Today, I was fortunate to observe the first stage to the two part surgery process needed to reconstruct an ear. This time, Dr. Chen had an assistance, non other than the talented fellow, Dr. Por. While Dr Chen worked on creating a pocket for the cartilage on the left side of what was the supposedly ear, Dr Por standing a foot next to him, surgically removed a part of the cartilage from the left rib cage. Even with two surgeons, this procedure will likely take almost the entire day.The operating room across from where the ear reconstruction was occurring was a case of rhinoplasty with silicone implant. The patient was a 32 year old male patient who was unhappy with the appearance of his nose. He felt his nose bridge was too shallow, making his nose appear shorter, although I could not see anything wrong with his appearance. Perhaps seeing patients with cleft lips or having no ear have obscured my judgement that beauty is in the eye of the beholder.
The surgeon that performed the rhinoplasty was undoubtedly very experienced. He was able to complete the entire surgery in 20 minutes. Within this short period, he explained his technique of making a small incision near the septum, then separating the fascia from the cartilage below, and finally inserting the silicone bridge snugly in the space created. The pocket had to be large enough for the implant to fit but small enough to prevent the implant from migrating. Throughout the entire process the patient was semi-sedated and locally injected with anesthetic. To my surprise the patient, upon request, was able to open his eyes and look at his new nose in the mirror with a smile. In the cosmetic surgery world, it is no surprise that success is determined by the satisfaction of the patients.Upon completion of the rhinoplasty, I decided to check on what Mariko and Bill were observing. As I look through the small window of OR 5, I see Mariko sitting to the side of Dr. Chen, and mesmerized by his art of creating an artifial ear. I suddenly remember that this will take the entire day, so I walk down the hallway, looking through the window of each OR. Several OR's were empty. Many meetings are held in Taipei so surgeries tend to be lighter on Thursday. Standind outside OR 9, I look through the obsured window covered by a piece of paper but could not see Bill who I saw earlier getting ready to observe a cleft lip. Thinking that he may have stepped out, I tap the door sensor with my foot and walk in to see the progress of the surgery. To my surprise, the gentleman in scrub assisting with suction and clamp was not a fellow, resident or intern, but our "not yet OMS-2" student doctor Bill Chou.
Bill needed extra large gown and gloves.
At noon Mariko and I headed back to Linkou to have lunch with Dr. Lin before her flight back to the US.
After lunch at Ikari and saying goodbye to Dr. Lin, some of us headed back to our rooms to rest while others returned to their roations. Soon after arriving in our rooms, like a scene from Gray's, Viet received a call from his preceptor about a procedure about to take place. Through the thick accent and broken English, Viet was not able to repeat what was said, but none the less, any procedure was exciting and worth seeing to us newbies. We quickly put back on our white coats and headed to the 7th floor of the Pathology Building.
Exiting the elavator we were greeted by a chaotic scene of nurses running back and forth with what looked like syringes and vials in hand. We follow the wake left by the frantic nurses to a room just around the corner. A sea of white uniforms surround a patient in distress. We quickly realize it was a patient in cardiac arrest. Among the nurses was Viet's preceptor unusually calm. He came over and told us that the patient had gone into hypovolemic shock, and they were frantically trying to determine the source for the loss of blood. Within several minutes, they determined that the bleeding was from the Eustacian tube and were able to seal it by inflating a tube. The patient had nasal pharangeal cancer and was likely terminal. Throughout the whole ordeal, I couldn't help but notice the family outside the room in dispair. A man in his early 30s clenches his fist and holding back his tears paces back and forth along the corridor while outside the patients room an elderly lady sits deep in prayer. I could feel my heart sink as I empathized with the anguish of the family. The dichotomy of the situation was disconcerting. On one hand I was very fortunate to have witnessed such a medical procedure, but I also felt a sense of selfishness. Even as I know that people get sick and some die no matter what, it is still a challenge each day.
My heart began to ease when I heard that the patient's prognosis was stabilized. Thinking that this was the medical procedure, I was surprised when Viet's preceptor directed us to another room to observed what he had invited us to see. We walked pass the nurse's station and he grabs three bottles that had a small amount of yellow liquid at the bottom, iodine, and a syringe. While we walk towards the patients room he tells us that he needs to perform an "ascites tapping" on a patient. We arrive at the room and observe a frail female patient in her 60s who has been complaing of loss of appetite. I perform percussion over the abdomen and notice dullness all around except for the midline. The preceptor then went ahead and showed us what ascites (fluid in the abdominal space) looks like on an ultrasound. He then inserted a needle into the abdomen and attached one end of a tube to the needle while the other to an empty bottle with the yellow fluid. He tells us that the bottle is under negative pressure and it helps with sucking the fluid out, while the yellow fluid is an anticoagulant. Amazingly, the procedure removed approximately 3L of fluid. We also learned that contraindications for ascites tapping include presence of blood and low hemoglobin count.
