Today was my last day getting to work with Mercy.  I finished my project and said my good-byes and thank-yous to all of the incredible people that I got to meet over the course of this internship.  This experience has given me so much to think about, and so much to look forward to.  Something tells me that I won't ever enjoy a school project as much as I did this one again, because I don't think it's legal to operate on people at school.  I think that my favorite part of this internship was getting to observe surgery, especially the total knee replacements.  The good thing is that now I have something that I can talk passionately about because I so genuinely connected with it.  I was so privileged to have all of my mentors show me what they did on a day-to-day basis.  They're obvious love of their careers was so inspiring to me, especially when they worked continuously throughout the day and week, with no break.  At the end of the day, I was exhausted, and I wasn't even doing anything!  I cannot wait to be able to experience something like this again, because it truly was life-changing.

Today I continued work with my project, I've still been unable to reach about six people, but considering how many people I wasn't able to reach at the end of yesterday, I'm feeling pretty good about it.  I also continued work on the excel spreadsheet, as well as began work on the general report for the case study, which I realized today is a lot of work.  As I head into the last couple days of my internship, however, I realize how much I'm going to miss it.  It may be a little unorthodox to post this onto a website that I created for school, but I really don't want to go back to school, now that I've gotten a taste of the real world, especially since it constantly ties back to my interests.  For example, today, in between periods of working on my project for Dr Lawton, I slipped into the OR to observe him perform one last total knee replacement, and even though I'd already seen two of them, it was still fascinating to me to see how everything connected together and worked.  And what still blows my mind, even when I think about it now, is how a body part can be completely mutilated and changed, and introduced to plastic and metal components, and somehow, after all of that, still function completely normally after given the chance to heal.  Tomorrow will be my last day as I will be leaving Thursday for Spokane for a volleyball tourn

I was gone for lacrosse on Friday, or day ten.  But Monday I started calling patients who are a couple years out from a specific type of hip surgery, and score them based on symptoms they may or may not be experiencing several years out of that surgery.  It was hard to do because so many patients have either moved or changed numbers, and for some of them it was impossible to track them down.  Sometimes, the patient left us the wrong number, so it was very challenging to get in touch with that person.  Once I started accumulating several results, however, I started feeling more and more optimistic about the project.  It was interesting to see the similarities and differences between the patients' symptoms. A large amount of the patients seemed to be experiencing back problems, which affected how long they could sit or walk without experiencing any pain.  For the most part though, in accordance with the surgery, several patients scored a 100%, which is outstanding.  Also, all but two patients are glad to have had the surgery, with one reason being that arthritis had developed in the hip and had progressed to a level that rekindled the pain that the surgery had temporarily fixed.  Tomorrow I will continue to work on my project.

Today I watched Dr Lawton in the OR at Animas Surgical Center, which is different from Mercy because it only does outpatient surgeries, or surgeries where the patient will be allowed to go home that same day, instead of spending a couple nights in the hospital.  I observed him complete two knee arthroscopies, two ACL reconstructions, and one rotator cuff repair.  It was interesting to watch him perform the ACL reconstructions because he would actually take out a hamstring tendon in order to replace the ACL, so it was amazing to me how a different body part could serve another's function.  I also continued with my project, and got all of the patients that I will need to sort through in order to determine who to call.  I will be scoring patients who had a specific type of hip surgery.  Tomorrow I will be gone for lacrosse games, so I'll have Monday, Tuesday, and Wednesday of next week to really focus on this project.

