Weeks 1-2, CGregg

Week1

For my first two weeks working with Dr. Spector in plastic surgery has proved to be enlightening.  Starting the first day of immersion, I followed Dr. Spector during office visits, his usual Monday schedule.  Here is where I saw many post-operative patients including multiple limb reconstructions from accidents, several skin wounds, and a few unfortunate patients who were suffering from complications from previous operations.

On Tuesday of the first week I met plastic surgery residents and followed them on rounds starting at 6am.  This side of care was very different from the standard office visits that I experienced on Monday.  Many of these patients had just undergone major surgery and were still recovering.  Additionally, some patients had suffered serious complications which needed to be addressed.

Wednesday proved to be the most exciting day when I was allowed by Dr. Spector to be a part of my first surgery.  After first seeing a scar revision, I then retracted a patients abdomen for 6 hours while watching a hysterectomy, abdominal wall reconstruction for a hernia, and inspection of the intestines for visible signs of complications from severe Crohn's disease.

Dr. Spector was out of town for Thursday and Friday of the first week.  During this time I worked on my Specific Aims and Gantt chart for my research project.  Through Skype meetings with Dr. Butcher in Ithaca and research meetings with Dr. Spector, we established that I was going to attempt to build a vascular network from bioprinted scaffolds from the Butcher lab.

Week2

After the first week, the schedule with Dr. Spector has become fairly routine.  On Monday, I follow him during his office visits.  Some post operative cases that I saw this week were a rhinoplasty due to a deviated septum and multiple breast reconstructions for breast cancer survivors.  Dr. Spector has also taken the time to explain how he does every operation and why he makes the surgical decisions that he does.  From Dr. Spector's patience and teaching, I have begun to gain important insights into the world of clinical medicine.

The most exciting day this week was a foot reconstruction surgery from a free tissue flap obtained from the patient's thigh.  This patients was suffering from severe diabetes, suffered blindness from diabetic retinopathy, and was currently on dialysis for renal failure.  Traditionally, the tissue flap is harvested which includes the skin, muscle, and blood supply and then the blood vessels are micro-surgically connected to the recipient blood supply.  This allows for large tissue transfers and reconstructive surgery, in this case a patient who has lost part of the foot from a diabetic foot ulcer, for reconstruction.  Without this technique this patient would have had a foot amputation.  Due to the renal failure of the patient and the dialysis treatments, the calcium homeostasis of the body was out of balance and the blood vessels suffer from a large amount of calcium demosits which causes hardening of the vessels and furthers the vascular disease that the patient was already suffering from.  During the surgery I was able to feel a small part of artery in the patient and it was clear that the vessels were quite hard.

Lastly, during a small reconstructive surgery that I observed on Friday, an emergency trauma was rushed into the adjacent OR.  This patient had fallen off of a roof onto the head.  Dr. Spector lead me into the next OR where I could witness how a trauma situation was handled.  The room was complete chaos with multiple different surgeons and nurses all trying to assess the patient's state at once.  While most of the patient's body didn't look terribly bad, the head and face were entirely distorted and it was clear from hearing the surgeons speak that there was a lot of internal damage.  This was absolutely the saddest thing I have witnessed in the hospital thus far.