Day 4
Today was my last day rotating through cosmetic surgery, and this time it was over at the Taipei branch. I took the shuttle bus over and met Dr. Hsiao in his office. His office was on the 12th floor, a combined floor of dermatology and cosmetic surgery. Exiting the elavator, I thought I was transported to a five star hotel. The department was decorated modern Japanese chic, wooden floors and sparkling glass pannels throughout the "lobby" or wait area. In the middle, there were individual rooms with sliding doors, and each room had it's own flat screen. Modern Asian art hung along the walls. Towards the back, lighted glass cabinets show off the many beauty products available to purchase. One could easily think they were in Bloomingdales, except for one difference. On this side of the world, women loath the effects of the sun. Many women desire the appearance of white porcelain but the softness of a baby's skin. Westerners may be surprised by the number of skin whitening products.
Dr. Hsiao saw 4 patients within half an hour of my arrival. The first patient was a little boy who had a laceration across his left eye canthus. Dr. Hsiao told his parents that he needed to have the wound debrided and sutured or else a deep scar would form, potentially deforming his eye. Although the procedure could have been covered under the national health care plan if they had gone to the emergency room, the little boys parents wanted Dr. H to do the surgery. They wanted assurance that the scar will be minimal and was willing to pay out of pocket NT$ 15, 000 (US$470).
The second was a female patient in her late 20s from China. She had a shoddy breast augmentation done that resulted on bursting of her silicone implants. The silicone was removed a month ago, but she presents to the office with pus from her surgical wounds. Dr. Hsiao advised her to have an X-ray completed by the following weak so he could further evaluate the next step for her.
After two more patients that came in for scar revision evaluations, we headed to the 8th floor for surgery, but not before changing into scrubs. On the operating table was a 32 year old male for keloid excision of the anterior chest wall. Dr. Hsiao began with an incision across the keloid, then cauderized the flibrotic tissue below before suturing the incision. He advised the patients to used wet saline gauze in order for the wound to heal nicely. The surgery took about 30 minutes to perform. Most of the work involved evenly removing the fibrotic tissue below and fine suturing.
Right after he completed the keloid excision, we went back to the 12th floor to debride and suture the boy with the left canthal laceration. The boy needed to be under generalized anesthesia and intubated because he was too young for local anesthesia.
Soon after, we headed back to the 8th floor again, but this time the procedure involved a removal of a lipoma posterior to the left popliteal fossa. The patient was a 56 year old female. Like many of his procedures, the patient was only required to be under local anesthesia.
Like a yoyo, we went back to the 12th floor for the last surgical case of the day. It involved a woman in her early 30’s for a scar revision. An excision was made circumferencial of the scar, fibrous tissue cauderized to even out the the skin, and hair-thin sutures used to close the wound.
Only after all his surgical cases, did we finally have a little break to have lunch, and the time was already 2:30pm.
But lunch was short, as he was running late and his next patient was already getting ready for lazer treatment for the face. The patient was a 30+ female. She was there for her "appearance maintenance". A device called the IPL was used to whiten the skin. A second lazer device with another acronym was used to shrink the pores. And lastly, another device was used to zap age spots. With each procedure, the patients face became redder, however, at the end of it all, she was given an ice face mask to sooth her face. The cost for the three procedures was US$400. Results were instant, and total recovery is 3-5 days.
After lunch at Ikari and saying goodbye to Dr. Lin, some of us headed back to our rooms to rest while others returned to their roations. Soon after arriving in our rooms, like a scene from Gray's, Viet received a call from his preceptor about a procedure about to take place. Through the thick accent and broken English, Viet was not able to repeat what was said, but none the less, any procedure was exciting and worth seeing to us newbies. We quickly put back on our white coats and headed to the 7th floor of the Pathology Building.
Exiting the elavator we were greeted by a chaotic scene of nurses running back and forth with what looked like syringes and vials in hand. We follow the wake left by the frantic nurses to a room just around the corner. A sea of white uniforms surround a patient in distress. We quickly realize it was a patient in cardiac arrest. Among the nurses was Viet's preceptor unusually calm. He came over and told us that the patient had gone into hypovolemic shock, and they were frantically trying to determine the source for the loss of blood. Within several minutes, they determined that the bleeding was from the Eustacian tube and were able to seal it by inflating a tube. The patient had nasal pharangeal cancer and was likely terminal. Throughout the whole ordeal, I couldn't help but notice the family outside the room in dispair. A man in his early 30s clenches his fist and holding back his tears paces back and forth along the corridor while outside the patients room an elderly lady sits deep in prayer. I could feel my heart sink as I empathized with the anguish of the family. The dichotomy of the situation was disconcerting. On one hand I was very fortunate to have witnessed such a medical procedure, but I also felt a sense of selfishness. Even as I know that people get sick and some die no matter what, it is still a challenge each day.
