Tuesday, June 18

         I woke up at 7:07 AM and started getting ready for the day ahead. On the agenda: writing emails to doctors at the hospital, making edits to some of our devices, and shadowing my first surgery ever. I put on my lab coat and lucky scrunchie and made a beeline for the kitchen. Around 7:30AM I grabbed my things and just like that Diego and I were off meet Dr. Sylvio at the surgical center to shadow his 8AM orthopedic surgery. I felt pretty good — some might even say great!

         We arrived at the surgical center, suited up in our scrubs and hairnets, and met Dr. Sylvio and a couple other medical residents outside of the operating room. Nurses and maintenance workers were busy cleaning up the room from a biopsy done just before. After a some minutes, the nurses guided the patient into the operating room and onto the surgical bed. Nurses and doctors began to prepare her anesthesia and track her vitals while a technician on the other end of the room laid out an endless spread of screws, poles, and drills that would be used for the surgery. The patient’s femoral cancer had spread and weakened the bone and it was time to introduce titanium supports. I looked over at the patient and she was beaming! If she was nervous she did a great job of hiding it. I, on the other hand, started to feel my nerves creeping in.

         The night before, I scoured the internet for tips and tricks to get through shadowing your first surgery. No surprise, most articles I read were written by doctors or medical students who LOVED watching surgeries. I couldn’t relate in the slightest but I wasn’t about to turn down free advice. The articles suggested, among other things, to

1. Drink caffeine to raise blood pressure. CHECK.
2. Drink water to compensate for dehydration caused by caffeine. CHECK.
3. Eat a big breakfast beforehand. CHECK!!
4. In the case that you start feeling light-headed, tighten legs to keep a constant amount of blood towards the brain or rock hips side to side to calm the nerves. (*spoiler* this tip did NOT work for me at all)

          I repeated my list of tips and tricks to myself as we waited for the room to be prepared. I was ready! This was going to be the day that I conquered my biggest fear of watching a surgery and I was going to learn so much from the experience. And with that thought, we were called into the room and the surgery began!

The First Incision

         Femoral cancer surgery requires three small incisions: one at the top of the hip, one about 10 cm below along the thigh, and another incision at the bottom of the femur near the knee. Dr. Lorena made the first incision near the hip and began to burn around the opening of the cut to inhibit excessing bleeding. Once the golf-ball sized hole was established, the doctors degan to introduce thin “guiding poles” into the openings of the femur. These guiding poles fit into the tight holes within the femur bone and allow for a larger drill to attach and carve out a more substantial tunnel through which the titanium supports and screw can be maneuvered. The operation itself seemed to be going by super smoothly! We joined a group of resident students standing about two meters from the surgical table. The medical team was like a well-oiled machine as one doctor was on constant watch of the patient’s vitals and administered additional anesthesia as needed. Dr. Lorena worked on guiding the poles into the bones while Dr. Nelson helped widen the incision. Dr. Sylvio kept track of the direction of the metal poles within the bone by constantly checking the x-ray images and directed the medical team accordingly. A surgical technician worked quickly to clean used tools and predict what instruments might be needed in the sequence of the surgery. It was neat to see these amazing doctors work so naturally together. (Also shoutout to Dr. Sylvio and the Queen playlist he had going in the background– definitely helped ease my nerves!)

         The surgery went on. The medical team focused on making the tunnels large enough to coax the titanium support into the hip-incision and span the length of the femur. Dr. Nelson took small breaks to make sure Diego and I understood what was happening while Edson, a resident, pulled up a diagram of the femur on his phone to further outline the procedure. We weren’t shy at all and asked questions when needed. Diego and I listened in on what the doctors and students were saying and reported back to each other to make sure we each comprehended while adding insights and potential technology ideas.

