Tag: surgery

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Brand New, and In You!

Daily writing prompt
The most important invention in your lifetime is…
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I can think of some inventions that might not occur to others if you haven’t been in the health care field. There are entire classes of surgical materials, from meshes to joint replacements, that did not exist when I was born. Personally, I am a beneficiary of all these.

When I was three, I had my tonsils out, and the anesthesia was by drip, drip ether into an ether anesthesia mask very similar to the 19th-century prototypes. I remember the induction well. Ugh! Today, the surgical environment is ages past that. During my time working in the OR, ether was used occasionally as a cleaning agent. I’d venture a guess that in a modern OR, even that use is gone. The darn stuff is highly inflammable and has numerous side effects.

To this, you can add modern suture materials, instruments, monitoring devices, and drugs. Arguably, inventions and advances in medicine probably directly affect more people than those in many other areas. Think about that next time you use your inhaler, take your allergy medication, or walk on your new knee.

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Snip Snip

Once upon a time, I worked in operating rooms as a surgical technician. At a very basic level, I was the instrument passer, “snap” – I’d pass a small hemostat – a clamp to be applied to a bleeding spot. “suture”- I’d pass the suture material to sew up a defect, incision, or wound.

You had to know a fair amount about the anatomy the surgeon was working on and the procedure. You needed to anticipate the surgeon’s needs. Inevitably, this led to your developing increased interests in various types of surgery and a desire to work with specific surgeons. I developed interests in orthopedic and hand surgery.

Eventually, if you work with one “team” long enough, you wind up assisting a bit. You hold a retractor and other small things when interns and residents aren’t available. If you are really lucky you wind up working with surgeons who just can’t help but teach.

When I got out of grad school, I could not find a job in anthropology for love nor money. Relying on old skills, I began to work at hospitals as an aide or orderly just to make ends meet – barely. One day, at lunch, I happened to sit downfor lunch with the Operating Room crew. We talked, and over a few days, they found that at one time, I had known my way around an OR fairly thoroughly. This led to a conversation with the OR supervisor and an offer to work in the OR. I jumped at it.

A Learning Community

For the next two years, I was back in the wonderful realm of surgery. Passing instruments, holding retractors, doing what surgeons needed, and generally having a good time of it. Very early on, I discovered that I was working with an extraordinary group of nurses, technicians, anesthesiologists, and surgeons. It was an involved learning and teaching community. Some of the surgeons, for instance, actively included us technicians in post-surgical rounds in the afternoons. Why? So we could understand the wider therapeutic context of our jobs. Anatomy? One of the hand surgeons quizzed me on anatomy after surgery. He gave detailed anatomic dissertations during surgery, and if you expressed an interest in it, he expected you to pay careful attention.

You don’t have this sort of attitude everywhere. We were all making our living, but there was a drive to excel and do well for the patient, an altruism that made that OR more than just a place where surgery was done. It made it a place where people excelled at making good surgical results happen.

Afterward

After two years, I moved on to working in my selected career as an anthropologist. But I’ve thought frequently about those two years in the OR. They were a sort of pinnacle of about six years spent in various ORs over a decade. And they were important in how I thought about my career as an anthropologist as well. I carried with me the enthusiasm for teaching and sharing.

An unexpected thing happened a few years ago. I needed a hip replacement. The surgeon who was recommended to me patiently put up with my war stories about orthopedic surgery, and then surprised me. He had done a residency with my favorite surgeon and had heard some of those same stories. Of course, he did my surgery, and I had excellent results. Training tells!

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A Snip Here, A Snip There

Daily writing prompt
Have you ever had surgery? What for?
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Part of the problem of having spent about seven years in surgery is that you become an insider. I took many years off from the Operating Room to get a few degrees, only to find out when I left grad school that there were no jobs for me. I turned to working as a med tech and aide for an agency just to feed and house myself and my cat ( the irascible Clancy -AKA the Grey Menace). While having lunch one day in the cafeteria, I had a conversation with an OR nurse. What do OR people talk about at lunch? Surgery, of course. About two days later, I was approached by the hospital administration about interviewing for work in the OR.

I’d stay employed on contract with the agency, but work in the OR for much better money than I got doing care on the medical-surgical hospital floors. How could I say no? I was there for two years; until I found professional employment as an applied anthropologist.