My heart began to ease when I heard that the patient's prognosis was stabilized. Thinking that this was the medical procedure, I was surprised when Viet's preceptor directed us to another room to observed what he had invited us to see. We walked pass the nurse's station and he grabs three bottles that had a small amount of yellow liquid at the bottom, iodine, and a syringe. While we walk towards the patients room he tells us that he needs to perform an "ascites tapping" on a patient. We arrive at the room and observe a frail female patient in her 60s who has been complaing of loss of appetite. I perform percussion over the abdomen and notice dullness all around except for the midline. The preceptor then went ahead and showed us what ascites (fluid in the abdominal space) looks like on an ultrasound. He then inserted a needle into the abdomen and attached one end of a tube to the needle while the other to an empty bottle with the yellow fluid. He tells us that the bottle is under negative pressure and it helps with sucking the fluid out, while the yellow fluid is an anticoagulant. Amazingly, the procedure removed approximately 3L of fluid. We also learned that contraindications for ascites tapping include presence of blood and low hemoglobin count.
Day 4
Today was my last day rotating through cosmetic surgery, and this time it was over at the Taipei branch. I took the shuttle bus over and met Dr. Hsiao in his office. His office was on the 12th floor, a combined floor of dermatology and cosmetic surgery. Exiting the elavator, I thought I was transported to a five star hotel. The department was decorated modern Japanese chic, wooden floors and sparkling glass pannels throughout the "lobby" or wait area. In the middle, there were individual rooms with sliding doors, and each room had it's own flat screen. Modern Asian art hung along the walls. Towards the back, lighted glass cabinets show off the many beauty products available to purchase. One could easily think they were in Bloomingdales, except for one difference. On this side of the world, women loath the effects of the sun. Many women desire the appearance of white porcelain but the softness of a baby's skin. Westerners may be surprised by the number of skin whitening products.
Dr. Hsiao saw 4 patients within half an hour of my arrival. The first patient was a little boy who had a laceration across his left eye canthus. Dr. Hsiao told his parents that he needed to have the wound debrided and sutured or else a deep scar would form, potentially deforming his eye. Although the procedure could have been covered under the national health care plan if they had gone to the emergency room, the little boys parents wanted Dr. H to do the surgery. They wanted assurance that the scar will be minimal and was willing to pay out of pocket NT$ 15, 000 (US$470).
The second was a female patient in her late 20s from China. She had a shoddy breast augmentation done that resulted on bursting of her silicone implants. The silicone was removed a month ago, but she presents to the office with pus from her surgical wounds. Dr. Hsiao advised her to have an X-ray completed by the following weak so he could further evaluate the next step for her.
After two more patients that came in for scar revision evaluations, we headed to the 8th floor for surgery, but not before changing into scrubs. On the operating table was a 32 year old male for keloid excision of the anterior chest wall. Dr. Hsiao began with an incision across the keloid, then cauderized the flibrotic tissue below before suturing the incision. He advised the patients to used wet saline gauze in order for the wound to heal nicely. The surgery took about 30 minutes to perform. Most of the work involved evenly removing the fibrotic tissue below and fine suturing.
Right after he completed the keloid excision, we went back to the 12th floor to debride and suture the boy with the left canthal laceration. The boy needed to be under generalized anesthesia and intubated because he was too young for local anesthesia.
Soon after, we headed back to the 8th floor again, but this time the procedure involved a removal of a lipoma posterior to the left popliteal fossa. The patient was a 56 year old female. Like many of his procedures, the patient was only required to be under local anesthesia.
Like a yoyo, we went back to the 12th floor for the last surgical case of the day. It involved a woman in her early 30’s for a scar revision. An excision was made circumferencial of the scar, fibrous tissue cauderized to even out the the skin, and hair-thin sutures used to close the wound.
Only after all his surgical cases, did we finally have a little break to have lunch, and the time was already 2:30pm.
But lunch was short, as he was running late and his next patient was already getting ready for lazer treatment for the face. The patient was a 30+ female. She was there for her "appearance maintenance". A device called the IPL was used to whiten the skin. A second lazer device with another acronym was used to shrink the pores. And lastly, another device was used to zap age spots. With each procedure, the patients face became redder, however, at the end of it all, she was given an ice face mask to sooth her face. The cost for the three procedures was US$400. Results were instant, and total recovery is 3-5 days.
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