ENT.

Today I shadowed an otolaryngeal specialist. It was a fairly interesting day due to the diversity of cases.

Most of the patients we saw in the clinic had some sort of cancer, though I'm not sure if that is representative of the specialty as a whole, or whether it just works out that at our clinic, the physicians see the more complicated cases and leave infected tonsils and other peds-type things to the PAs.

One middle-aged man with a history of sleep apnea was told he had Barrett's esophagus, a precancerous condition caused by chronic acid reflux disease. His voice was extremely hoarse, even though he had previously undergone some sort of surgical procedure to correct the apnea.

An otherwise-healthy 36-year old female was in for a two-week follow-up appointment for her total thyroidectomy. Her scar was healing nicely with no signs of infection. I learned that unlike most other cancers, thyroid cancer may involve lymph nodes and still be classified as Stage 1 (the best prognosis). In this woman's case, her biopsy showed three positive lymph nodes, but she was essentially cancer-free following the surgery.

For the two or three patients who had various forms of throat cancer, Dr. F passed a fiberoptic camera through the nose to inspect the vocal cords. This was particularly cool because they gave me a teaching scope to attach the to real one so that I could watch as the doctor did the procedure. One woman who was complaining of a sore throat had a yucky white mass of mucus sitting directly on her vocal cords, which explained her hoarseness.

The final patient of the morning had undergone a total laryngectomy a few years back, and used one of those creepy robot-voice amplifiers to speak. The voice nearly made me laugh at first, but I found that after two or three minutes listening to her talk I didn't notice it as much.

In the afternoon I was sent up to the OR to watch procedures. Unfortunately, two of Dr. F's three patients ended up canceling, so I was only able to watch one nasal septum repair. The procedure was extremely fast - I doubt the patient was asleep for longer than 20 minutes, though she was fully intubated. Dr. F first cut through the mucosa on the right side of the septum to expose the cartilage and bone, then cut away what appeared to be a large bone spur which was disfiguring the septum. He then punched a hole through the middle turbinate and drained some of the fluid inside. The turbinate drainage was repeated on the other side. Finally, he cauterized the incisions (the patient only lost about 20 cc, so there wasn't a whole lot of bleeding to control anyway), inserted and sutured splints into either side of the nose, and rechecked the surgical site with a fiberoptic camera. It was a fun, short procedure.

Since there were so many cancellations in the afternoon, I was invited back to watch some longer procedures. Lucky for me, the ENT team was in the middle of scheduling a patient for a very complicated radical neck dissection/laryngopharyngectomy, so as soon as they have finalized the date for that procedure they will let me know so I can watch. The way Dr. F explained it, it should be a pretty intense surgery (and long, too - at least 5 or 6 hours, probably more). Anyway, as the end of the semester approaches I should have some free time to pick some elective rotations, so if that surgery gets the green light then I will definitely try to scrub in. More OR time is always a good thing.