Samuel Armen

I was already buzzed from too many glasses of red wine, yet I was sitting next to MIT Graduate and family friend, Noubar Afeyan, MIT graduate and Head of AGBU’s station in Syria, Vasken Yacoubian, and the famous virtuoso, Ara Gevorgyan. Among these three there were many others. My impeding drunkenness was completely allowable considering the level of festivity at our table.

If I could select one word to best summarize the night it would be LOUD: The Zurna screeched in high-pitched solos and sounded like bees swarming around the eardrum, the table boomed with laughter or cheers in between each story, and the tables around us seemed to compete with our table’s festivity.

Throughout the night there was: A story of a king, a story about Noubar’s relation to my father, a story I told about my father, the story of Ara Gevorgyan’s music, a story Noubar’s daughter told us about her crew practice, the story of my days at the internship so far, and a story about Noubar’s daughter’s experience at YSIP last year.

I was asked to tell a story about one of the other interns. I then realized what these daily journals were missing.

So began a story about one of the other interns.

Now, I suppose, with a fair amount of certainty, that it would be extraordinarily naïve for me to consider these articles informative when I have not included details of the other internships my fellow interns are pursuing. As stated before, there are 21 people (including myself) in the 2011 AGBU YSIP. The internships range from architecture, sculpture, art, zoology, marketing, broadcasting, 3 in journalism and 7 in medical fields.

There are three groups of medical interns – a group of three in cardiology, a group of two in pediatric orthopedics, one in general orthopedics, and one in neurology. I interviewed the group of three cardiologists.

Originally this group was supposed to work under the Head of the Department of Cardiology, but, according to them, he is almost always busy. His occupation includes Head of the Department of Cardiology at Yerevan State Medical University Hospital, and professor at Yerevan State Medical University. Because of this they would have to shadow another doctor - one who is the head of the CCU – the Cardiac Care Unit.

The doctors try to teach the interns what they are doing. Often they become disappointed and surprised because of the varying educational systems: In Yerevan one goes to medical school for six years. After the first two years of general studies, one jumps straight to things one would learn in American Medical Schools. This varies greatly from America’s four-year undergrad and four-year graduate school curriculum. Thus, American undergraduates may feel immediately overwhelmed.

According to them, when they first began working things were not as hands-on as they expected. They were not working with surgery but rather with diagnosis – reading EKGs, performing Eco-Cardiographs (a machine similar to an ultrasound, but for the heart) and interacting with patients. They have also seen a few angiographs.

Fortunately, these interns met an Indian resident who opened up the opportunity for them to work at Nork Marash – a larger and busier hospital. It is here where these three undergraduates and future doctors had the honor of being able to witness surgery up close.

All three of them explained to me one of the first procedures they witnessed called a CABG (Coronary Artery Bypass Graft Surgery). The following is a summary of their account:

The three interns walked in to see a naked man on a table. He was completely uncovered.

An anesthesiologist inserted a catheter into the patient’s neck, deep enough that it went into the body.

A surgeon sliced open the chest skin and chest muscle with a device that utilized electricity in such a manner that it prevents the flow of blood.

Using the aforementioned device, they sliced down to the bone.

A surgeon took out a saw-like tool, and sliced the middle of the sternum.

Another Surgeon clamped a machine atop the patient’s ribcage.

When the device was cranked, the left side of the patient’s ribcage lifted and opened ajar.

Using previous electricity device, a surgeon cut through the layer of connective and muscular tissue.

A machine is connected to the heart to allow bypass – blood flowing from body to machine.

While this is occurring, a third surgeon is slicing open the area from ankle to knee on the right leg.

A 15-inch vein from the leg is extracted. This surgery is just as important as that on the thoracic cavity because if this particular vein is lost, they will need to open up the other leg.

The aforementioned extracted vein replaces the patient’s clogged artery.

I asked these three interns if the procedure was intimidating and they all responded that it wasn’t too terrible. The entire operation was six hours, but the interns only stayed for the first two hours. The smell of bone was rather putrid but to see everyone work was exhilarating. There was 1 surgeon working on the leg, 1 opening the hest, and the head surgeon watching over. Besides these three surgeons, there were a dozen assistants moving about.

The interns told me that without the YSIP internship they would not have the opportunity to stand in on a surgical procedure. In America it would be nearly impossible to have an undergraduate in the operating room. There are too many obstacles in the way of allowing an intern the opportunity to shadow a surgeon.

I asked them if they had any complaints and they presented three problems they have witnessed.

First, the price of a Cabg surgery is 7,000 dollars – 2.5 million Dram. That is extraordinarily expensive in Yerevan, Armenia. When one of the interns asked about those who could not pay for such a surgery, he was told that they will not get it if they can’t afford it. The Armenian healthcare system is also, to the interns’ opinions, largely unhelpful in this situation.

The second complaint was also related to finance. In America, the average resident (2nd or 3rd year) makes close to $2,000 dollars a month. The Head of Cardiology in Yerevan State Medical University – who is a MD, has a PHD, and is also a professor at the University, makes the same amount - $2,000 dollars a month. He is making $24,000/yr when, according to the interns, an occupation of that stature in America would be upwards of $400,000 in America. Such figures make it apparent that the medical units are being largely underpaid.

The third complaint would be less important if the month’s average temperature didn’t tip over 100 degrees Fahrenheit. The male intern in this group said that he had an immediate problem violating a dress code. He was told he could not wear shorts under his lab coat. This puzzled him because the woman wore skirts, shorts and other bottom-wear that exposed their lower legs. He was told over and over that men are only supposed to wear pants. It was quite obvious that this was not at all a safety procedure but rather some sort of unnecessary traditional practice.

When asked what the highlight of their experience was, they unanimously agreed that it was witnessing surgery first-hand. One medical intern working in one of the other hospitals had a similar experience. He told me that being in an operating room gave him motivation to wait the years of undergrad and medical school. “Very few people have the privilege of knowing how they will react to surgery so early.” He stated, concluding with, “I’m probably going to remember that before each exam.”