Externship at Sharp Grossmont Hospital
For my one week during spring break, I been fortunate to have met many great doctors at Sharp Grossmont. Through a family friend, I was able to connect with other doctors and watch many procedures. During my time there I shadowed gastroenterologists (GI) and cardiologists.
The gastroenterologists spent most of their day performing endoscopies and colonoscopies. During an endoscopy, a flexible tube with a camera, suction, and water pipe is sent down the esophagus, stomach and into the first part of the small intestines called the duodenum. The endoscopy can be used to diagnose a various number of diseases such as ulcers, hepatic portal hypertension, hernia, infections, and even cancer. During an endoscopy, biopsy are taken and tested for H. pylori, cancer etc. In the cases I saw there was some gastritis/duodenitis (inflammation of the stomach/duodenum); the stomach/duodenum is lined with “red polka dots” and looks irritated. In another patient, the skin surface had an interesting lace like pattern. I also saw an esophageal and a stomach ulcer, they are usually red (like it's bleeding) and the skin looks “eroded.” There was one case where the patient had a narrow esophagus. The doctor treated that by sending a balloon into the narrowing and then inflating it.
There were also many colonoscopies done, and I got to many different diseases/conditions and how they manifest in the colon. The most common reason people came for a colonoscopy check up was for colon cancer checkup. Many older people had polyps. Hyperplastic polyps are usually benign (non-cancerous) growth, while adenomatous polyps can lead to colorectal cancer. These polyps are removed by a wire biopsy or by burning the polyps.
Another really cool, life-altering surgery I saw was an endoscopic ultrasound and ERCP (Endoscopic Retrograde Cholangio-Pancreatography). The patient was a woman that was losing weight and had a narrowing of pancreatic ducts and the common hepatic duct. The ultrasound was used to confirm the hypothesis and an ERCP was performed to help fix the problem. The goal of the ERCP is to insert a stent that will expand the duct or vessel and allow bile and pancreatic enzymes be secreted into the duodenum. This was achieved by sending the endoscope down to the duodenum. Then wires were sent through the endoscope, through the ampulla (where the common hepatic and pancreatic duct intersect the duodenum) and into the respective ducts. These wires were used as a transport system. Contrast was used to identify the strictures in the ducts so the stents could be placed there. After the contrast, a balloon was sent to the stricture to dilate the duct. After that a tiny brush was sent to collect a biopsy. The balloon and the brush were attached to cables that were fed through the wires that were already placed. This surgery is important because it could help the person digest food better. Pancreatic enzymes are crucial because the body can only absorb and make use of simple molecules like glucose or individual amino acids as opposed to carbohydrates and peptides.
During the externship, I also had the opportunity to shadow cardiologists and see a few cardiac catheterizations, renal angiograms, and a transcatheter aortic valve replacement (TAVR). A cardiac catheterization is done right after a heart attack or for someone at risk for a heart attack to find a dilate any narrow cardiac vessels and to remove plaque buildup. This is done by sending a catheter into a major cardiac vessels and sending contrast. Doctor’s can find narrowed or partially blocked arteries by the flow of the contrast. If a blocked artery is found a balloon that is attached onto the catheter is sent through the blockage. After, a stent is placed to keep the vessel open. A renal angiogram is similar to a cardiac catheterization, but assesses the vessels in the kidney. A TAVR is done when the aortic valve becomes stiffer due to calcium buildup, which restricts the amount of blood flow going out from the heart and into the body and can lead to heart failure. During a TAVR, a replacement valve, similar to a stent, is placed inside the aorta. This is done by sending a catheter through an incision made at a major artery. The patient this was being done on, happened to have a radial artery, so the doctor’s had to send the catheter through a different artery. It was amazing how patient and tenuous the doctors were.
During my one week, I also saw the rare case of a heart tumor called myxoma. This abnormal growth was found while doing an echocardiogram of the heart. An echocardiogram is done by sending a probe down the esophagus and recording the ultrasound waves.
All in all, I learned a lot during my externship, especially the tension, the stress and the problems doctors go through, but also how they are calm, composed and tenacious - they never give up. During the one week, I learned alot about the skill sets doctors must have and about differences in human anatomy.
