11/13/15

This was another irregular day; I didn’t have school and Dr. Nguyen had a resident lecture to give early in the morning, so I ended up going at 8:00 instead of 6:50. So, I skipped valve conference and went straight into pre and post-op patient checkups. I usually don’t see a lot of these, but since I didn’t have to get back to school at a certain time, I was able to get involved in two of them:

The first was very, very standard (this is good); the patient was a woman in her mid-60s, who was recovering from an open-heart valve replacement (I can’t remember if it was aortic or mitral) a month or so ago. She was doing fine, but was concerned with the development of bacteria over her scar. To remedy this, she was given some betadine, an antiseptic used for surgery prep. Daily applications of that, along with some gauze, would be more than enough to deal with her issue.

The second was a pre-op patient, a man in his early 60s who worked at an auto shop. He had mitral calcification (his mitral valve was blocked and couldn’t pump as much blood as it normally could), type 1 diabetes, and some breathing issues. Throughout my time in the room with him, he brought up how his vision and memory hadn’t been very sharp in the past few weeks. This led us to believe that something was wrong with his carotid arteries (which lead to the brain). This could be a possible clot, which is an entirely different issue for another department. A recurring theme throughout the time I spent with him was the difficulty he had with the medical terms being thrown around. He was hesitant to attempt saying the names of the surgery options he was given, even refraining from saying cardiologist or MRI. This gives me extra incentive to pursue the stenosis project with Dr. Nguyen; it’s so integral that people know the scope of their condition and what exactly is wrong with them. 

10/30/15

Quick Update: for those of you that actively read this blog (if there are people who do), both Dr. Nguyen and I were out of town last week, making me unable to attend. He will be gone this following Friday as well. I might be going this Wednesday if possible, or at the least discussing the animation project with him and using that info as the next blog post.

Last Friday, I spent most of the morning in the hospital at valve conference. Most of the patients had aortic or mitral stenosis, with nothing too irregular. None of the patients had extreme defects or early heart irregularities, and were mostly old patients in their 70s and 80s that had a past of heart disease. I’ll talk about a few of the cases. 

The first was 66 y/o woman with mitral regurgitation (valve is loose, leaks when pumping blood or drawing blood into the heart), moderate-to-severe in condition. Most of the cardiologists in the room recommended a MitraClip, a minimally invasive catheter-based valve repair device. This did not take long to go over, but more interesting and lengthy case discussions followed shortly after. Another patient had a bypass done in the early 2000s, with a subsequent aortic valve replacement in 2005 that came with some complications. Heading to the present, she was recently admitted to the hospital with acute kidney injury (as well as the continued heart problems), and has been on dialysis almost every day because of this. Aside from her kidney issues, she needed work on both her aortic and mitral valves. Going even further, her lungs were functioning poorly. There was a long discussion over how to deal with this woman’s serious conditions- she’s a high-risk patient with limited long term benefits from invasive surgery, so the best thing right now would be simple medical care and making the rest of the time she has left pleasant. Just being in the room while these talks deciding a person’s life were happening feels very odd, but I’m glad that I was able to get a glimpse into the harder decisions that must be made in a hospital. 

10/9/15

     This past Friday I had the day off, but decided to go to Memorial Hermann for my internship anyways. I know, I could’ve slept in until noon- which was tempting- but I usually have good experiences up at the hospital, and it’s something that I enjoy doing. After arriving, Dr. Nguyen informed me that the urinary tract infection he had scheduled for the morning (and had told me about in the days prior) had been moved due to some patient complications. Bummer. Instead, the morning schedule consisted of the usual: a lecture, valve conference, and patient checkups. The lecture involved a young patient with internal bleeding of the left colon along with a nasty case of necrosis, which is a fancy word for cell death. The necrosis was caused by ischemia, an inadequate supply of blood. Multiple surgeries were performed on him, and he spent two weeks on a ventilator. After all of this, the doctors just couldn’t walk away, and proceeded on with treatment- as of now he is back in school, with his only issue being a slightly-elevated diaphragm. An operation to solve this is soon to follow. Valve conference was very short, and only a few cases were presented. One case that caught my eye was that of a middle-aged patient with no past medical history, who suddenly had a stroke. It was later discovered that he/she had a mass in the right atrium of his/her heart, and that it could be some rare form of sarcoma. Only time will tell. From here, we went to post-op patient checkups. I saw one of the patients we checked with get operated on a few weeks earlier, and even got to meet with him before that surgery. I’ve seen him work through his entire process at the hospital; pre-op, surgery, and post-op/recovery checkup. I thought that this was pretty neat, but for the doctors around me, this was just another day at the hospital. 

