Samantha Wu ’16, MedStar Union Memorial Hospital

Samantha-WuOne of the reasons why I decided to participate in a Princeternship was to observe surgery for the first time. There is a difference between reading about the intensity and intricacy of surgeries online to witnessing them firsthand from the lengthy start to finish. As such, I was really excited that I would be shadowing Dr. Gage Parr ’91, a cardiac anesthesiologist at MedStar Union Memorial Hospital in Baltimore, MD. On day 1, I met Dr. Parr at 7:15 am and proceeded to change into scrubs. Then Dr. Parr went to a patient waiting room to sift through the medical records of the patients to be operated on that day, while filling out Anesthesia Evaluations and part of the Post-Anesthesia Records. The first patient of the day suffered from renal failure and would be undergoing an arteriovenous (AV) fistula. An AV fistula widens the vein by connecting it to an artery, causing the blood to flow faster and better dialysis access. Dr. Parr then went to talk to him, gathering more medical history, providing comfort, information, with a splash of humor here and there. In the end, she knew what anesthetics to provide him with the most comfort during the procedure given his specific medical condition and current health issues.

Afterwards, Dr. Parr went to the operating room (OR) to prepare for the AV fistula surgery. The first thing I noticed was how high-tech the room seemed. In the right corner was an estimated $1million beast of a X-ray machine. Dr. Parr prepared her “cocktail” and set up the anesthesia machine and when the patient arrived, she sedated him, inserted a breathing tube, and connected him to a ventilator that would help him breathe. During the surgery, Dr. Parr informed me of every drug she was administering and what was happening during distinct stages of the procedure while explaining the biochemistry behind it all, all while regularly monitoring the patient’s heart rate, blood pressure, breathing, and blood oxygen level. After about 3 hours the surgery was over and the patient was transferred to his recovery room. Dr. Parr continued to monitor the patient’s vital functions and manage his pain immediately post-operation to ensure the best comfort possible.

