A window to the lungs

Hood River Valley High School students witness life-changing surgery

November 5, 2005

Forty-five students from Hood River Valley High School had a potentially life-changing experience on Tuesday when they got to watch a live surgery to remove a cancerous lung tumor from an 80-year-old woman.

The students, from teacher David Clarkson’s advanced placement medical biology class, joined about 100 others from the Portland area at Providence Portland Medical Center for the Providence-sponsored Chest Watch.

Chest Watch is one of several educational programs the hospital sponsors throughout the year to give high school students a unique opportunity to learn about medical careers. This program, with its focus on the lungs, also included an emphasis on the health risks of smoking.

“The thing about cigarettes,” Dr. John Handy, head of the chest surgery program at Providence, told the students in the hospital’s amphitheater before he performed the surgery, “you can get to see a guy like me a whole lot faster by smoking them.” Handy spoke to the students about his specialty, thoracic surgery, and about Providence’s three-pronged chest surgery program that includes patient care, research and education.

Handy and his Providence team perform the most chest cancer surgeries of any hospital in Oregon; last year they did nearly 400 of them.

Handy then gave some background on the patient he would be performing surgery on. The woman had developed a persistent cough last spring which didn’t clear up with antibiotics.

Eventually an X-ray followed by a CT scan showed a tumor on her left lung. Handy said the woman had smoked a pack of cigarettes a day for 45 years before quitting 14 years ago, and suffered from moderate to severe emphysema.

“There’s strong evidence for the tumor being cancerous,” Handy said. “There’s a 90 percent chance it’s cancer.” He explained what he would do during the surgery. Through minimally-invasive incisions, and with the help of a camera inserted into the woman’s chest (which would also allow the students to watch on a huge screen everything Handy would see), he would cut out the tumor and remove it. The tumor would be biopsied immediately in the hospital’s lab to determine if it was cancerous or not, and if so, Handy would remove the surrounding lymph nodes.

After Handy left to prepare for the surgery, students heard from a pathologist, a medical researcher, a nurse specializing in treating tobacco dependence, and the head of the anesthesiology department at Providence.

Each explained their jobs in detail and fielded questions from students.

Finally, just before 9 a.m., word came that Handy was about to start the surgery. The operating room appeared on the screen and Handy and his assistants went to work. Handy was wired with a microphone so he could talk to the students in the amphitheater. A nurse at the front of the amphitheater had a telephone line to the operating room so she could relay questions posed by the students to the doctor as the surgery proceeded.

The incisions had already been made and a camera was inserted into one of them. Suddenly the screen was filled by the woman’s chest cavity. The left lung had been collapsed so Handy could manipulate it easily. Her heart beat steadily on the left side of the screen.

Handy spent several minutes searching for the tumor, moving the lung tissue around with his instruments. He pointed out the black lines riddling the surface of the lung.

“This is a typical smoker’s lung,” he said. “It’s far from the worst I’ve seen.” Finally he found the tumor, an abnormal-looking dark spot on the upper lobe. With an instrument that cut and simultaneously stapled the cut with tiny titanium staples to stop bleeding, Handy removed a piece of lung about an inch and a half long. He then inserted a small plastic bag into the chest cavity to put the piece in to remove it from the body.

“If it is cancerous, we don’t want to implant cancer in the skin on the way out,” Handy explained. After the piece of lung was safely outside the body, Handy removed it from the bag and it was sent to the lab for a biopsy. That portion of the surgery had taken about 20 minutes.

Handy inserted the camera into the woman’s chest cavity again.

“Let’s have an anatomy lesson,” he said. He began pointing out and naming specific veins and arteries, and tracing their paths to and from the heart. He traced the esophagus with his instrument.

“The anatomy is very beautiful in here,” he said. After a few minutes, Handy announced he was going to “break scrub” and go to the lab to oversee the biopsy.

“I learn things from the pathologist, and I also like to check for myself about the diagnosis of cancer or not cancer,” he said.

While Handy was gone, a nurse in the amphitheater demonstrated some of the instruments and devices used in the operating room.

At 9:45 a.m. Handy returned to the operating room. The verdict: cancer. He would need to remove the surrounding lymph nodes.

“We’ll take the lymph nodes to try and see if the cancer has spread and to help determine a treatment course,” Handy explained.

He made another incision higher up in the woman’s chest wall. Handy explained that even with the several incisions, recovery time would be far less than in chest surgeries requiring major opening of the chest cavity and spreading of the ribs.

“She could throw a javelin tomorrow,” he said. “She won’t want to, but she could.” He said her main post-operative symptoms would be fatigue and lack of stamina. “We’re doing quite a bit of work inside even though it’s minimally-invasive,” he said. She would likely remain in the hospital for a few days, then continue to recover at home.

Within a month, Handy said, she would be completely recovered from the surgery. In contrast, recovery from chest surgery requiring rib-spreading can take six months or more.

Handy located the lymph glands one by one and removed them.

He explained that the glands are usually situated in general areas, but not everyone has all of them or has them in exactly the same place.

He found one that he pointed out was “very close to the pulmonary artery.”

“There are quarts and quarts of blood flowing through there,” he said. “This is a very dangerous area.”

He gingerly teased tissue away from the dark-colored gland and slowly pulled it out.

In response to a student’s question from the amphitheater, Handy said that the lymph glands were darker than normal due to smoking.

“They’re blacker than healthy ones,” he said. “They look like the typical lymph nodes of a smoker.”

By 10:20 a.m., Handy had all the nodes out and he and his team began closing the incisions.

“Would you please let her family know that we’re closing,” he said to a nurse.

After finishing, Handy told the students he would return to the amphitheater after he spoke to the woman’s family.

In the amphitheater, the students heard from a clinical social worker at Providence, who explained his role as a support-provider for patients who have been diagnosed with cancer, as well as their families.

He also spoke of November being lung cancer awareness month and gave some sobering statistics, including that nearly 90 percent of lung cancer is smoking-related.

When Handy returned to the amphitheater, he elaborated on the no-smoking theme as students asked questions on the topic.

“There are few things you can do in your life that will have more beneficial effects than not smoking,” Handy said. He fielded questions about the surgery he had just performed and about his job in general. One student asked him what his greatest satisfaction was.

“It’s the privileged position I find myself in with the patient’s family,” Handy said.

He explained that today was probably the most important day in the life of the woman whom he’d just performed surgery on.

She was diagnosed with cancer, and she and her family, with the guidance and advice of Handy, would decide on a course of action.

“It’s a huge amount of trust,” he said. “It’s a huge privilege. That’s my greatest satisfaction.”

The students gave Handy a loud and long round of applause. The HRVHS students were enthusiastic about the day’s experience.

“I thought it was really interesting,” said HRVHS senior Stefanie Draper. She interns at the Veterans’ Hospital in The Dalles and is interested in going into the health care field.

After two years of advanced placement biology classes, Draper appreciated viewing the live surgery. “It was great to be able to see it on a human subject,” she said.

Hood River Valley High junior Sarah Lee agreed.

“It was amazing,” said Lee, who said she plans to become an obstetrician. “It was amazing to be able to see inside.” Then she echoed Handy’s sentiment.

“It was an incredible experience — and a privilege,” she said. The morning spent in the amphitheater at Providence Portland Medical Center, Lee said, made her all the more determined to become a doctor.

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