Spotty Vision

         My eyes bounced from the x-ray projector to the actual incisions while my feet tapped to Seaside Rendezvous. Training models are amazing tools yet being there in the room I saw a medical team working in harmony and actively problem solving through unexpected challenges. I was enjoying the experience and learning so much. I looked over at Diego to mention something I noticed on the x-ray when, suddenly my vision was littered with periwinkle dots that I couldn’t seem to blink away. I could feel the weight of my lead apron pressing down on my shoulders, my chest began to constrict, and my blood began to drain from my head to my legs. Tighten your legs! Rock back and forth! I kept trying for what seemed like five minutes but decided to stop fighting it and excuse myself from the room to get fresh air.

         I snuck into the hallway and stumbled against a wall behind some medical equipment and scanners. I focused on my breathing and tried to calm myself down and regain my vision. No luck. I was getting weaker by the second and could feel my knees buckling. I called out for a nurse walking by, “Vou desmaiar!” (“I’m going to faint!”). She came to my rescue immediately and called to a fellow nurse to help prop me up and get me to a chair down the hall. They grabbed me some cold water and asked if they could take me to a medical room to take me vitals. It was a very sweet gesture but I declined. Edson and Dr. Nelson came out from the surgical room to check on me.

         If I’m being completely honest, this was a huge low for me. I felt like I had totally failed and I was deeply embarrassed. I had placed so much weight on this surgery and had set very high expectations. Beyond facing my fears, it was supposed to be the moment I proved to myself that I was cut out to be a successful bioengineer. Well, that’s pretty dramatic! I KNOW! The link between shadowing surgeries and my prospects of being a good engineer seemed pretty simple to me. I want to design medical technologies — some of which would be used on open flesh. Therefore, I need to see open flesh to know what to design. If I can’t sit through an operation, what good am I to a design team or to a patient? And while some might argue that that’s not the case at all, unfortunately, it’s a mantra I’ve repeated for years.

“It happens to the best of us”

         Edson and Dr. Nelson could tell how embarrassed I was and began to share their own experiences with almost fainting while observing or conducting surgeries. Soon enough, other surgeons and nurses from the ward came to check on me and added their own stories and words of encouragement. This meant the world to me. I went from almost crying from embarrassment to almost crying from gratitude. Things had not gone according to plan. In that moment I decided to stop dwelling on something that was out of my control and focus on how far I had come and how much I had learned through it all.

         When I came to Barretos, I promised myself I’d work on becoming comfortable getting uncomfortable. For the longest time I let the fear of failing dictate the things I did or cap the extent to which I’d pursue new ventures. The purpose of fear is to make us act, not to make us freeze. No longer did I want to stay complacent; I wanted to learn!

         Sitting in that hallway, surrounded by experts in the medical field cheering me on, I decided to act. A few jokes and thumbs-up later, I stood up, resuited, and returned to the operation room. Edson suggested that we stand by the door (in case I’d have to take another break –which I did not!). I hadn’t missed too much. Dr. Nelson was forcing the femur support into the bone which proved to be a bit harder than expected since the pole was getting stuck. About fifteen minutes, some hammering and shoving later and the titanium support was snug in place within the femur bone. Dr. Lorena made another incision near the knee and, while checking the x-ray monitor, secured the support in place using titanium screws. The surgery had gone perfectly.

         This experience opened my eyes to how important it is as an engineer to expose yourself to the types of environments and situations you wish to design for. I learned about the various complications that can arise when performing such a procedure (a few of which actually occurred) and the problem solving skills needed to address them. I was able to spot potential room for improvement and began picturing devices that could be implemented. Leaving the surgery room, I had a notebook filled with observations and areas for further research. Could we create a single, 3D model of a person’s limb and update it in real-time during the surgery to guide surgeons? Could we reinvent the custom-made titanium support and screws?

Final Thoughts and Thank You’s

         All in all, I exited the surgical center feeling accomplished and thankful. I had witnessed a metastatic femoral cancer procedure! WHAT?? And, crazy enough, I wanted to see more. I could not have gotten through this procedure without the support of Dr. Sylvio, Dr. Nelson, Dr. Lorena, Nelson, and the many other nurses and doctors that came to my rescue in the hospital hallway. Thank you for the words of encouragement and for sharing your own experiences with nearly-fainting. I’m happy to say that it will not be the last surgery I will shadow 🙂

Até logo,

Paula