This week’s rotation has been with anesthesiology. This means that it could be any department that uses anesthesia for surgeries or procedures. I got to see plastic surgery, neurosurgery, urology, and vertebral medullary surgery this week. The first day was the most informative about anesthesia. The anesthesiologist, who said to refer to her by Christina, was able to speak to Maddie and I for the majority of the surgery to explain the procedure. One thing Christina enlightened me about was how to evaluate and predict the difficulty of the laryngoscope insertion for patient intubation. On this first day, Maddie and I got to observe two surgeries related to plastic surgery with Christina. The first one was a male with genitalia wounds that failed to heal properly due to his hyperhidrosis. To assist with this and to prevent the cause of infection, there were skin grafts placed on the patient’s affected areas. The second case was a middle-aged female who was a diabetic psychiatric patient. Due to rejecting medication for her worsening diabetes, the court decided that she loses all health autonomy. The surgery was to clean her diabetic ulcer wounds. The surgeon also decided to inject her with insulin during her intubated state so she wouldn't refuse it while conscious. On the second day, Maddi and I were in neurosurgery. This department begins its mornings with a daily physician meeting. On Tuesdays, when Maddi and I shadowed, there are an additional meeting of smaller teams within the neurosurgery department. During the meeting, I noticed that all the present physicians were male. This was the case for every surgery I have shadowed this week. The surgery I went into was a brain tumor removal for an older male patient. The most fascinating part about this surgery was the technology used. There was a calibration machine that had a tracing of the patient’s CT scan to track the tumor during the surgery. A metal rod was used to point in the direction the surgeon was digging and the machine located where that is in relation to the tumor. The intern present at this surgery explained that there was local anesthesia that was injected in addition to the original anesthesia. This was to raise the blood pressure and then constrict the blood vessels to prevent any hemorrhages during and after the surgery. This was a very long process because of the many layers leading to the brain. This included the skin, skull, dura mater, and then finally the brain which included the tumor. The surgeon operating had been on call for more than 24 hours which I couldn’t tell whatsoever. With this surgery specifically, it seemed like there was an endless amount of carving so this is when I definitely had to lean on my patience. The next day I was in urology. This patient was under an abundant amount of anesthesia due to his old age as well as the invasiveness of the procedure. Not only was the patient taking out his bladder due to a tumor, but this also required him to have his prostate and appendix removed due to the location of the tumor. Lastly, I shadowed in vertebral medullary, known as Unidad Vertebrimedular (UVM) in Portuguese. As soon as we walked into the locker room, Maddi and I were told that there was a head trauma coming in. Because of this I expected a very fast pace surgery, however, it was the complete opposite of that. I believe because it was an unexpected surgery, this was the slowest-moving surgery I have shadowed all week. There were many questions asked and so much time was spent on the patient's preparation for surgery. When the surgery finally began, the cutting of the neck was quick but then there was no context given to us after that.
I feel that a huge part of this experience is to decipher the social and medical determinants of health. From my observations this week, the social determinants of health ultimately led them to that operating room. For example, the female patient with diabetes was certainly not born with a 400 glucose level, however, it is the conditions that she lived that gradually increased her hyperglycemia. This could have been due to many reasons such as being uneducated on having a healthy diet or it could have been the lack of money to purchase said foods. A medical factor I have observed has been that all but the patients with diabetes were males. I am not sure if this was a coincidence but it could be that males are more susceptible to disease so it would be fascinating to find out more about that.
Healthcare in Lisbon is very different from the United States. The most obvious contrast is accessibility. Portugal’s healthcare is able to be universal through the National Health Service (SNS) which is the insurance provided to every Portuguese resident that is paid for through taxes. When I first heard of this, I immediately thought every country should do this and although there are many benefits of this system, there are also many harms. When speaking to an intern, he mentioned the need to prioritize peritectic compared to geriatric patients because of the limited resources. However, when shadowing in the United States, I saw that everyone is given equal effort and most physicians don’t have a “we can’t live forever” mentality like in Portugal.
My expectations for Portugal’s healthcare system were much different than my experience so far. From the statistics that we covered in class comparing the United States to Portugal, Portugal is much more established in healthcare than the United States. However, based on my observations, the United States seems to be doing most things right. For example, smoking in Portugal is very normalized that physicians and healthcare professionals regularly take smoke breaks during their shifts. This in return influences the rest of the population to believe that it must be okay to smoke if doctors do. Although smoking rates reflect in the data, it doesn’t in life expectancy rates. This makes me excited to find more differences between the countries to connect the reason why the United States is behind on those statistics specifically. I am also looking forward to seeing more patients and especially observing the physician-to-patient relationship here and comparing it to the United States.
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