Internship Journal:

31 hour job shadow internship with Dr. Brittany Evans MD, at

Adventist Medical Center in Portland, Oregon.

2/06/19
6:45 am- I meet up with Brittany, and get scrubs, a scrub cap, a
badge and a surgical mask.
7:00 am- Brittany administers a spinal tap to a patient getting a hip
replacement. She gives pain medicine or numbing medication, that lowers
blood pressure, and constricts blood vessels. We then place the patient on
the side of the replacement, so the medication takes more effect on that
side because it works with gravity. We then take the patient to the OR and
get them set up on the operating table. Brittany administers propofol to put
the patient to sleep while they finish preparing for surgery. She uses an
infusion pump to continue the administration of the anesthetic. Brittany also
give Blood pressure medication, a saline drip a prep surgical pain
medication of lidocaine, all through the patientś IV. The surgery begins, the
best part was the removal of the ball of the hip because the surgeon had to
pull so hard he almost fell over. The patient was a snorer which can cause
a headache post surgery but no long term effects. The job of the
anesthesiologist is to essentially keep the patient alive and comfortable.
10:00 am- Britney performs another spinal tap on our next patient that
is having a hip replacement. The patient requires a higher dosage of pain
medication, because she takes them on a regular basis, meaning she has
a higher tolerance. The patient is also on blood thinners and has a high
stroke risk because of the complicated medical history.
12:00 pm- The next surgery is a knee arthroplasty, with a full general
anesthesia. The patient is allergic to propofol, so they get full general.
Brittney attempts a spinal tap but has difficulty and is ineffective because
the patient has a history of a spinal injury, making it extremely hard to find
the gap in the spinal bones. Brittney uses a trachea tray instead of a tube
down the patients throat, that administers a gas anesthetic, sevoflurane,
and oxygen. She also tapes the patient's eyes closed to protect them from
anything getting in them.
(Ended the day at 2pm)

2/07/18
6:45 am- We begin the day with a spinal tap on a patient getting a
knee arthroplasty. The patient when in the OR is given propofol and put to
sleep. Brittany uses an LMA to hold the tung back and get the patient
oxygen. After all the drilling and sawing in surgery to make the knee
replacement fit, the surgeon uses part of the cut off patella to plug the hole
he made in the femur, and keep bone marrow in the bone. The surgeon
also used bone cement to connect the pieces to the bone. The cement
heats up very hot with a chemical reaction before it hardens and sets, hard
as rock. Next the surgeon had to use soap and water to clean the knee
from any excess bone marrow. Then closed the knee with a biohazard
degradable stitching that will last 4-6 months within the body. Brittney
finished the patient off in the PACU with a nerve block in his thigh. She
inserts a catheter into the thigh, next to the sensory artery. She uses an
ultrasound to find her way around within the leg. This nerve block allows for
less pain in the front and medial locations of the knee while still keeping the
patient mobile.
10:00 am- The next surgery is another knee arthroplasty with a spinal
tap in preop. She does another nerve block in the patient but later in the
future when the patient is fully awake.
12:00 pm-The next procedure is a short hardware removal in the
knee with a full general anesthesia. Brittany uses intubation, an LMA and
the sevoflurane gas to put the patient to sleep.
1:00 pm- The final surgery of the day was a biventricular ICD heart
monitor check. The ICD was malfunctioning in the patient who had received
it the previous week. The patient also had a long and complicated history of
a heart attack, stroke and tracheal damage. ICD’s are given to patients with
a history of cardiac failure or with a bad heart. The RV stent node was not
screwed in all the way. (ended the day at 3pm)
2/08/18
7:30 am- Brittney begins with prep for an epidural to the first patient
getting a left radial nephrectomy. The needle for the epidural is inserted
around the same location in the spine as where the surgery will take place.
Acts a a band of pain medication in the site of operation. The kidney in this
patient was 20 lbs plus, double the size of my head and could be seen
popping out of the patient's stomach prior to surgery. It was dead and full of
urine and cystic fluid. The ureter was blocked off by kidney stones and a
mass cancerous tumor that was causing the kidney to grow in dead weight.
IN order to remove the kidney, the ureter, artery and vein had to be
cauterized. Brittney gave the patient full intubation with a tube that reached
down the correct tube into the lungs and general anesthesia. She also put
an extra lateral IV into the patient hand to access if the patient needed
blood or extra medication. After they found out the tumor was cancerous
the full ureter was removed and a second incision was made all along the
patients lower stomach. The first stretched from the from the top of the ribs
to below the belly button and around the side of the body. (ended the day
at 1pm)

2/09/18
6:45 am- We begin with a right inguinal herniorrhaphy wish a mesh
graft around the bowel. They uses a local anesthetic to numb the patient,
and propofol to put the patient to sleep and is monitored and continued by
a propofol infusion pump. The patient will react to the numbing medication,
and is shown in the patients statistics, but not the the actual procedure if
numbed properly. Brittney gives lidocaine and fentanyl before and after the
surgery of pain management.
9:00 am- Next procedure is an exploratory laparotomy debulking
staging dinentectomy cholecystectomy- no more cancer production or
continuing uterine sarcoma, so procedure became a simple gallbladder
removal.Brittney gave an epidural in T8 or T9 of the spine before surgery.
12:00 pm- Last procedure of the day is a bowel resection laparotomy,
small bowel obstruction with anastomosis poss resection. The patient has
crohn's disease and cannot get large portions, or specific foods. Patient is
given an epidural in T10 or T11 to help with pain. The surgery is full general
anesthesia. I got to observe the process of the bowel creating a fistula to
the colon. (ended the day at 3 pm)