Back in the days of Surgery Residency

My first ever surgery: about 16 years ago (from 11/17/13), this (brachial basilic arterio-venous fistula) was my very first surgery I’ve ever done in my life. It was a strange way to start because the technical aspects of this surgery is high – I still consider it difficult. But I was a lowly surgical intern in Cleveland, and highly respected transplant surgeon, Dr. James Schulak, was doing the surgery. I was just retracting (Surgical Interns didn’t operate, they just held things), but during the case, Dr. Schulak was time-pressed and accidentally I got showered in the face with blood – blood dripping down my face, luckily it didn’t hit me in the eye (I love wearing glasses). He told me to get out, clean up. When I leisurely (I took my time getting all the blood off) made it back to the surgery after wiping off my face and changing. I saw that he was just waiting for me without having made any progress in the surgery. He was just sitting there without moving – bizarre. He said he had a policy: if he splashed a resident with blood, the resident gets to do the entire case. So, that’s how I did my first surgery. It took about 2 more hours, and I didn’t even know how to hold the specialized vascular instruments (given that I hadn’t even done any surgeries at all), but he guided me expertly through it, I managed to do it, and the patient had a great result. In Modesto, the operation would have taken me about 30 minutes – but we all had to start somewhere.

One stage vs. two staged surgical procedure

I sorta miss these cases (and my crazy method I personally innovated for laparoscopic peritoneal dialysis catheters). Now, with a cosmetic surgery practice, I’m focused on my Modesto Botox Patients, Veins and Acupuncture.  When I used to make these brachiobasilic AV fistulas, I did them in one stage which included a pretty long incision from axilla to antecubital fossa, my theory was that I would spare the patients two trips to the operating room. There’s a theory out there that separating the operation into 2 stage approach is better in case the fistula doesn’t mature. Stage One: make the anastamosis (connection between vein and artery), and Stage Two: mobilize the basilic vein to the surface (because it is deep and not easily accessible from a dialysis standpoint). Dr. Fung of Modesto very kindly helped me improve my technique for these vascular procedures – he is the master.

2 Degrees of separation from Mr. Quinton, inventor leading up to these surgeries:

My nurse practitioner friend Jaimee wrote on 11/17/13:

I was on a small-ship cruise a few years ago, and my family became friendly with this older couple. The woman asked what I did for work, and I told her I was an NP. She said her husband had created some medical devices – his name was Wayne Quinton. He also invented the first dialysis machine. He’s up in his 90s now and still tinkers with inventions.