10/2/15

                 This Friday was an especially busy morning. When I met up with Dr. Nguyen at the Heart and Vascular Institute elevators, we immediately rushed off to attend a presentation, our hands kept warm by our cafe mochas as we briskly walked to our destination. Shortly after we got into the room,  a 72-slide collection of information on carotid artery stenosis intervention commenced. The left and right carotid arteries carry oxygenated blood directly to the brain, making it fairly important, and stenosis is the tightening of blood vessels. So, the presentation was about different interventional methods for vessel tightening in that area. The two main contenders for intervention in the area are stents and endarterectomies-both have their benefits and drawbacks, which became extremely apparent once the doctors began to argue after the presentation had ended. No good fix-all exists for different arterial blockages, so we'll just have to wait and see what sorts of developments come along.

                At 8:00, we headed over to valve conference, which is when the cardiologists and cardiothoracic surgeons meet up to discuss individual post-op patients. It ran much longer than usual, stretching to around two hours. One of the most interesting cases they discussed was that of a person with a quadricuspid valve. Normal valves in the heart have three pieces to them, called leaflets, that section off the chambers of the heart. They open and close when blood needs to be pumped through them. This patient had an extremely rare defect that caused one of his valves (I believe it was his aortic valve) to have four leaflets, putting him at a higher risk for a variety of other heart diseases. The patient is getting a valve replacement soon, which is a surgery that I wish I could see- that would be a really unique experience, simply because his/her condition is so rare. It was definitely a fun morning in the hospital. 

First Post/ Blog Introduction

Hi, my name is Brayden Chavis. This blog is for my internship under Dr. Tom Nguyen, a cardiothoracic surgeon at Memorial Hermann's Heart and Vascular Center. I go every Friday morning (so, expect blog posts on Saturday or Sunday), with the occasional switch-up to accommodate for surgeries and other things that I get involved with. And no, I'm not operating. I attained this internship with two things at my side: commitment and a willingness to learn. When I interviewed for this position, I was too young, so I kept a dialogue with the doctor I aimed to work with until I was able to go. We sorted out the times I would be able to meet with him during his busy week, what my position would entail, and other organizational details. If you demonstrate interest, most people in any field will be happy to help you learn to the best of their ability- and that's what happened here.

For the past three weeks, the internship has been in a sort of testing phase. I got to know my way around the medical center a bit more, became even more inundated with medical jargon, and started to flesh (ha) out a project that I'll be helping Dr. Nguyen to get off of the ground. More details on that will come soon. A part of that testing phase was figuring out how this blog would work with the internship and what I can and cannot do, which is something that is definitely worth explaining. To start on that topic, do not expect a great amount of pictures- especially from the operating room- simply on the grounds that patient confidentiality is important. Like, legally speaking. Patient release forms to get pictures could be a possibility, but that's still a bit difficult to sort out because I'm a student. Descriptions of the surgery and how it went are still possible, as are pictures from clinic or post-operation patient checkups. I'll have plenty of content to sort through and post on the blog every week, so it will stay enjoyable to read through. I'd like to thank the Post Oak High School, which I attend, for allowing me to have this opportunity integrated into my school schedule. I look forward to sharing more of the stories-to-come from this internship.