I have, or had, a reputation as being a nudge in the operating room. Luckily, I was rapidly teamed with Rob and Marilyn, who were also nudges. Interns and residents beware, reach for an instrument on my Mayo stand and get your hand slapped. Accidentally contaminate a sterile field and get sent out to the scrub room to strip, scrub, and return to be regowned and gloved. 99.9 percent of the surgeons liked our approach, even if it became inconvenient once in a while. The .1 percent? We made life hell for them.

On The Game

Why were we liked? We made a point of having everything an individual surgeon needed ready, working, and at hand. We were intently interested in the procedure, the anatomy involved, and the approach taken. Most of the surgeons liked to teach. And they respected an interest in what they are doing. A surgical team that understands the procedure and the anatomy is more likely to be “On the game”, respond appropriately when something goes wrong, and can lend a hand if needed.

A Snip Here and One There

So what about me and surgery? It came about a year after I left the OR to work professionally as an anthropologist. I needed a procedure, and one of the surgeons I had worked with would do the procedure. Gordon was someone whom I had immense respect for, a professor of surgery, and an intently professional surgeon. He, like me, was a bit of a nudge. Our “nudginess” hadn’t always matched up. But we always had had the best interests of the patient at heart. I knew that I’d be in good hands for the procedure.

The morning of the procedure, I was prepped and then rolled into the operating room. I was prepared for the surgery by the anesthesiologist and operating room crew. Then in walks Gordon, moving in two big mirrors. These he set up so I’d be able to watch the procedure in detail. Looking at me, he said, “I know how fussy you are, so now you’ll be able to watch and tell me if I’m doing anything wrong. OK?” All this was accompanied by grins and laughter from the OR crew who knew Gordon, and had heard about me from him.

Gordon had his revenge for my “nudginess,” and I recovered completely from the procedure. The Scrub tech didn’t have to slap my hand once.

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Take two, and call me in the morning

Daily writing prompt
How do you practice self-care?
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Way back years ago, I worked in the “City Hospital” of a large city, not too far from Boston. One summer, the on-call schedule was brutal. It seemed like a few of the residents and I were up all night, every night, with emergency surgery. It was complicated by the new OR supervisor firing most of the surgical technicians. Her mission seemed to be a total purging of the old guard in the department. The hiring was taking a while, given that Beatrice’s reputation had gotten out. This left me with lots of undesired night work until she hired new staff.

Sponge, Please!

My sleep and social time were suffering from all the overtime. And being that on-call personnel had to sleep in the tiny dorm rooms provided by the hospital, I was rarely home. This threw me into closer interactions with the interns and residents, whom I might not have palled around with normally. These guys were turning into top-notch surgeons with all the gunshot wounds, exploratory abdominal surgery for gall bladder, appendices, foreign bodies – you name it, we cut it open.

And I was dragged along with them. I found myself doing much more than passing instruments and sponges. I was assisting, from the straightforward holding of a retractor to helping with hemostasis, and doing some simple suturing. We’d have two rooms running at the same time, and to say we were tight on staff would be kind. Frankly, it was a summer that forever changed my views on surgery. When MASH came along in the movies in 1970, I had flashbacks to my summer of overtime surgery.

Work Hard, Party Harder

Work hard, party harder became our after-hours motto. Anyone who says there is no emotional drain for surgeons or the surgical team has never worked hard for hours, on saving a victim of a gunfight, only to have him die in recovery two hours later. Or have a patient come in with a “spaghetti wrist” ( everything severed from putting a hand through a glass window) that requires four hours of surgery. Try having one after another of those and tell me there is no cost.

Oh, yeah, this is supposed to be about self-care! Well, it is. We didn’t always make sterling self-care choices. The local bar saw us often. We didn’t reel off into the night or anything like that, but there were a few relaxing beverages right after the day shift ended, and before we had dinner. It was not a very swanky place, there we were ( sometimes still in scrubs) having beers with the guys from the local factories. Nobody reeled into the operating room with fumes. We were responsible, but ask me now if I think it was a good choice, and I’ll give you a different answer than then.

Paying the Piper

Over the weeks, the cost, emotionally and physically, added up. Then Sawyer came up with his Vitamin and Water prescription. Every morning before coffee and breakfast, we took a multivitamin and about a quart of water. Hopefully, we were getting at least a minimal amount of our required vitamins and were adequately hydrated. This became something of a ritual. How effective it was, I don’t know, but we felt it was essential to do something positive.

