Dr. Piering...kind of

More playing doctor was in store for Toby last week while he went from the small clinic in rural Chicabracan to help out our friend Heidi in the operating room in nearby Chichi. Every Wednesday more or less, Heidi travels the half hour to the Good Samaritan Hospital in Chichicastenango to operate on a variety of patients. She usually schedules one to two surgeries per week, hoping that her patients don’t cancel on her. Heidi is an American OB/GYN and therefore more than qualified to operate on the variety of cases that are encompassed by her specialty, however, living in Guatemala has presented her with a very unique situation. Seeing as there are almost no well-trained doctors in the area where we live, especially those that will donate their time and facilities, Heidi can often be found operating on a variety of cases that in the United States would normally be handled by a doctor of a different specialty. Heidi’s presence in Quiché has allowed her to help numerous people that would otherwise have no where to turn. As living in Guatemala has provided Heidi with the unique opportunity to operate on a variety of cases and patients, it also allowed Toby the opportunity to scrub in and assist Heidi in a surgery last week, an idea unheard of in the United States. In fact many of Toby’s friends that have been in medical school for a few years have merely observed surgeries thus far. Heidi, not turning away a potential assistant and always eager to teach and help others learn, graciously invited Toby to help her take a biopsy of a large mass that had developed on what remained of a patient’s leg that was amputated last December. Toby, intrigued by medicine and eager to take advantage of this unique opportunity was very excited to help out. Once at the hospital Toby and Heidi changed into scrubs (apparently very comfortable according to Toby who has to try and talk Heidi into letting him buy a pair off her) and Heidi brushed up on her upper leg anatomy (not a bad idea). Once the patient was in the operating room and sedated, Heidi and Toby scrubbed in (just like you see on TV, more or less) with Heidi explaining exactly how to scrub, rinse and dry every bit of the hands, fingers, and upper arms while not contaminating the already cleaned areas. Heidi did point out the irony though of rinsing with the water from the sink that was at one time in the past undrinkable. Welcome to Guatemala. Once their arms were sterile (in theory), Heidi again played teacher, verbally guiding Toby as he dressed into the sterile surgical gown and gloves with the help of the scrub nurse. Once finished, it was important for Toby to never drop his hands below the level of the patient and the table, areas that were considered not sterile. Toby and Heidi then prepared to operate. The purpose of this surgery was to open the mass to take a biopsy that could be sent away for diagnosis to determine if it was cancerous or benign. With the mass isolated by sterile cloth, the working surface was actually quite small. Heidi examined the mass for the best area to begin her incision then proceeded to cut into the patient. With only a small amount of skin and fat to pass, the mass was soon visible.
Unfortunately, to everyone’s dismay, the mass was quite clearly cancerous from the beginning. Cancerous tumors actually drawn in their own blood supply by signaling the body to produce small vessels that supply it with the food it needs to survive and grow. The presence of many vessels was a pretty strong indicator of cancer from the beginning. Taking a small piece of the tumor, the task then was to stop the bleed that came as a result of the biopsy. Cancer, with its heavy blood supply, bleeds significantly for the size of the cut, and the small piece taken out required about 30 minutes to stop all of the bleeding. Heidi went to work with an electric cauterizing scalpel to seal off the small bleeding capillaries. While Heidi was working on this, Toby was suctioning the blood from the wound and the smoke from the cauterizing scalpel. He is also holding the wound open with the forks in the picture above. Once that was accomplished, she sealed up the incision with stitches actually in the subcutaneous layer of the skin which left no exposed stitches and only a small wound. Unfortunately for Toby’s first surgery and such a unique and amazing experience, the patient sees to have an aggressive form of bone cancer and will not likely have much longer to live, leaving behind four kids. Heidi has already enlisted Toby’s help for two more surgeries this Wednesday, a much longer vaginal hysterectomy (3-4 hours in surgery) and a breast biopsy. After this relatively short surgery, Toby has a large mount of respect for surgeons that must stand up for such lengthy stretches of time without breaks, not to mention the knowledge and skill it takes to operate on a person. This experience has sparked Toby’s interest in medicine, yet lucky for us he has already been accepted to law school and will not be changing his plans.