Georgetown Week 11

On Monday, I spent the morning with a nurse in the hemodialysis room. She showed me the whole routine - how to prep the machine, how to hook it up to the pt (Mediport), and how the machine works. In this case, the red/arterial line was difficult to draw blood from, so she had to reverse the lines. She showed me the catheter tip with the holes for each line, and explained that the holes are strategically placed so that when the clean blood comes back in, it flows with the blood in the artery, and it gets quickly flushed into circulation. In reversing the lines, there is a chance that you could just be recycling the same blood over and over.

The rest of the week I was with inpt and outpt small bowel transplant, peds and adult. Apparently, people come from all over the world to see the docs here for small bowel transplant. It was very interesting!

I saw one kid in clinic, he was so cute! about 13 years old, but very small. He's been waiting for a transplant for over a year, and came in for a check up. He has Hirschsprung's disease, and his abdomen was huge, I could not believe it when I saw it. I knew his abdomen would be distended, but I was NOT prepared for this, I honestly thought there was some padding under his shirt, but then they lifted his shirt and it was just him! But the rest of him is tiny because he doesn't absorb most of his food because the intestine is so dialated. At first he was in a good mood, joking around and asking if he would be able to watch a videotape of his surgery. Then, the doctor asked for updated labs, and he started to tear up because he hates getting his blood drawn, so sad! His mom was saying they really hope to have the surgery soon because he is going to start high school in a year and he wants to play basketball and girls are starting to come into the picture! The good news is, his primary doctor said he's barely started puberty yet, so he will have time to catch up absorption and grow after a hopefully soon transplant!

I also sat in on a meeting with a pt who is thinking about SB transplant. It was the pt, her best friend, the surgeon, the dietitian, and me! It was so helpful hearing the surgeon explain why people get SB transplants, how it works, the recovery time, and lifelong meds, etc. In this case, he thinks the pt is a good candidate for transplant because she is TPN dependant, anything she eats goes straight through her because of multiple bowel resections which resulted in short gut. In this case her liver is fine so far, but she's had multiple line infections. The vessels on her whole right side of the upper chest are all clotted, so she now has a line on the left side. One thing I didn't even think about before - if a pt keeps getting infections, scar tissue begins to form, and the vessels start to clot, so a pt could eventually run out of access points for TPN and die from starvation/malnutrition. We also talked about how pts are matched with donors - blood type, CMV positive or negative, sensitivity (her blood is matched against 100 random samples and tested for rejection, then assigned a score), size (she was a tiny woman in her 50's who needs about an 8 yo SB). This was probably the most effective, informative, interesting experience of my clinical internship!