Been a busy week – (Yea!) but now that it is the weekend, I have a chance to post some more pictures and talk about my day in the operating room with Dr. Gabriel Omar Ramos Orozco.
Despite living in a neighboring apartment, interviewing Dr. Ramos proved to be more difficult than anticipated. But after several weeks, I was able to catch up with the busy surgeon.
Outside of the operating room, he is a brash, young surgeon with an off-beat charm and quirky sense of humor. But inside the operating room, as he removes a large tumor with several cancerous implants, Dr. Gabriel Ramos Orozco is all business.
It’s different for me, as the interviewer to have this perspective. As much as I enjoy him as a friendly neighbor – it’s the serious surgeon that I prefer. It’s a side of him that is unexpected, and what finally wins me over.
Originally from San Luis Rio Colorado in the neighboring state of Sonora, Dr. Ramos now calls Mexicali home. Like most surgeons here, he has a staff position at a public hospital separate from his private practice. It is here at IMSS (Instituto Mexicano del Seguro Social) where Dr. Ramos operates on several patients during part of the extended interview.
During the cases, the patients received a combination of epidural analgesia and conscious sedation. While the anesthesiologist was not particularly involved or attentive to the patients during the cases, there was no intra-operative hypotension/ alterations in hemodynamic status or prolonged hypoxia.
Dr. Ramos reviewed patient films and medical charts prior to the procedures. Patients were prepped, positioned and draped appropriately. Surgical sterility was maintained during the cases. The first case is a fairly straight forward laparoscopic case – and everything proceeds rapidly, in an uncomplicated fashion. 45 minutes later, and the procedure is over – and Dr. Ramos is typing his operative note.
But the second case is not – and Dr. Ramos knows it going in..
The case is an extensive tumor resection, where Dr. Ramos painstakingly removes several areas of implants (or tumor tissue that has spread throughout the abdomen, separate from the original tumor).
The difference between being able to surgical remove all of the sites and being unable to remove all of the gross disease is the difference between a possible surgical ‘cure’ and a ‘de-bulking’ procedure, Dr. Ramos explains. As always, when entering these surgeries, Dr. Ramos and his team do everything possible to go for surgical eradication of disease. The patient will still need adjunctive therapy (chemotherapy) to treat any microscopic cancer cells, but the prognosis is better than in cases where gross disease is left behind*. During this surgery, after extended exploration – it looks like Dr. Ramos was able to get everything.
“It’s not pretty,” he admits, “but in these types of cases, aesthetics are the last priority,” [behind removing all the tumor]. Despite that – the aesthetics after this large surgery are not as worrisome as one might have imagined.
The patient will have a large abdominal scar – but nothing that differs from most surgical scars in the pre-laparoscopy era. [I admit I may be jaded in this respect after seeing so many surgeries] – It is several inches long, but there are no obvious defects, the scar is straight and neatly aligned at the conclusion of the case – and the umbilicus “belly-button” was spared.
As I walk out of the hospital into the 95 degree heat at 11 o’clock at night – I admit surprise and revise my opinion of Dr. Ramos – he is better than I expected, (he is more than just the kid next door), and he deserves credit for such.
*This may happen due to the location of metastatic lesions – not all lesions are surgically removable. (Tumor tissue may attach to major blood vessels such as the abdominal aorta, or other tissue that cannot be removed without seriously compromising the patient.) In those cases, surgeons try to remove as much disease as possible – called ‘de-bulking’ knowing that they will have to leave tumor behind.