Tag Archives: empyema

In the operating room with Dr. Wilfredy Castaño Ruiz

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I am still working on several posts – but in the meantime, I wanted to post some photos from my visit to the operating room with Dr. Wilfredy Castaño Ruiz, one of the thoracic surgeons at Hospital General de Medellin.

Readers may notice that some of the content of my observations of the operating room have changed.. In reality, the reports haven’t changed – I have just chosen to share more of the information that I usually reserve for the books since I probably won’t get time for a “Medellin book”.  So, if you are squeamish, or if you don’t want to know – quit reading right about now…

It was a surprise to meet Dr. Wilfredy Castaño Ruiz because it turns out we’ve already met.  He was one of the fellows I encountered during one of my early interviews in Bogota, with Dr. Juan Carlos Garzon Ramirez at Fundacion Cardioinfantil.

Since then (which was actually back in the early spring of 2011), Dr. Castaño has completed his fellowship and come to Medellin.

Dr. Wilfredy Castaño Ruiz, thoracic surgeon at Hospital General de Medellin

Dr. Wilfredy Castaño Ruiz, thoracic surgeon at Hospital General de Medellin

Yesterday, I joined him in the operating room to observe a VATS decortication.  The case went beautifully.

Dra. Elaine Suarez Gomez, an anesthesiologist who specializes in cardiothoracic anesthesia managed the patient’s anesthesia during the case.  (This is important because anesthesia is more complicated in thoracic surgery because of such factors as double lumen intubation and selective uni-lung ventilation during surgery).

Anesthesia was well-managed during the case, with continuous hemodynamic monitoring.  There was no hypotension (low blood pressure) during the case, or hemodynamic instability.  Pulse oxymetry was maintained at 98% or above for the entire case.   Surgical Apgar: 8 (due to blood loss**)

Monitors at HGM are large and easily seen from all areas of the OR

Monitors at HGM are large and easily seen from all areas of the OR

Dr. Wilfredy Castaño Ruiz was assisted by Luz Marcela Echaverria Cifuentes, (RN, first assist*). The circulating nurse was a very nice fellow named Mauricio Lotero Lopez.

Enf. Luz Echaverria assists Dr. Wilfredy Castaño Ruiz during surgery.

Enf. Luz Echaverria assists Dr. Wilfredy Castaño Ruiz during surgery.

*”Registered nurse” is not terminology common to Colombia, but this is the equivalent position in Colombia, which requires about six years of training.)

** In this particular case, the surgical apgar of 8 is misleading.  The anesthesia was excellent, and the surgery proceeded very well.  However, due to the nature of surgical decortication (for a loculated pleural effusion/ empyema) there is always some bleeding as the thick, infected material is pulled from the lung’s surface.  This bleeding was not excessive for this type of surgery, nor was it life-threatening in nature.

Life as a student (again) in Mexicali

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It’s my first week in Mexicali, and it’s already been an interesting and educational one!   It took a few days to get hooked up to the internet – but I must say Telnor is certainly faster, more efficient (and cheaper!) that any internet service provider I’ve had before.

So far, everything has worked out with fewer complications that I’d expected, and I’ve already been back to the operating room with the good doctor, and visiting several of his patients.

Right now I am working on creating a pre-operative optimization protocol for the thoracic patients with one of the respiratory therapists at the Mexicali General Hospital.  (You may remember hearing about Jose Luis during my first visit.)  The doctor I am studying with is pretty easy-going but that doesn’t mean he lets things slide.  When I first proposed the ‘pre-op plan’ he said – “sure, sure, by all means… but I want to see a review of the literature on the items you want to include” (pulmonary toileting exercises, pre-operative beta blockade, patient teaching methods).  So, yeah – I’ve got homework, but I am enjoying the intellectual exercise.

I am almost finished with the English version of a patient education brochure, so once he looks it over – I’ll start trying to translate it into Spanish (with lots of help!)

Saw a couple of cases yesterday and Friday – including a pediatric case on a little tiny two-year old girl with an empyema, which meant I also got to meet one of the pediatric surgeons who was assisting on the case.

Dr. Ochoa, VATS case

 

In the operating room with Dr. Rafael Beltran, Thoracic Surgeon

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Dr. Rafael Beltran, Thoracic Surgeon

Spent the morning at the National Cancer Institute, which really is a pretty amazing place, with a pretty amazing guy – Dr. Rafael Beltran. He’s one of the many incredible people I’ve met here – that truly make the world a better place through their work. I could have spent all day with him, seeing patients, surgery, discussing his cases and research – (Heck – I’d love to work with him!) but unfortunately, I had to race across town after several hours for another interview..

Dr. Beltran (tall gentleman on the left) and his surgical team

I really like this picture here, I think it highlights one of the important aspects of surgery – the surgical team.. As you can see above, Dr. Beltran (left) certainly doesn’t work in isolation – and that’s his philosophy about cancer care – the surgeons from different specialties work together closely, along with oncologists, radiologists, hematologists, therapists and other specialties to give well-coordinated, and well-rounded care. While I was the operating room, I stood next to a shy young woman.. After I badgered her for a little bit – she told me her story. She’s a respiratory therapist – and she was watching the surgery, so she would better understand how to take care of her lung surgery patients – and to understand exactly what they had been through. Not often do surgeons find room in their ORs for respiratory therapists – but Dr. Beltran understands that by having this young woman here observing – she learned more today than she could ever glean from books.. By doing so – he’s integrated her into the surgical team, and that’s important when often today’s medicine is an exercise in fractured and fragmented care.

In the operating rooms all around us – the same thing was occurring, with orthopedics, plastic surgery, neurosurgery.. As you can tell – on all my visits to the National Cancer Center, I’ve been very impressed with the physician commitment and the level of care.

As I raced off – I received a text that the doctor I was next scheduled to meet had to go to another hospital – he offered to meet me there, but he had an emergency, so I thought it best to reschedule for when he had more time.  I’m really looking forward to talking to him – so I didn’t want him to be too distracted.. I get the best interviews when we can just sit down and talk..

Then – a thoracic surgeon we’ve talked about before – texted me that he had 2 interesting cases – did I want to go? So I spent he remainder of the afternoon talking with Dr. Juan Carlos Garzon, thoracic surgeon. I’m glad I did – because I had lots of questions from our previous interviews, and between cases, he spent the time to answer my lingering questions; about his practice, about thoracic surgery in general, and about Colombian medicine so it was definitely a worthwhile trip..

  Dr. Juan Carlos Garzon, Thoracic Surgeon..

In the Operating Room with Dr. Andre Jimenez

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Dr. Jimenez, Thoracic Surgeon

In the operating room with Dr. Jimenez, thoracic surgeon at Santa Fe de Bogota today. Despite having multiple co-morbidities, the case went well – according to protocols with no intra-operative complications.

In other news, I am sorry to disappoint my readers but I actually declined an opportunity to go to the operating room (gasp!) today. After contacting a surgeon (sorry, folks – not Camilo Prieto) several times over the last two months, I actually met him face-to-face in the operating room. I introduced myself, but he was quite visibly reluctant to talk to me. I brashly asked when I could visit him in the OR (I was hoping to break the ice – and show that I’ve relatively harmless, but I probably came off as obnoxious.)

So, I had the opportunity to try and interview him, and see him operating – and I declined, so as to respect his privacy. While the book is everything to me – it’s a voluntary project. So, my sincerest apologies..