It's hard to say what part of the day I found to be the most impressive. As a nursing student and a structural engineer, it would be easy to argue that several different aspects of the day were the most impressive. However, what I can say for certain is that this was one of the most enjoyable and educational experiences I've had and I would love to do it again.
When I arrived it was the end of the first surgical case and I was able to evaluate the outcome of the surgery. The patient had a very advanced case of scoliosis and I was able to see both the before and after x-rays. I was absolutely astounded by the amount of correction Dr Hey was able to achieve. I have seen my fair share of pre and post scoliosis surgery x-rays and I have never seen that degree of correction. In fact, I didn't think that amount of correction was even physically possible. Dr Hey invited me along as he met with the patient's family to update them on the outcome of the procedure and on the patient's condition.
Between surgical cases Dr Hey invited me back to his clinic. He gave me a tour of his clinic, showed me the information management system he developed, and then we saw two patients. The information system he developed is first class and appeals to me both as an engineer and as a nurse. It is the most inclusive, most global, and most user friendly system I've ever seen. The patient record is started by the patient as they enter the clinic. The extender or MD then expands on this record during the interview and examination. All x-rays, CT scans, and MRI's are imported into the patient record and can be reviewed ad lib. Outside reports are scanned and entered into the record as well. From this record, notes, consents, and reports are generated. So, each patient has one comprehensive electronic file that contains all of their information and it is readily accessible and readily editable. As an engineer, I am truly impressed with the seamless integration of data entry (both pre-formatted and free text), importation of images and text, and the ability to generate reports from the acquired patient database. As a nurse, I find myself a little jealous as the documentation/record systems at Duke, Durham Regional, and Duke Raleigh are nowhere near that integrated or that user friendly. All aspects of this system work well and work together. I would absolutely love to have a program like that for nursing.
Back in the operating room, I was able to see Dr Hey in his element. He was performing scoliosis corrective surgery and a laminectomy on a patient. These were two procedures I had not seen before but had really wanted to see. The incision was made from mid thoracic spine to the proximal sacrum. Portions of the spinous processes in these areas were removed and processed to be used as an autograft at the end of the surgery. After extensive prep work, Dr Hey began the installation of the pedicle screws that would hold the support rods. We discussed how the screws were placed. We discussed fastener length and diameter selection, installation angle, fastener placement and symmetry, hole preparation, and installation torque. Once the pedicle screws were installed, Dr Hey performed the laminectomy on the lumbar vertebrae. I was absolutely in awe on his ability to dissect away the lamina without so much as disturbing the dura mater (outer covering of the spinal cord). Once the laminectomy was completed, the patient was repositioned and measured for support rods. These rods were cut to length with a highly specialized device that appeared much like a rebar cutter. However, this cutter left a very clean cut end. Once both rods were cut, Dr Hey pre-bent each rod in three dimensions. He added sacral and lumbar curvature to each rod as well as bends in a perpendicular axis. Each rod was inserted into the pedicle screw heads starting from the sacrum. The caps were inserted with a device that closely resembled a 2-jaw gear puller. The two jaws of this device locked into slots on the heads of the pedicle screws. The center screw drove down the cap and pushed the rod down into the head of the pedicle screw. Several of these tools were placed in succession and advanced progressively to minimize stress on any one pedicle screw. This procedure was continued up the entire support rod as each pedicle was successively capped. The procedure was repeated on the opposite rod. An intra-operative x-ray was taken to confirm placement. Once confirmed, the caps were all given a final torque. Bone graft material (both the patient's and donor) was spread along the portion of the patient's spine immobilized by the rods. Closure of the wound began with deep suturing of the muscle with large gauge sutures. A superficial continuous run of light gauge sutures closed the subcutaneous and cutaneous layers of the skin. Dermabond provided the final approximation of the incision edges and provided a water-tight seal. With the incision closed, Dr Hey went to discuss the results of the operation with the family and I headed home after a pretty long day.
Watts School of Nursing '10
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