their mouth. I have
to say that television and the movies get these surgeries wrong. First, the lighting
in these rooms is way better than depicted on screen. Second, the surgeons are
a lot calmer in this setting than I have ever expected. Listening to rock music
and making jokes is not what you would think is part of the surgery process. I
will now describe the entire all-day process from the moment I stepped in the
OR with my maroon scrubs, head cap, and face mask.
Walking into the OR, the room is slightly chaotic as the
patient lies in the middle of the room in pain. The doctors must sedate him
carefully through his nose (due to the tumor being in his mouth). The massive tumor
was visibly protruding from the inside of their cheek to the gumline. I was
informed that it would be removed with a good chunk of surrounding tissue. It
was unclear whether this was benign or malignant, but either way, you could tell
this patient was in pain. Once he was asleep, the feeding tube was inserted and
pulled through the stomach to prevent tubing in the mouth. The doctors then
proceeded to put on the radio and begin their long day. Removing a tumor in the
mouth is a very delicate process that leaves a giant gaping hole from the
inside of the mouth down to the neck. To fill that hole, a tissue graft from
the forearm was surgically removed using heated tweezers that would just snip away
at the fat and skin tissue. The tissue would be pulled back until veins and
arteries attached to them would come into view. These were then cut from the
forearm to provide an entire vascular graft that would be inserted into the
mouth. One of the more awesome visuals was seeing tendons and muscles that were
alive in the body just in their proper place but fully exposed. The next step
involved putting skin from the thigh (a small layer) onto the forearm to cover
the exposed tissues. This would help the forearm repair itself from the inside
out. By far the most interesting part of the surgery was the vascularization of
the newly implanted graft. The surgeons used a microscope to catch every detail
of the veins and arteries they need to attach and suture together. Once this
was done, the blood would rush back in and you could see it was like any other
vein flowing through the body. After they closed the neck, I left that surgery
in awe of what we could do to repair the body using its own parts and how we are
pretty much like a well-oiled machine.
After that experience, I spent the rest of the week back in
genetics learning more about dysmorphisms and developmental delays in genetic
disorders. Genetic disorders come in a wide variety of symptoms and visual cues.
They are often way subtler than what Google shows. For worried parents to be
who go through in vitro fertilization, there is an option to discover hereditary
genetic disorders called pre-implantation genetic diagnosis (PGD). PGD checks
for any embryos that carry inheritable genetic disease and this allows for
viable embryos to be implanted into the uterus that do not carry any marker for
the genetic disorder being screened. This is, of course, limited to a known genetic
disorder in one of the parents. However, there are concerns that technology like
this and genome sequencing could have ethical ramifications. This discussion is
always ongoing as the philosophy of our society grows with the advancement of
such technologies. Questions that are often asked when something new like sequencing
and screening arise are how this affects people’s information or to what end
could this technology could be used against people. Being on the clinical end
of this type of work clearly shows the concerns that both clinicians and patients
can have with such tools, but advancement is mostly optimistic since these
conversations are often very open and respectful to patients.
So far, this week has been an interesting experience on both
the clinical and philosophical level and I have thoroughly enjoyed it.
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