Gowned, masked and awed, I stood on the anestheologist's raised platform at the patient's head and peered over the blue drape. Three feet away, cardiac surgeon Jack Copeland, M.D., was busy using a cautery tool to separate a partially-clogged blood vessel from the muscle of the patient's beating heart.
Once Dr. Copeland prepared the heart's blood vessels, he would put the patient on bypass — the heart-lung machine that performs the function of oxygenating and circulating the patient's blood so the surgery could continue on a still heart — and then attach a vein harvested from the patient's left leg to bypass the clogged vessel and re-establish a vital flow of blood.
Dr. Copeland glances up at me and winks. "Pull back on that lung," he says to an assistant. "It's getting in the way."
Simply another day on the job for Dr. Copeland and the surgical team performing this heart bypass operation, yet a phenomenal opportunity for me to get a feel for the complexity and intricacy of the surgery, courtesy of University Medical Center's Community Intern Program.
During the three hours I spend in the operating room, I'm encouraged to wander the perimeter of the sterile field (don't touch anything draped in blue, because it's sterile and you're not, I was instructed) and view the surgery from any angle. The bypass team gives me a rundown on what will take place once Dr. Copeland gives the word for them to go into action.
The registered nurse providing surgery tools to Dr. Copeland is a big man with a serious cast to his eyes, his glance darting from the surgeon's hands to the patient to the trays of instruments. The RN always seems to have the precise instrument Dr. Copeland needs, a moment before the surgeon calls for it.
The two assistant surgeons are busy too, one harvesting the leg vein and then suturing the incision, and the other working nearly hand-in-hand with Dr. Copeland at the long incision in the patient's chest.
My time in the operating room will expire before the patient is pulled off bypass, but a later check with the staff assures me the patient is doing fine and the surgery is considered a success.
Heart work is a big deal at UMC and it's an area I'm particularly interested in. Another day, I'm gowned, masked and wearing a lead chest apron when I'm ushered into the cardiac catheterization lab, where Carl Kern, M.D., is performing a procedure on a woman who had a heart transplant two months previously.
Dr. Kern is checking the blood flow through the heart's vessels, as well as the internal pressure of those arteries and veins. Every so often, he shoots a dye through the vessels and records the track of the fluid on video monitors arrayed over the procedure table. The patient, awake but sedated, is doing fine and her new heart is working well.
During a working lunch, Doug McClellan of the Heart Center gives me a hands-on tour of the workings of artificial hearts, from the first model conceived to the current units being used in today's procedures. Looking at the line-up of artificial hearts is a bit like looking at the development line of the first large, clunky laptop computers down to today's smart phones and iPods.
Later that day, I'm sitting with William R. Roeske, M.D., associate chief of the cardiology section, as he questions a patient about his symptoms in the Cardiology Clinic. The Italian patient speaks English as a second language, and his wife is there helping translate. I ask the patient a question in Italian about his home in Italy, and his face brightens. "Milano," he says. "Napleotano," I reply, and he heaves a sigh, relaxed for a moment.
The hour with Dr. Roeske goes quickly as he deals with three patients in succession with wildly different symptoms and problems. He takes his time, questioning them about their symptoms, and is deliberative in how to proceed. Dr. Roeske ties into the patient's medical history on his laptop, reviews past visits and consultations, and gives the patient a plan of action.
One of the wonders of UMC is its Arizona Simulation Technology and Education Center, where David Biffar, chief of technical and laboratory services, gives us a brief overview of the lab and its functions and turns us loose on a variety of video game-type machines where we have to prove our surgical dexterity in tying virtual knots, slicing off chunks of tissue and picking up tiny items with forceps.
As I arrived in the simulation lab, Tucson Fire Department paramedics were leaving, having finished a training session with one of the lab's stars — a mannequin as close to a living, breathing person as one might get. The mannequin has a pulse and breathes — its chest rises and falls, and air can be felt at its open mouth. It can be intubated in the throat and chest, and has skin that feels close to real.
Biffar controls the mannequin's symptoms from a Macintosh laptop and can change the dynamics of its treatment with a few keystrokes. He shows me how he can make the mannequin's blood pressure crash, or limit its breathing so the trauma team has to change its course of action to "save" the patient.
The two days of internship are filled with activity, from 7 a.m. to 5 p.m. each day. I also visit the Arizona Poison Control Center, where Theodore G. Tong, PharmD., and Keith Boesen, PharmD., give me a sweeping rundown on the fabulous service this center provides to the whole state, and at times, to other facilities around the country.
I learn about the various imaging services at UMC, arthritis, blood and marrow transplantation, home health visits and the Arizona Cancer Center.
But the emergency department is the place where a lot of the action happens. On the afternoon I'm there, Arthur B. Sanders, MD, professor of emergency medicine, is the attending in charge. He's dealing with a patient with a concussion who was flown to UMC after being hit by a car that came through the wall of the Patagonia Post Office.
Once Dr. Sanders is sure the trauma team has a handle on the patient, we travel the length of the emergency department and look in on a woman experiencing throat and chest pain, along with dizziness. In the next bay is an operating room nurse who had slumped to the floor in the OR with an irregular heart rhythm. They're working her up to determine the cause of the problem.
Satisfied all is being done that can be, Dr. Sanders leads me to a bay with an eight-year-old patient with a broken wrist. Dr. Sanders speaks to the girl quietly for a few moments, explaining what will be done. She smiles weakly. The team will sedate the girl and reduce the break so they can set the bone with a cast.
Another day in the trauma center works its way toward the end.
Internships have reached more than 400
Your mother always wanted you to be a doctor. Well, here's your chance — sort of.
University Medical Center's Community Intern Program is designed to give interested persons an in-depth look at the challenges, teamwork and technology found in a modern academic medical center. Its goal is to acquaint individuals in a variety of fields — industry, finance, government, media, education and others — with the complex process of delivering modern medical care.
The program is an intensive two-day internship focused on medical, clinical and surgical procedures. Community interns observe surgery, make rounds with doctors and residents, view medical procedures and treatments, and observe the hospital's trauma program in action.
Since the internship program's inception 18 years ago, more than 400 individuals from around the state have participated.
The program offers three sessions per year, one in spring and two in the fall. The next scheduled sessions run Sept. 13-14 and Nov. 15-16. Interns are provided with personalized lab coats, an individualized schedule based on personal interests, and are accompanied throughout the internship by preceptors expert in their fields.
Persons interested in participating in the community internship program should contact Adaline Klemmedson, vice president of administrative and corporate relations for UMC and administrator of the program, at (520) 694-7567.