Today Dr Lawton was back in the office and I observed him in clinic again.  I also got started on my project and we were able to formalize the process.  Before I got started, Dr Lawton told me about how he wanted me to go about things in the survey, and said that first I would need to find some sort of test that would "score" the patients'  symptoms post-op.  This project will be a very useful project for the practice, because hip arthroscopy follow-up data is not very common due to the fact that this procedure (specifically in the hip) is relatively new.  My first step to finding this "score" was to go to the American Journal of Sports Medicine Website, and research hip arthroscopy, to compare different types of methods for follow-up.  It turned out that there is actually a test called the Harris hip score, which has been used for scope patients in the past, and is what I will use to conduct my surveys.  I'm really excited to finally get to work on this project; because it is a little-reseached subject in sports medicine, this information could not only help Dr Lawton's practice, it could be published in an article in a journal on a regional or even national level, which would be incredible.  It will be interesting to see how much I'll be able to do with this project.

Today was my last day getting to work with Dr Youssef.  I observed him in the OR again today, except this time he briefly let me see what he was doing; I got to see the spinal cord that had been fully exposed due to his dissection of the vertebrae.  It was interesting because you would think that if they were going to make the incision on the back, the spinal cord would be very close to the back, but it turns out that the spinal cord is actually a good four inches inside the body, and is encased by that much vertebrae.  
I also learned a little about the neuro-monitoring systems they used in order to ensure that when Dr Youssef was drilling screws into the back, he wouldn't strike a nerve.  It was cool to see how the nerves in the body would emit signals that let the neuro-physiologist know just how close Dr Youssef was coming to the nerves.  
But nerves aren't the only thing that Dr Youssef had to worry about.  The aorta and the venacava both run very close to the spinal cord, which is something to be concerned about, because if Dr Youssef were to drill into one of those blood vessels, the patient would lose three liters of blood in two seconds, resulting in death.  The kidneys are also near the lumbar spine, but it is much less likely that he would hit one of those with his drill.  And of course there is the actual spinal cord to worry about; if Dr Youssef were to damage the spinal cord in any spot, every part of the body below that spot would lose functionality, resulting in paralysis.  
Spinal surgery seems to me like a very stressful and complicated thing, yet people like Dr Youssef operate on arguably one of the most sensitive parts of the body several times each week, which is an amazing ability in and of itself.
Tomorrow Dr Lawton will be back in the office and I will start my project with him. 

Today was my first day getting to observe Dr Youssef in surgery.  I got to observe two disk fusions, and one repair of a nucleus pulposus herniation, which is the soft cartilage inside the disks, that helps to absorb shock and protect the spinal cord.  I thought the disk fusions were the most interesting because I was able to see what he was doing; he used the microscope to be able to see, and what he saw was projected onto a television via the microscope.
It was interesting to compare and contrast spinal surgery  and orthopedic surgery.  For example, orthopedic surgery seemed to happen on a much larger scale than spinal surgery.  Spinal surgery was so delicate and in such a small portion of the body area, that Dr Youssef had to use a microscope to finish some of his procedures, whereas orthopedic surgery seemed much more open and large-scale; it involved several mechanical parts, and a somewhat unnerving amount of pulling and pushing that was necessary to make sure the piece fit correctly in the knee.  
Tomorrow I will be observing Dr Youssef in surgery again.

