MedEx Day 23 - July 29, 2021

Today was my final day of shadowing with MedEx Tier III. I had the wonderful opportunity to shadow Dr. Sagar Gandhi, a vascular surgeon, at Prisma's Greenville Memorial Hospital. During my time shadowing Dr. Gandhi, I observed 4 different procedures/ surgeries which all pertained to the area of vascular access/ dialysis care. Three of his four procedures were fistulagrams. A fistulagram is a procedure in which a guidewire is taken up the fistula (which is an abnormal connection of two vessels, in this case an artery and a vein) to de-clot it or to increase the circular surface area of the vessel which had stenosis. Dr. Gandhi discussed both of these procedures with me at length and talked about how this is a necessity for people with dialysis, since a vein has essentially been made into an artery, leading to a higher-than-normal pressure in the vein, which can cause stenosis/ less access for dialysis. Dr. Gandhi also discussed how many who are on dialysis do not show up for these fistulagram appointments because they see healthcare in a very negative light/ never see their kidney disease being fixed but only getting worse. From my father's own experience with dialysis, I can certainly see how many might think this; however, I am thankful my father was always upbeat about it.

The other surgery that Dr. Gandhi did was to create a graft in a patient's arm. A graft is an artificial vessel that is attached to an artery and a vein to make dialysis easier. Pros of grafts include that it is a much easier needle stick at dialysis centers/that it allows for a higher rate of flow for dialysis. Cons are that the likelihood of infections and clots are increased; however, for some patients that do not have great veins, this is their best option.

One thing that I found interesting from the shadowing experience was that every patient that Dr. Gandhi treated during my time with him was an African American. I saw this as more evidence of disparities that exist in healthcare, especially considering that African Americans are more likely to be diagnosed with many conditions that might lead to chronic kidney disease like hypertension and diabetes. I hope that in the future lifestyle/ preventative healthcare can play a greater role in society so that less people will ever need dialysis.