Week 6 - Marie

This week was an exciting week for me, as I observed my first surgeries. I shadowed Dr. Gupta as she performed three very different gynecologic oncology surgeries/procedures. What was most interesting to me about the surgeries is that none of them involved incisions through the abdomen, as the urethra, vagina, and anus provided sufficient access points. The first surgery I watched was a staging procedure, in which a woman with cervical cancer was being examined to determine the extent of her disease. Her bladder was visualized with a camera on the tip of a catheter, which showed cancer at the attachment of the ureter and the bladder (but no where else). A small biopsy was taken, but the entire cell mass could not be removed without significant risk of incontinence or a fistula forming. Her rectum and colon were also examined for metastasis; fortunately, none was found there. With this information, her cancer was staged at IVa.

The second patient I saw was one I had previously seen in the gynecologic oncology clinic, so I was more familiar with her health history. She is currently seeing Dr. Gupta for condyloma (genital warts caused by HPV) and was in the OR to have the lesions removed with lasers. This was pretty interesting to watch. The third patient I saw was in the OR for a more invasive biopsy of / removal of part of her cervix.

For each of these patients, Dr. Gupta and her team of residents clearly explained the health history of the patient, what procedures they would be undergoing, and what each step of the procedure was. She also made sure I was able to see each step. I will be shadowing her in the OR again this Thursday.

Earlier in the week, I also shadowed Dr. Gupta in the gynecologic oncology clinic at WCMC. Dr. Gupta's patients in the clinic ranged from 20-80 with a variety of health concerns and diagnoses. Minor procedures can be performed in the clinic, so I saw multiple pap smears, vaginal exams, and colposcopies. The colposcopies were quite interesting; acetic acid is used to indicate portions of the cervix that are HPV-infected, and a biopsy is then taken of this region. I really appreciated how trusting and generous the patients were to let me watch these personal procedures. I also really appreciate the opportunity Dr. Gupta has given me to shadow her--she sees a diverse set of patients from initial visits to surgery/treatment and follow-up, allowing me to see the whole process of medicine with continuity of patients.