This past week I have spent my time in GI and was pleasantly surprised to find that it was quite interesting. I spent most of my time in the endoscopy lab with the nurses and Dr. Paula. Typically our day began around 9am and ended around noon. The GI unit itself was not very busy due to most of the doctors being on holiday. The nurse that I spent most of my time with was Nurse Gilda who did a spectacular job of tackling English so that I could understand what was going on. The doctors and nurses on GI had such a great relationship! They seemed to really value each other's opinions and worked really well as a team. They were especially good about helping one another find the appropriate words in English to describe the situation or procedure.
Patients were normally positioned on their left side with their knees bent. Local anesthetic was given (Lidocaine) via a lubricant that was put in and around the anus as well as on the scope. Most patients were above the age of 60. In the Azores people normally get their first Colonoscopy around 60 years of age unless they have a family history of polyps or some other GI disease. I was really surprised that patients were only given a local anesthetic during the procedure because in the US they give general anesthesia. I saw several Colonoscopies. Each colonoscopy I saw had either a biopsy of tissue or a polypectomy. These were really interesting to watch and were also quick. Inserting the tube throughout the whole colon took the most amount of time and seemed really uncomfortable for the patient despite the use of local anesthetic.
This is a before and after of a polyp found in the colon of a 73 yo male
The actual device used to remove polyps
Something else that was really interesting was watching an endoscopy. Much like the Colonoscopy, patients were given a local anesthetic via an oral spray and then with a Lidocaine lubricant. A plastic tube was then strapped to the patients mouth to stabilize the scope. Patients were laid on their left side as well. The endoscopy I observed was on a 65 year old male who was an ex-smoker with esophageal cancer. He had been diagnosed 6 months prior. The idea of this particular endoscopy was to expand the esophagus via an angioplasty. Dr. Paula fed the balloon into the esophagus while the nurse expanded the balloon. Unfortunately they could not expand the balloon to its full capacity due to the risk of perforation. Dr. Paula then chose to end the endoscopy because the scope was still to pass through the opening.
After endoscopies and colonoscopies in the lab, Dr. Paula visited her various patients on the GI unit. While on the floor I got to meet many nurses who were at first shy about speaking English but opened up quickly. They described the unit to me briefly and said that it was generally slow. I did get to meet a 16 yo female who was diagnosed with Crohn's Disease when she was 8 years old who was not taking care of herself. In the past 4 months she had lost 5.5kgs which the doctors and nurses were concerned with because she was already very thin. She did not seem to care about the weight loss and when told that she needed to make sure she got enough calories in her diet she said she was fine. Unfortunately my contact with patients was limited due to the language barrier. It really made me relate to patients that we see in the US who do not speak English as their first language...
I was also able to see a liver biopsy which was pretty amazing. First the area was cleaned with betadine and draped with a sterile draping. A sterile field was then made on top of a medicine cart where the doctor put on a sterile gown and gloves. The nurse set up the field for her and put out her supplies. The doctor percussed the intercostal space on the right side of the patient to locate the liver which gives off a dull sound rather than tympanic (which is indicative of air). Local anesthetic was used to numb the area. A needle was then inserted just above the selected rib in the intercostal space. Saline solution was injected into the space, the needle was then inserted fully, and the syringe pulled back on to create a vacuum. A string of liver about an inch long was removed and placed in a biopsy container. I was really surprised by how quick and easy the biopsy was. The patient was then instructed by the nurses to remain supine for 24 hours.
Unfortunately there is not a typical day on the GI unit over the summer. Like most of the hospital, the GI unit is "slow" during the summer because many people leave Terceira for holiday. Nonetheless, when the unit became excessively slow, or all the nurses and doctors were charting for several hours I was able to go home. They were all very welcoming! I have seen hostility between nurses and doctors in the hospital (like all hospitals) and was glad to be on a unit where everyone was generally friendly. I do however not think that Dr. Paula knew her nurses names which kind of bothered me. When she addressed Gilda she would just call her nurse. This could be a cultural thing but it still made me a little uncomfortable.
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