So today, June 27th (let’s pretend okay), was surgery day. Dr. Carlos invited us to observe the small skin cancer removal procedures, and we accepted another great opportunity to conduct some needs finding. I am usually extremely excited to get to know yet another environment, team and service within the HCB network, but, unfortunately, medical procedures and I have not been getting along. This was me a few weeks ago after I saw a blood draw for the first time (I usually close my eyes).
I am in the emergency room but wait… Let Nikhil take a selfie
As great as the hospital’s emergency care was, with attentive staff and some shared laughs at the Bioengineer who passed out at the sight of blood, I did not fancy another visit. However, I am too stubborn to let an overreactive vagus nerve get the best of me, so to surgery I went!
That day Dr. Carlos would be seeing seven patients whose skin lesions were identified with the teledermatology system HCB has established with the regional health units. With nurses trained in what to look for, and images of suspect lesions sent to Dr. Carlos, the hospital has an effective and expansive skin cancer prevention program. This amazing feat was now not only right in front of our eyes but weaved us right in with scrubs, hairnets and all.
Us, the small surgery room nurses, Cyntia and Patricia, and Dr. Carlos
Each surgery is very, very similar. Please excuse my engineer as I make these observations. There is this cloth, with a hole in it that is draped over the lesion to be removed. With the cloth it was easy to forget everything but the cancer. For my two colleagues, Nikhil and Tendai (future surgeons), that little hole captured all the action. As for me, even my stubborn self knew better than to stare intently at Dr. Carlos excising pieces of flesh, so I focused elsewhere. Each patient expressed discomfort with the local anesthesia differently. Some verbalized pain, others tensed their legs, pointed their toes or clenched their fists and without even looking, I was able to tell exactly when the needle poked in the patient’s body.
With the site numbed, the cutting could begin and I found yet another focus; the equipment, the procedure and any potential holes for improvement. So Dr. Carlos used this little tool that could both cut and cauterize. I was not very familiar with it so I decided to look it up here. In 1926, William T. Bovie invented the little gadget known as the electrosurgical unit (ESU) using a slew of preceding scientific discoveries (check out the full evolution here!) The tool passes an electric current from the machine to the active electrode held by the surgeon, through the patient’s body and back to the machine through the patient’s electrode. The concentration of current achieves temperatures of around 1,000°C. This heats the tissue, causing the cells to explode and dehydrate, promoting the cut and coagulation… Pretty cool right?!
This little device sparked my interest because it too came from people in our same mindset; a mindset on the lookout for hiccups in what seems to be a well-oiled machine. People adapt pretty easily and it is hard to complain about what becomes routine. There was a time when scapels and hot irons were used instead of our little friend the ESU, but someone (actually very many people) dared to question and to dream of something more efficient and effective. Although this has become quite difficult nowadays since it seems that we have everything, we were still looking, questioning and dreaming.