Week 2: Surgery

THIS WEEK WAS CRAZY.

I had my surgery rotation this week at the Military hospital in Quito. Monday morning George and I arrived at 8 am after spending nearly half an hour trying to hail a taxi. We were told to arrive in our scrubs and lab coats so we wouldn't get questioned by the guards but we still found ourselves being denied access to the elevators and having to sneak into the stairs and climb all the way to the 9th floor. Once we got to the surgical floor we met our doctor for the week, Dr. Vargas.  He is easily the most intimidating man I have ever met. Picture a Latin version of Dr. Cox (from the show Scrubs) with a hint of Professor Snape. 

The rest of Monday was spent following Dr. Vargas and his med students around as they did pre and post-op visits. Its general surgery, so there was a lot of appendicitis, gall bladder infections, and hernias. After, George and I were ordered to sit in silence for two hours as Dr. Vargas lectured his students on each patient and their case. And by "lectured" I mean he was red in the face, yelling across the table at these poor med students for being "incompetent and lazy morons." Somewhere between the yelling, George and I realized we weren't going to see an surgeries today. We left the hospital disappointed and a little terrified for the rest of the week.

El Hospital del Militar

Tuesday I woke up sick and couldn't go to rotation, so George faced Dr. Vargas solo. He befriended one of the med students that day who told him that in 1986 Dr. Vargas' uncle, General Frank Vargas, kidnapped the president of Ecuador and held him for ransom. The Vargas name is famous in Ecuador and mixed with Dr. Vargas' temper he is notorious in the medical community.

Wednesday we went into surgery right away. The first surgery was a hernia repair on a middle aged woman. It was incredible. From beginning to end I was standing shoulder to shoulder with the doctor as he opened her up, cut through the abdominal muscles, located the site of repair and sewed in a mesh net to reinforce the walls of the organ. I was completely absorbed by the surgery and forgot all about Dr. Vargas' temper until one of the nurses informed him they were missing a towel. Every gauze towel used in the body is carefully counted to avoid misplacing one. The nurse counted 9 towels entered the body but only 8 left. Vargas exploded and began screaming at the surgical team about how its their responsibility to count, not his, and that its his license on the line. The next 20 minutes were very tense as Vargas dug through the body cursing and the rest of us started looking under the table and through the trash. He finally found the missing towel jammed deep in the body. This is a common medical malpractice issue, and it was a very eye opening to see just how easily it can happen.

The second surgery of the day was a laparoscopic gallbladder removal on an elderly woman. We watched a TV screen as Dr. Vargas used the robotic arms to cauterize and cut away the inflamed gallbladder. His skill and speed were impressive and at one point I turned around to the window and saw a group of other surgeons watching and taking pictures from outside. Although I still think Dr. Vargas is unnecessarily frightening, I can see how he gets away with his temper. He is a very skilled surgeon and I'm glad I had the opportunity to see him work.

after 4 hours of surgery

Thursday Dr. Vargas sent us with another doctor to to watch a surgery because he didn't have any scheduled that morning. We watched a second laparoscopic gallbladder removal done by a female resident. It was virtually the same procedure as the day before except this time she put the inflamed gallbladder inside a condom before pulling it out of the body. This allows the surgeon to cleanly remove the gallbladder without worrying about it bursting all over the body. Very creative!

Friday was a nation holiday (don't ask me what it was, I have no clue) so we didn't have rotation or class

This week more than the last, I found myself realizing obvious differences between the United States and here. For example, I was never once told to wash my hands, before, after or between surgeries. The doctors kept the same booties, masks and hair nets through the whole day, throughout multiple procedures and I counted 5 doctors/nurses playing games or texting on their phones DURING surgery.

I learned SO much this week just by observation. I had no idea how much the human body can withstand and how resilient it is. It is incredible.