Dr. Emily Dubina did her best to keep an open mind throughout her medical training at the David Geffen School of Medicine at UCLA, but she never let go of the dream she'd had since she was a young girl.
"I've wanted to become a doctor since I was 5 or 6 years old. Even then, I told everyone I wanted to be a surgeon. While I kept an open mind as I was rotating through the different specialties as a third- and fourth-year medical student, I couldn't find anything that made me happier than being in the operating room and taking care of patients before and after their surgeries. There's something special about being able to identify the problem and then turn around and fix it before you send the patient home."
For Dr. Dubina, a resident in general surgery at Harbor-UCLA Medical Center, her first chance to perform a surgery came as a surprise. "My team was in the middle of morning rounds when the junior resident caught me between rooms and said, 'By the way, the first case today is yours.' I was floored."
Her first case was to surgically adhere an artery and a vein, a procedure called an AV fistula. This procedure is performed to facilitate dialysis in a patient with compromised kidney function. It's delicate work that requires knowledge of anatomical structure and a skilled hand to bind the vessels together.
She describes the surgery as an incredible experience. "From the first incision to the final suture, I learned an incredible amount and gained an unbelievable amount of experience. I was learning from the best how to handle and manipulate the different instruments on the vascular tray." During the surgery, the attending physician happened to be the head of the surgery program, who was also her mentor during medical school. The attending physician helped guide her in the use of the delicate vascular instruments, and provided support as the surgery progressed.
The AV fistula procedure is not without its risks. The biggest concern for surgeons performing the surgery is the inadequate union of the vessels, which permits blood to pour out into the forearm, creating a massive bruise or hematoma. Dr. Dubina had to make sure that each suture secured the vessels together and that the suture stayed strong.
Though the surgery lasted a few hours, the time flew by. "Before I knew it, we had anastomosed the cephalic vein to the brachial artery and had a strong palpable thrill with a good distal pulse — the surgery was a success." Thrill is the vibration of blood flowing through the new vessel space, and a strong pulse means that blood flow was restored all the way down the arm. The patient returned to the clinic a few weeks later, with the incision fully healed and the fistula maturing as she had hoped.
With the first of many successful surgeries complete, Dr. Dubina plans to complete her medical training in general surgery at the David Geffen School of Medicine at UCLA, and may go on to specialize in either trauma surgery or surgical oncology.