Did you know that there are 30 bones in each of your upper limbs? Also known as your upper extremities, each upper limb is a network of your arm, your wrist, and your hand. Together with these 30 bones, your muscles, nerves, and tendons create a system that most of us rely upon every day, but usually take for granted.
This summer, I had the privilege of interning with orthopedic surgeon Dr. Andrew Stein at Boston Medical Center (BMC), who specializes in surgery of the upper extremity. I now understand that even the smallest amount of damage to any part of this system can impact the function of the entire hand, wrist, or arm. After following Dr. Stein and his patients for the past six weeks, I have truly earned newfound respect for my ability to use my limbs—even to be typing this blog.
Throughout my time with Dr. Stein at BMC, I witnessed hundreds of consults in his clinic and a wide variety of surgeries. It was fascinating for me, after having had a minor procedure done on my knee this past winter, to witness a patient’s orthopedic journey from the physician's perspective.
With Dr. Zeller With Dr. Stein
My weeks started off in the clinic, where I worked with Dr. Stein, his Chief Resident Dr. Zach Zeller, and many physician assistants (PAs). Each Monday and Wednesday, we worked as a team to see about sixty different patients. These appointments ranged from first-time consults to follow-ups and post-operative appointments. Despite the volume of people coming in and out of the clinic, Dr. Stein and Dr. Zeller always took the time to ensure that I understood the patient’s condition, diagnosis, and treatment plan. Most commonly, we saw cases of trigger finger (when a tendon becomes swollen and is unable to move smoothly within its sheath), carpal or cubital tunnel syndrome (compression of nerves in the wrist or forearm), and arthritis. Some of these cases were able to be treated in the clinic with injections of strong anti-inflammatories, while others were severe enough that the patients required surgery. I was also able to see more traumatic injuries, including lacerated tendons and nerves, large fractures, dislocations, and broken hardware from previous operations. These cases often required more urgent treatment and were repaired in the operating room within the following week.
An arthritic finger fused by Dr. Stein Dr. Stein releasing a trigger finger
On Tuesdays and Thursdays, I worked in the operating room with Dr. Stein and Dr. Zeller. They usually performed around eight surgeries each day, with each one varying in length and complexity. Almost every day involved a few carpal tunnel and trigger finger releases, which Dr. Stein was often able to complete in under five minutes. Fractures and tendon repairs tended to take longer because they required the implantation of hardware. Each plate, screw, wire, and anchor placed into the body had to be carefully measured and contoured to the bone to ensure that it was comfortable and functional for the patient. Not only did these operations require a wider variety of tools, but they also required the use of a mini C-Arm, which is a small imaging machine.
One of the most fascinating and complex surgeries I witnessed required the use of a surgical microscope. The patient had injured three of her fingers with a knife and had completely severed the tendons, nerves, and blood vessels in her small finger. In order to successfully restore blood flow to the finger, Dr. Stein had to meticulously reattach the walls of the blood vessels using a suture ten times thinner than a human hair. He used the microscope to ensure that he didn’t accidentally close off the blood vessels because the tissues were so small and delicate. Toward the end of the surgery, he was kind enough to let me look through the microscope and watch as the freshly repaired vessels began to pink up and pulse with blood. I was also lucky enough to observe surgeries in other orthopedic specialties, including spine, sports medicine, and trauma cases, as well as a knee and hip replacement. During the knee replacement, orthopedic surgeon Dr. David Freccero even allowed me to hold a sliver of bone that had been extracted in order to fit the artificial joint!
Looking through the medical microscope Dr. Stein using the microscope to operate Holding a bone
Each operation I witnessed reminded me how crucial teamwork is in the operating room. The kinetic energy in the room was tangible as I watched the rotating nurses do everything from sterilizing the patient to bringing in extra equipment in the middle of the operation. The scrub nurses were also incredible to watch, as they had to be able to anticipate the surgeon’s every move and hand them the exact right tool before they asked.
