Friday

The final two hours of my senior project were the most important, as I saw one of the most difficult procedures to execute; Dr Demarco performed a double ballon dialysis on the woman from the interesting case yesterday. He essentially went through the most narrow area of the colon (theascending colon) to get to the area of constricted ness; the colon actually gets so narrow that two gallons inflate while inside the colon to create more room for the scope to continue. After using the push/pull method for almost an hour, Dr. Demarco finally got to the constricted area, where he inserted a tube that dilated and expanded the area to reestablish the flow of digested materials. The tube expanded so much that it blocked her colon from allowing gas excretion, causing her to aspirated at an alarming level of noise; the anesthesiologist had to quickly remove all of the backed up gas by sucking it out of her throat with a device similar to a vacuum cleaner. After removing the gas the opposite way it should exit the body, the dilation tube was removed and her bowels were flowing fine. The moment when the aspiration occurred was the most exciting aspect of my week, because the patient could have died, but didn't because of the quick acting of Dr. Demarco, the nurse and the anesthesiologist. 

This week has had an impact on me that I never would have imagined; when I agreed to follow Dr. Demarco, I was excited for the chance to follow a doctor in general, but not one that sticks a scope up people's butts and throats all day. This feeling quickly changed after I was able to get accustomed to viewing the procedures, which switched from being unwatchable to interesting. Saying this now still is odd to me, but in the scientific realm such things become part of a daily routine and are necessary for the treatment of all patients. After following Dr. Demarco for a week, I have a newfound appreciation for the practice of gastroenterology which I never had before.

Thursday

Our final day was full of surprises and odd procedures. First, Dr. Demarco and his colleague examined a patient who had radiation treatment for colorectal cancer, which made areas of his rectum inflammed; demarco used a tool that burnt the surface of the inflamed areas so that further inflammation would not be possible. After that, another procedure was done where the woman was anemic from being stabbed 10 times in the head which accounted for all of the blood loss which lead to the anemia; she needed a colonoscopy, but ate food beforehand, which made it absolutely disgusting to watch. 

The first consultation of the day was a symbol of how much I have progressed through my time here at Baylor; a woman who had colorectal cancer 3 years ago (that had had it treated completely) came in because of abdominal pain in the same area over and over again. After alot of questions, it became apparent that a certain area of her colon was constricting, making it hard for food to be digested; the conclusion was that she needed a colonoscopy to dilate the constricted area, increasing the flow of digested material through the already shortened colon. This case was so interesting, I decided to attend the procedure tomorrow, even though I am already done with my hours, and for this reason I feel like this case represents my experience at Baylor - actual interest in scientific exploration of the body, no matter how stomach-churning the procedures can be. 

We then went to a conference presented by a doctor on CML, or chronic myeloid leukemia. Dr Cooper said that the leukemia  comes about through translocation in meiosis of the presence of the 22nd q- chromosome, or the Philadelphia chromosome. This chromosome leads to a high platelet count in the blood. Although very confusing, the lecture had a lot of good information on leukemia which I didn't know anything about. The conferences during the week have been informative, but today's presentation taught me a huge amount of information about white blood cells and leukemia in general. 

The last portion of the day was spent at Dr. Demarco's office, where we were presented with limitless information on the different types of scopes used to perform colonoscopies/ endoscopies. What amazed me about the scopes was that some of them were actually developed by Dr. Demarco himself, who has been pioneering the progress of scope-effectiveness with another engineer; I never knew how incredibly lucky I was to follow such a prominent figure in gastroenterology. 

Today, although my last official day, was the most diverse in information given and procedures seen, making a fitting end to a great mentorship; tomorrow's procedure should be the grand finale to an amazing experience.

Wednesday

Today, dr demarco did many procedures, ranging from colonoscopies to variceal ligation; for the most part, today was also the most fun.  The procedures that dr demarco performed were extremely informative and i almost felt like I was a doctor for a day. Although many of the things we do now are repetitive (such as consultations and regular endoscopies/ colonoscopies), the procedures today were different; dr demarco did a variceal ligation or banding of varicose/dilated veins in the esophagus. This procedure involved placing rubber bands around areas where cirrhosis of the liver showed in the esophagus, where if the areas bled again, the bleeding would be stopped by the lack of circulation in those areas; the procedure took 15 minutes to do but accomplished so much for the patient, who didn't have insurance and would have most likely died if he bled from the areas of cirrhosis.  Another procedure I thought was interesting was where an anesthesiologist came in to put the patient to sleep through sedating her to the maximum level a human can take; this requires that a machine breathes for her, pumping oxygen into her lungs, so that dr demarco has more time to get his procedure done. Using the tube to help the patient breath also enables the scope to go farther down into the small bowel, where because of this, dr demarco's spinal endoscopy was successful. I attended another lecture today, where the topic was a medicine called prozac that was tested for those who have had a stroke to measure the amount of recovery the patients had had over a 90 day period; the limiting and controlling factors of the experiment made me realize how alot of what I learned at Parish in AP Biology was used in hospitals nationwide.  Without prior experience in the field of Biology, this project could be much more confusing, but so far it has been an extremely rewarding experience.

Tuesday

Today, our explorations were taken further into the realm of Gastroenterology, where I was able to witness another PEG, two endoscopies, one colonoscopy, an autopsy, and a plethora of random facts.  The patients who needed the endoscopies checked out fine, except for one woman who had signs of Crohn's disease.  Because of the complexity of the scientific terms involved in internal medicine, I was not able to understand alot of what Dr. Demarco was saying during the consultations, but during the procedures that were done, words were not needed, as Dr. Demarco pointed out every single problem during all the procedures.  Signs of Crohn's, ulceration and other topics came up frequently during the procedures, giving me first hand experience on how to spot harmful things to the colon/small bowel; none of this, however, was nearly as informative as the autopsy I was able to sit in on.  Students from Southwestern Medical School (in Dallas) came to Baylor to analyze some cases of topics such as death from influenza and such, where slides were shown of the organs of those who died and everything from their bodies that could point to a reasonable cause of death.  Although the actual bodies were not there, the presentations on the autopsies of extremely rare cases taught me things I could have never have known without following Dr. Demarco. During the endoscopy at the end of the day, Dr. Demarco informed us that the anesthesiologist would be using the same anesthesia that Michael Jackson died from, where the body tries to metabolize the high concentration of lipids quickly, causing the patient to fall asleep; if too much anesthesia is given, the patient will have a hard time absorbing all the energy and will most likely die from loss of blood sugar. Dr. Demarco has even more procedures tomorrow, and I can't wait for what is in store for us.

Monday

My first day was like assimilating into a country so different it causes culture shock; the hospital scene was not something I was prepared to experience on a day to day routine.  At the beginning of the day at 8:00 A.M., I arrived at Baylor Hospital, where during my wait for Dr. Demarco I witnessed a colonoscopy for the first time.  To keep the details brief, it's like hunting for treasure in a cave like playing a video game; removing polyps and navigating through the intestines is an exploration by itself.  during the day, various patients came in for followups for various problems regarding topics from Crohn's to simple abdominal pain.  IBS or Irritable Bowel Syndrome seems to be apparent in many individuals, because half of the patients today had the same disorder. At noon, Dr. Demarco did a PEG on a woman who had a stroke, where a camera was threaded through the throat so Dr. Demarco could know where he needed to puncture the stomach so food can be directly transported to the stomach (she was unable to eat); this is the way in which most unstable patients are fed - after a PEG is performed.  Many thrilling random facts are taught to me every day, where i cannot ask for a better senior project; a better first day is something I cannot have asked for.