The first case was a 18 month old female with neurofibromatosis which is a rare autosomal dominant genetic defect. If there is 1 parent with the effected gene, on chromosome 17 then there will be a 50% chance of the offspring inheriting the disease. What is the disease? It usually presents with cafe au lait spots (look like brown birth marks). There are a few different versions of the disease and variable degrees of severity. The most severe presents with multiple tumors, including acoustic neuromas causing deafness and brain tumors.
This girl's doctors wanted to rule out tumors / hemangioma in the bronchi as she has continually had respiratory problems. We did a bronchoscopy which is a procedure that involves using a camera to explore the bronchi of the lungs and see if you find any pathology. This girl turned out to not have any pathology in the bronchi.
The second case was a 5 month old male infant that was born premature at 26 weeks to a mother who abused crack and drank lots of alcohol. This baby has never left the hospital and is very sick. Most likely this child will expire and if it does survive it will be a miserable life. The baby has been on a ventilator his whole life and so we were doing a tracheotomy to make the ventilated breathing easier.
Whenever you do anything medical / surgical with infants it is like working on a time bomb. They are so fragile and things can go bad fast. Plus all the surgical techniques and pharmacology have to be altered. I do not think I would like pediatric surgery or medicine of any kind. To me it feels like you are on the edge of disaster at all times. Both of the pediatric cases went fine but we did have some tense moments. Also it was hotter than Satan's rectal vault in the OR. When operating on infants you have to keep the room very hot because infants do not do well in surgery with added thermoregulatory stressors. If the body has to focus on maintaining normal temperatures the overall system does not do as well and the surgical outcomes are worse.
The final case was an unbelievable case. I was fortunate to be able to see and do part of this surgery. We were doing a resection of a parotid body tumor. The parotid gland is located in the face where last weeks surgery on the carotid body tumor was in the neck. In today's case we had to expose a lot of the neck anatomy but also the face anatomy. We exposed the facial nerve and had to be careful not to damage it. We were successful in protecting the facial nerves and arteries. This case took 6 + hours, it was long. We also had some bleeding issues and it became tense as we had to find the bleeding vessel and tie it off. This took some time and fancy maneuvering to avoid damage to the structures. DUring this time I was working the retractors to move structures out of the way so the chief resident could find the vessel. During this whole time we were battling against blood flooding out. It is amazing how calm everyone stays, which is not the case when doing surgery on kids. Ultimately, after 20 minutes we were able to control the bleeding by finding the bleeding vessel and tying it off.
At the end of the day I felt so charged and this makes me consider surgery. I entered medical school wanting to do surgery but I also wanted to see the rumored lifestyle and see how painful it is. The plot thickens as we look at surgery as an option.
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