I was also able to help in small but meaningful ways. During my first day in the operating room, Dr. Zeller showed me how to help the surgeons scrub in by tying their gowns, which I was able to do every day thereafter. I was also able to aid in setting up equipment, positioning the C-Arm, and taking down equipment as the patient was being bandaged. Being in the operating room was amazing to experience, and it opened my eyes to how much thought and care the team puts into each patient, regardless of how minor their surgery may be.
On Fridays, I had the option of following around the residents and medical students. One of the most valuable parts of my internship was being able to see what life is like on the path to becoming a surgical attending. For four of my six weeks at Boston Medical Center, I had the pleasure of working with Dr. Fatima Anwar, a fourth-year medical student. Throughout our time together, we talked a lot about her three years spent at the Ohio State medical school, and her final year of rotations. We discussed her responsibilities, experiences, and lifestyle as a medical student. We also discussed her preparation for matching into residency, and how her rotations at hospitals throughout the country impacted that process. One week, I followed Dr. Anwar and Dr. Zeller into what is known as “the dugout”: a corner of the hospital dedicated to the residents. There, I was able to attend what they refer to as “Bone School.” Every Friday morning, an attending physician gives a presentation on a specific topic within the surgical curriculum. When I attended the presentation, it concerned a medical condition called sepsis—a life-threatening internal infection to which the body struggles to respond. The speaker, who gave her lecture via Zoom, used a variety of charts, acronyms, and example cases to remind the residents and medical students about how to successfully identify and treat sepsis. After the presentation ended, they played Orthobullets for a couple of hours. This online website presented cases throughout all orthopedic specialties, and the residents and medical students took turns presenting their thoughts and answers. Luckily, they let me sit this one out!
On another Friday, I came in to watch as orthopedic surgeon Dr. Xinning Li repaired a fractured humeral head (shoulder), which had drifted dangerously close to the patient’s brachial artery. Despite the high stakes of the difficult procedure, he showed me each step and made sure I was able to see what he was doing. The entire OR staff was incredibly welcoming, and I was even able to talk with the cRNA about the type of sedation given to the patient, and how he had prepared to transfuse blood if the artery ruptured.
Dr. Li's operating room Dr. Li operating on the humeral head
For me, the most rewarding part of the internship was getting to follow a patient throughout their treatment, and being able to see their improved quality of life. There were many patients for whom I was able to witness their initial diagnoses, observe their surgery in the operating room, and reconnect with them a couple of weeks later to see their progress. Though most of the cases involving the upper extremities were non-life threatening, they significantly impacted the patients’ lifestyles. The pain or weakness that they experienced prevented them from going about their lives as usual, like being unable to pick up their newborn, play basketball, or even sleep—among other things.
I enjoyed being able to interact with patients from all walks of life and to be able to hear their stories and observe the entire treatment process. As a public safety net hospital with a commitment to helping patients regardless of their ability to pay, BMC attracts people from a wide variety of racial and socioeconomic backgrounds, with many patients speaking languages other than English. I learned how important medical interpreters are in making these patients feel heard and understood. I was even able to understand most of the Spanish-speaking patients, and occasionally converse with them when there was no interpreter present.
I would like to thank Mr. Schlenker and the Rivers Science Internship Program for providing me with this unique opportunity. I am incredibly grateful for my time spent at Boston Medical Center this summer, and for everyone who made this experience possible. This internship provided me with invaluable experiences and has taught me so much about orthopedics and the medical field in general. I would like to thank Dr. Stein for being an amazing mentor and always taking the time to explain his work to me. I would also like to give special thanks to Dr. Zeller and Dr. Anwar for their kindness and patience when answering my numerous questions. My gratitude extends to the entire BMC staff, who made me feel immediately welcome and part of the team. I also feel so fortunate to have learned from the patients who were willing to share their journeys with me. I have the utmost respect for Dr. Stein and his team, and others in the medical profession, who dedicate their lives to improving the lives of others. They are truly inspiring.
.png)
Comments