Today was my last day working with Dr Pansze.  We discussed a case that had been brought up at the tumor board meeting yesterday, because the board was having a hard time determining which of the several tumors was the primary tumor (the tumor who's cells had metastasized to other parts of the body to grow new tumors).  This case was very rare because it included an esophageal mass, which may or may not have been a tumor.  
In order to determine the primary tumor, we used a number of stains that would indicate what kind of cancer the tumor had either been affected by or what kind of cancer the tumor could eventually lead to causing.  It was kind of like using the indicators in chemistry to determine the pH of a solution.  
We also discussed endoscopic surgeries and procedures while looking at different types of colon cancer.  He showed me the basic anatomy of the stomach and proximal small intestine, including the duodenum, gall bladder, bile duct, and liver.  He showed me how if the bile duct were to be blocked by a gall stone, how somebody may become jaundist because the bile was forced to go back to the liver.  
Dr Pansze's partner, Dr Masters, showed me a slide that had lymphoma, or a dying lymph node.  It was very interesting to see the different stages in which it occurred, and how the immune system tried to combat, but in the case of genetic mutation, couldn't, so the antibodies took over the lymph node, resulting in lymphoma.  It was amazing to me to see how smart the immune system is.  It's like a multi-functional army that can combat anything, and knows how to do it.  It was amazing to have Dr Masters explain to me how the T cell would kill off all of the genes besides the exact one it needed to kill the specific antigen that had intruded the body.  
During the last hour, Dr Pansze got a slide of a teratoma tumor, which is a tumor that starts with a germ cell that grows into a tumor and starts differentiating into normal body tissues.  In our slide, we saw parts of teeth, hair follicles, cartilage, bone, tissue, salivary glands, everything.  It was BIZARRE.  It usually occurs in the ovaries of women, but also sometimes occurs in the testis of men.  The prefix "terato" means monster in Greek, and this type of tumor was named that way because when the tumor was first being discovered, scientists originally thought that the "devil had impregnated the woman" with the tumor, because it looked like a monster with different body parts growing in a person.  This has by far been the weirdest thing I have ever learned about. 
This week has been eye-opening on so many different levels, and I have been so lucky to be able to shadow and meet all of these remarkable people who share a love of the medical field.

Today was my second day working with Dr Pansze.  I got to attend a Tumor Board meeting with him in the afternoon, and it was very interesting.  It was kind of like the show House M.D., because the meeting was basically composed of a team of doctors, consisting of radiologists, pathologists, oncologists, and surgeons, working together to make a diagnosis.  They were all very interesting cases, and there were lots of suggestions, full of complicated medical terms that I couldn't comprehend, as to the diagnosis.  Once the doctors all agreed on the diagnosis, treatment would be discussed, and they would all work towards a general solution for the patient.  

It was very interesting for me to attend this meeting because of how all of the doctors interacted; they all knew who specialized in what and asked for advice on that specialty.  It was good for me because I had always thought that the hospital operated as one big group, but now I know that there are multiple sections and even sub-sections in the hospital, ranging from nurses to lab technicians to anesthesiologists.  So far this week, I have been 100% reassured that I want to work in the medical field, but now I'm having doubts as to what I want to do specifically.  This week has shown me so much in so many different ways, but I suppose I'll have PLENTY of time before I have to make a choice as to my career, as so many doctors have knowingly told me.  

Today I worked with Dr Trent Pansze, who is a pathologist at Mercy.  He gave me a tour of the lab, and explained some of the instruments to me.  For example, he showed me how several different slides are created, using a variety of machines.  We also looked at several interesting slides, containing different examples of cancer or anemia.  He showed me how he diagnosed leukemia, and what that looked like on a slide, compared to somebody who is anemic on a slide.  It was all very interesting to see how these complicated diseases could be diagnosed on the molecular level, without even asking the patient about preexisting conditions or symptoms, as I had observed Dr Lawton doing.  

Two of the most interesting things I saw today was a colon that had been removed due to volvulus, which is when the intestines literally flip over on themselves, which is common in horses or dogs but rarer in humans.  I also got to see a 10-12 week old fetus, which was very rare because when a fetus is miscarried that early, rarely are they found to be in whole condition.  

Also, while Dr Pansze was showing me some of his slides, an urgent call was put in from the OR, with a surgeon wanting to know whether or not they had gotten all of the cancer out of the urethras, so Dr Pansze examined some slides that his lab technicians had prepared for him from the urethra samples, and he found that all of the cancer had been removed, because of what he was able to observe using the microscope and his knowledge of cancerous tendencies when involving a specific body part, and its interactions with the non-contaminated area. 

It was interesting for me to see another side of the medical field that didn't necessarily involve surgery, because it was still really interesting, and instead of looking at only very specific types of illnesses, it concerned everything from looking at colon biopsies to determine the presence of cancer, to observing PAP smears to determine the presence of HPV.