Hospital del IESS

At Hospital IESS I worked with OB-GYN Dr. Salazar. Although I only shadowed for 3 days, I saw a ton that interested me. I made a point to arrive early on my first day because the hospital is ENORMOUS. Very easy to get lost. I definitely got great practice asking for directions, in spanish, inside this maze of a hospital. The ironic thing about that is whenever I´m wearing my white lab coat in a clinic or hospital, passersby think I have all the answers so people are constantly asking ME for directions! I always explain that I am a student, and just as lost as them. This always ends in a good laugh.
Day 1* 11/10: Cryo/Colpo Procedures
I found the Cryo/Colpo procedure room with 15 minutes to spare. A girl my age was waiting patiently outside for Dr. Salazar with questions about the need for a 2nd Colpo. She explained to me that didn´t feel that the first Colpo had been warranted, and now she had an appt for a 2nd with the same doctor as before (Her first doc was not Salazar.) She and I had a good chat about health, life, working at National Parks in the U.S. I definitely imagined her to be someone I could be great friends with. But we parted ways and I never saw her again.
Dr. Salazar´s visits that day consisted of 3 procedures: the most interesting was a Cervical Cone procedure performed on a young woman who had malignant cell build-up on her cervix. Evidently her first Cx Cone procedure had not been successful, therefore over time causing her cervix to build up a significant amount of cancerous tissue. Dr. S numbed her cervix with Lidocaine (2%?) and began the cauterizing the malignant cervical tissue. After cauterizing he used a tool that looked like a vegetable peeler to scrape away/remove it from her cervix. Yikes. The pt could feel everything! He had to numb her up 2 more times before it was completely effective. She also bled profusely and he had to cauterize and gauze her cervix for 30 minutes until it subsided. I asked him about this reaction to the procedure and he explainedthat there was additional pain and excessive bleeding because of the trauma caused by her first cone. The final product removed from her cervix was golf-ball sized tissue that he saved to send to pathology. We brought a wheelcahir for the patient to leave in and recover in a private room. Dr. S followed up with her 45 minutes later, checked her cx bleeding, her condition had greatly improved.
Day 2* 11/11: Consulations with Dr. S, Dra. Paez and Marco (resident.)
Dr. Salazar saw femal pts in 15-min appts for: APEs, mgmt of high-risk pregnancies, prenatal care and referrals for surgery. It was a slow day; we had a few no-shows. I learned a lot of gynecological vocab and talked with Dr. S et al about music, dancing, pop culture. I learned that Dr. S loves Cat Stevens, Barbara Streisand, and that his favorite song in all the world is "Dust in the Wind" by Kansas. His cell phone ringtone is an instrumental electric piano version of that song; when his cell-phone rang in surgery the next day it took everything I had not to laugh out loud!!!!

Day 3* 11/12:  Laparoscopic Surgery: Total Hysterectomy for 47 y/o woman with uterine miomatosis
I arrived early to meet Marco, the current resident working with Salazar. Marco showed me the ropes about how to scrub-in, where to get booties and bouffants etc. We entered a pristine surgery room with 3 crash carts full of sterile pack-wraps containing a range of instruments and sterile scrubs for the operating staff to wear.. Each sterile pack had a perfect envelope-fold that I appreciated and I knew my old Lab Supervisor Patti would rate as A+! (Shout-out to Patti McKie @ SRPP who taught me all I know about sterile technique.) They used state-of-the-art equipment and had 6 different monitors displaying the hysterectomy. I wasn`t able to snap many great pics because the room had green lighting for most of the procedure. The surgeon used a pedal to control the cauterizing and cutting of the uterus. There were 4 incisions (points of entry) on the patients´ belly to allow a pathway for the instruments that would cut and cauterize internally. ......Fascinating.

To do the work of a surgeon you must apply so many forms of knowledge, skill and kinetic technique. As a team of docs, nurses, & residents you must work as a team to achieve the desired result. This was by far the most calm & collected team of medics I have seen conduct surgery. After the uterus was cut away laparoscopically, the uterus was removed from the vaginal canal with several instruments. Marco was excited because he got to assist in the removal of the uterus. The uterus came out with ease and was immediately placed in a plastic bag for future biohazard use? no sé. It was the size of an oblong football because of the uterine miotoma. The docs inserted a thick mesh to support her internal remains and avoid a prolapse. The patient awoke from anesthesia in a panic, as I would imagine. The docs were very good with her and used the phrase "sea tranquila" to calm her down and return to a stable state.