Week 1: OR

The first week was off to a bit of a slow start for me as I had to take care of some administrative issues. We were able to work through most of them though and I hope to be more productive next week! I shadowed Dr. Bostrom in the OR on Thursday, which was very exciting.

            I observed a primary total hip replacement, a primary total knee replacement, and a hip replacement revision. One especially interesting process I observed in the primary joint replacements was the system used in the OR to confirm implant compatibility. As most of these implants are modular, the surgeons have some flexibility in choosing different components. The circulating nurse was very helpful in describing this to me. The surgeon can mix and match between sizes, materials, and even brands. Exchanging components across brands is especially interesting to me because these components are only tested within the company to achieve FDA approval. Other things I found interesting in the OR included some of the material preparation. The nurse within the sterile field who handles the materials was actually threading the suture onto a needle prior to giving it to the clinician. This humbled me in many ways as in my animal studies, I have found suturing to be very difficult – and my suture is already threaded! It simply shows how many of these jobs are still dependent on human input and human talent.

            Overall, I found that talking to as many people as possible was very beneficial as everyone has a different responsibility in the OR. Speaking with the residents and interns in the OR is also very useful and eye-opening. One of the interns was explaining to me the differences between the type of total knee replacement done here at HSS and the type done at Harvard (her alma mater). At HSS, both the PCL and ACL are compromised but in Boston, only the ACL is compromised. While there have been no conclusive studies showing one over the other, the resident explained that many surgeons will perfect their techniques during the end of their residency and during fellowship. I found this especially interesting because it is easy to forget that surgeons will have a large learning curve to learn new methods or techniques, which can delay the introduction of new technologies.

            The most interesting case I saw on Thursday was the case that actually did not occur. A patient with juvenile rheumatoid arthritis, now in her 50’s, was going to be receiving a custom implant for a second hip revision. So much of her bone has been resorbed that she did not have enough of an iliac crest left to receive a normal revision instrument. There is a biomechanics team here at HSS which specially designs these implants so I enjoyed speaking with the engineers about their design process. However, this patient also had pulmonary complications and was unable to be intubated for the surgery, so the procedure had to be cancelled. I could more directly observe the anesthesiologists and better understand the difficulties they may face during these procedures.

            Outside of the operating room, I have been preparing the materials and protocols for RNA extraction. Next week, I plan to try some extractions and ensure that I will be able to extract enough RNA for successful sequencing. Outside of work, I have really enjoyed living in the city. I saw a Broadway show, The Book of Mormon, and have enjoyed many meals. Tibra and I had a marathon afternoon this week and went to the MoMA, Central Park, saw a piece of the Berlin Wall, and walked 11 miles to do it! My favorite desserts so far have been the banana pudding from Magnolia Bakery and the Blood Orange donut from Dough. I am looking forward to more exploring (and more dessert) this weekend!