The next operation I observed was the beginning of a coronary artery bypass grafting (CABG).CABG is a type of surgery used to treat people who have coronary heart disease- plaque build-up in the coronary arteries, which limits oxygen-rich blood flow to heart muscle. During CABG, a healthy artery or vein from the body is grafted to the blocked coronary artery, bypassing the blocked region of the coronary artery. When I entered the OR, the patient was completely covered with sterile blue sheets but the chest was still sterile and transparent. A camera was inserted into the leg. According to Oliver, the surgeons were harvesting the greater saphenous vein in the right leg and the left internal mammary artery which will serve as the greater conduits. After seeing the first incision to the chest and the opening of the ribs with a saw (!) to expose the heart, another anesthesiologist came to take over Dr. Parr.

~~~ Dr. Parr’s Words of Wisdom #1: “3 Rules of Surgery. Eat when you can, sleep when you can, and don’t touch the pancreas.”

After a quick lunch, Dr. Parr’s next surgery would be another AV fistula. We went through the drill again: paperwork, meet the patient, have the patient sign consent forms, and then OR. During the second AV fistula, I took this opportunity to ask Dr. Parr more questions on what being an anesthesiologist is like and why she was specifically attracted to cardiac anesthesiology. She said that the advantages to being an anesthesiologist are that call is well defined and self limited and there is no rounding. She also said that an anesthesiologist is more focused on the one-on-one interaction with the patient, which I easily noticed during my first day of shadowing. From what I learned, it seems that surgeons do the dirty and then leave the OR when the surgery is done. An anesthesiologist, on the other hand, is with the patient every step before, during, and after a surgery. As to why she was attracted to cardiac anesthesiology, she liked that there was a lot of action and collaboration. When you’re dropping the heart and blood pressure to non-homeostatic conditions, it requires people who can stay calm and focused under these stressful situations.

When the surgery was over, the drill continued: Dr. Parr brought the patient back to consciousness, moved her to her recovery room, comforted her at her bed while asking questions and taking notes. Dr. Parr spent the final part of her day filling out pre-operation paperwork to prepare for next day’s surgeries. She then met and chatted with the two patients, going over what to expect the next day before, during, and after surgery and obtaining signatures for the consent forms.

I felt I had learned so much from my first day of my Princeternship about the various medical professions and a great mountain of biochemical knowledge required in anesthesiology. If you are in the OR, you need great listening skills. People will usually be talking at the same time and when one person says one thing, you have to immediately recognize if it is being addressed to you, picking it out from the rest of the crowd and then act on it. Dr. Parr is a hilarious person and I was also shocked to see the rest of the staff crack so many jokes. It definitely diminished my initial misconception that doctors were high-strung, overly-serious people.

The second day of my Princeternship began at 8 am and thank you to Debby for helping me get ready! Preparations for the first surgery actually began at 7 am but by the time I arrived, they were nearly done and the operation was about to begin. The patient I had met yesterday in the afternoon would be undergoing aortic valve surgery to treat aortic stenosis, a condition when an aortic valve does not fully open because of calcium deposits on the valve leaflets, rendering them thick and stiff. The heart has to work even harder to push enough blood through a narrowed valve. Since she had heart surgery before and was too high at risk for typical open aortic valve surgery, a minimally invasive procedure would be conducted instead where a tube is inserted through an artery in the groin, leg, or a small incision between the ribs. The artificial valve is compressed and fed through the tube until it reaches the aortic valve. A balloon expands the artificial valve, pushing against the old aortic valve, and the tube is removed.

Given that this was a more complex operation, there were over 10 people in the OR. There were two cardiologists, a surgical assistant, an anesthesiologist, three nurses, a perfusionist, and a number of surgeons. On top of my scrubs, I also had to put on lead because today I would actually see the great claw-machine-shaped X-ray machine in use. The surgeons first cut the femoral vein, snaked a wire up to the heart, and inserted a pacemaker wire that would be controlled by Dr. Parr. While doing this, the surgeons were assisted by the X-ray machine as an image of a wire going up to the heart appeared on the room’s TV screen. The machine also spins, capturing a 3D view of the patient’s chest. As the surgery continued, I was able to see them operating on the chest, real-time, through a video feed on the TV screen. Although I looked calm on the outside, in my head I was screaming, “I can actually see the heart beating!!!” It was definitely one of the coolest experiences I have ever had in my life. Although Dr. Parr was very busy, she still walked me through the procedure answering my questions regarding what was happening. Whenever she would use a different drug, she told me the name, what it does, and the biochemistry behind the mechanism of action.

When the time came to insert the tube through the aortic valve and expand the valve by inflating a balloon, I realized how much teamwork this particular field demanded. When Dr. Wang said, “Let’s all help out,” almost every surgeon stepped up and played a crucial role in this critical step. However, the valve was so calcified that they had to inflate the balloon again. They then inserted a catheter, injected dye into the coronary arteries to check that the aortic valve was working properly and that there were no leaks. Thank you to Kodsi for explaining this part of the operation to me!

After lunch, Dr. Parr wanted me to observe more of the CABG even though we would have to separate briefly since it was not her operation. I am very grateful that Dr. Parr went to great ends to ensure I had an enriching experience at my Princeternship and observed all the new and great sights I ought to see during my stay.

In the OR, I got to chat with Dr. Mantel, another anesthesiologist and Kurt, the perfusionist. I want to thank Kurt for devoting so much time to explaining to me how such a complicated machine functioned. The perfusionist operated the cardiopulmonary bypass machine (heart-lung machine). During CABG, the heart is temporarily stopped and the blood is drained from the body and cycled through the bypass machine, which takes over the function of the heart and pumps blood to the body.

~~~ Dr. Parr’s Words of Wisdom: (Regarding the blue drape separating the surgeons from the anesthesiologist) This is the blood-brain barrier. (Points to surgeons) That’s the blood. (Points to herself and her work station) These are the brains.

I had an unforgettably amazing and eye-opening experience during my Princeternship and it was another reminder of why I was really attracted by medicine. There is just a unique power of cutting into the person, patching them back up, and reviving them. The patient resumes life just as it was before as if nothing had happened (ignoring the post-surgical pain). The Princeternship was also a great opportunity to observe patient care in a hospital setting. Although I am unsure as to what field I would like to specialize in as a doctor, I am considering anesthesiology for its deep connections with chemistry, versatility and applications in all forms of medical procedures, and the opportunities for patient interaction. This Princeternship allowed me to gain a better idea of the duties of different medical professions, clear insight into the hospital environment, and I am gradually gaining a better idea of what area I want to specialize in. The entire staff was helpful, hospitable, and explained to me what was going on during surgeries despite how busy they were. Working at a hospital is a high-stress job, but the surgeons were all laid-back people who love to make jokes, including the air-guitar playing Gary, the chief cardiovascular surgeon, Fiocco, who enjoys listening to the radio during his surgeries, and my “best friend” Lisa who never fails to tease me. I want to extend my deepest thanks to Dr. Parr for sharing her world with me and giving me one of the most rewarding experiences I have had in my life.