Shadowing in the Oncology Department

By Farah Ahmad – Guest Blogger from Cusco SALUD
Today was my last day in the Essalud hospital in Cusco and it ended on a high note. There have been some rotations during our two week shadowing period that have included more down time than others, but our last two days have been really interesting. I've been in the Oncology department and the first day that we were there, we met a doctor who had us observe two biopsies. The first patient he had was a woman where he took a sample of breast tissue to be sent for analysis. The next patient was a bit more invasive as the man had a lump in his neck that needed to be excised. With local anesthesia, the surgeon cut into the man's neck to the point where we could see his platysmus muscle.
The doctors in the department told us about oncology as it's practiced in Peru and in the hospital. For example, the hospital in Cusco has only three oncologist-surgeons. Doctors are more plentiful in Lima because salaries are higher there. In addition, even Essalud, which is supposed to be the best hospital in Cusco has problems with supply shortages. The doctor we were shadowing said that the biopsy needle he used is supposed to be discardable but he has to clean it with different gases etc. because they only have the one. Another problem mentioned was the lack of focus on public and preventative health in terms of oncology. According to him, there aren't good health campaigns to focus on preventative screenings and mammograms. Also interesting was that sometimes doctors end up fighting and trying to educate other doctors who will treat their cancer patients as if it's a death sentence. They tell them that there are few options even though there are many types of cancers that are treatable.
Today we were in the operating room and saw three surgeries. The first was a woman who had a benign tumor in her submandibular gland and the surgeons removed the whole gland. I have to admit that it was really cool to be able to watch all of that today. The doctor HAD the gland in his HAND after it was done. He also reviewed some of the structures that are right there (facial nerve, lingual nerve, hypoglossal nerve…ugh!) While we were waiting for his next patient, we wandered around the hallway in the operating area and were pulled in by another surgeon who was watching a microsurgery being performed on a woman's cataract! It's really amazing and incredibly humbling to realize all the crazy things we can do in medicine today.
Finally the third patient we saw was interesting but also the saddest. This man had pyloric syndrome where he had a tumor blocking the pyloric sphincter leading from his stomach to his intestine so he would feel full even after eating very little. They had to do an exploratory surgery to see how far it had spread before they would know what they could do next. As soon as they opened up his abdomen they had some idea that the problem was advanced. He had ascites (fluid in his peritoneal cavity) and that indicated a problem. They could tell that the cancer had spread to his pancreas, which makes it inoperable. The doctor explained that all they could do was a palliative surgery to help him be able to eat again. This involved connecting his stomach to his small intestine to circumvent the block.
To be honest, I'm hyper-aware right now that I'm writing about all of this in kind of a distant tone. I think I'm just not really able to process right now that this is basically a death sentence for this man. It feels even more surreal when it's a man in another country who you've never spoken to. I think I need to be in a field where I'm constantly confronted with people's stories and realities because I really fear being someone who takes that road of just turning a blind eye to the truth. I imagine it's hard when you have been in the field for a long time, but it also feels like it's hard right now because as a student you have so little control and knowledge.
Sorry to end on that unfinished note. As for now, I need to head home as tomorrow is our first day at Machu Picchu and I am going to soak in the experience.