from Michele Torosis, medical student

Friday was one of those milestones all medical students (not so) patiently anticipate, the first time scrubbing in on a surgery.  After spending Thursday with one of the general surgeons, Dr. Sharp, seeing the far less glamorous clinic side of surgery, I was able to scrub in for the first time in the glamorous OR of Ayacucho.

The morning started with the anesthesiologist, Dr. Rinehart, guiding me through starting an IV on the patient.  After that I learned the sterile procedure for scrubbing in.  Finally my hands were inside the patients abdominal cavity.   The surgery was a palliative gastrectomy on a 80 year old lady with a large gastric tumor which had most likely metastasized.  Due to the high cost of a CT scan, the surgeon had decided to proceed with the surgery without one, deciding that a CT would not change the treatment of the patient.  Having done the fore, mid, and hindgut dissections in anatomy class, I felt confident knowing exactly where and what I should find in this region.  However, with blood actually coursing through all the arteries and veins, I learned I couldn’t even identify for certain the middle colic artery.  The two general surgeons verbally guided me through what they were doing.  My job was to retract, cut sutures, and suction.

Freeing the stomach from the greater omentum and the transverse mesocolon was the most tedious part of the surgery, not having the same tools as in the US.  After the tumor had been isolated and the stomach freed, it was time to remove it.  The tumor had taken over the entire greater curvature of the stomach and the majority of the stomach had to be removed.

Four hours later, my back started hurting, my hands were cramping and I was seriously starting to question my stamina.  Surgery has always been something I am interested in, but what if I am not strong enough to make it through back to back to back 5 hour surgeries?

After the patient was closed and bandaged up, I put in a foley catheter and helped the anesthesiologist transfer her to the recovery room.  Watching the patient quietly rest in post-op, surgery a success, I felt for the first time in Ayacucho that I had helped significantly improved the life of someone.  I had been a part of seeing the patient in clinic, taking her history, examining her, scheduling her surgery, and removing her tumor.  This experience was a nice finale to a diverse week of experiences and has excited me for our second week in Ayacucho.