I had it in October. I had lined up another job and never again had such an exhausting on-call schedule. The hospital soon after found cause to fire Beatrice, and stabilized the department.

I now know that our one pill and water regimen was a joke. But it was a suggested thing by many MDs for patients who drank and had strenuous lives.

Now, just one more thing. MASH. I had mixed feelings about the TV show. But the damned movie gives me flashbacks.

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Nudge

High Expectations

Upon leaving graduate school, I experienced one of those episodes that you always hope won’t happen after earning a college degree. The inability to secure work that aligns with your profession. If it’s happened to you, you’ll understand the looks from family and friends that seem to hint that the forecasts of greatness have eluded you despite the huge investments of time. And of money.

There I was, with a Master’s degree in hand, and within reach of the doctorate. But I was working in an Operating Room. I had been there before. A total of about five years had been spent in one OR or another. And after undergrad and grad school, it was the last place I had expected to land. You don’t always get what you want. But in many ways, I did get what I needed.

Back In the OR, again

There is something deeply rooted about work in the operating room. You don’t make silly mistakes, and continue working in one. In many ways, it reminds me of martial arts. It may be a routine case, you may look relaxed, but you are always centered. shit can happen in an instant and someones life can depend on your reaction. A vortex of tragedy originates with one misstep.

About this point, you are saying that leadership in these situations must be an incredibly tense deal. I guess it can. But when you watch a good OR supervisor, you’ll note an individual just continually walking about, from one operating room to another, “Everything alright? Do you have everything you need? Yes, Doctor Smuckright, those sutures are on order.” It’s a brand of called Management By Walking About. The interesting thing about it is that after a while, all the techs and nurses emulate it. It’s how you keep things running smoothly.

Back in the office, the big boss is on the phone with an istrument company about them sending someone out to repair the Transhomeopthizer 4000 that’s been on the blink for a week. Docker Tarbethian is screaming that he needs it, NOW! But even as she mashes that phone against her ear, her eye is on the orderly transporting a patient in the hallway. She knocks on the window and points to where a catheter hangs perilously close to a wheel, He may not be able to hear her gravely admonition, but he fixes the problem right away. Back in the office, she finishes her call and heads out to check on the new hire, Lou Carreras. He’s rusty on a lot of things…will he work out?

The Model

It’s a good model of leadership. It’s distributed, everyone not only does their job, but looks to correct lapses before, or as soon as they happen. Leadership is by walking about. You are a follower, but you also lead. You know that you can depend on your team to catch you, and in turn, you support them.

When I left the OR for professional work as an applied anthropologist I carried the model with me into those jobs.

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A Full House

Open wound, you said? That took me right back to my days “on call” at night for the Operating Room of a good-sized city hospital in the Boston area. We saw lots and lots of open wounds on a good night. On a bad night, it was knife slashes to the throat, almost severing major arteries, emergency abdominal surgery – lots of causes. Little compares, in my memory, with a spaghetti wrist. What’s that? The National Library of Medicine describes it like this:

“The idiom “spaghetti wrist” refers to a deep laceration of the distal volar forearm. Because structures at the wrist are tightly packed and thinly covered, lacerations of tendons, nerves, and arteries are likely. Exposed tendons on a red background resemble pasta noodles in a bed of tomato sauce. Despite the term being more colorful than scientific, it is accepted by hand surgeons. The expression “full house” is also occasionally used.1 There is, to our knowledge, no alternative, more formal descriptor.”

So there it is—a Full House. The drunk comes into the EW at 2 AM, and you are prepping a room for surgery at 2:30. At three, the anesthesiologist is through expressing his doubts about the patient to the surgery, and the choice of anesthesia method has been made. The surgeon explains that Mr. Smith, in a moment of rage, put his fist through a plate glass window. His hand and wrist now need a relatively comprehensive series of repairs. You will be there for the next three hours while the hand guy, a pair of residents, and an intern sort out the bits and try to shuffle everything into proper order. 

At about 4 AM, the circulating nurse sticks a straw into your mask, and you suck down a cup of lukewarm, overly sweet black coffee – gratefully.

At 6 AM, you break scrub and head to the break room for an hour’s nap. The OR supervisor takes pity on you and allows you to nap until you wake up for an 8:30 case.

Yes, I could have posted a picture of a Full House, but some of you might have been disturbed.

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Cut and Splice

Daily writing prompt
Have you ever had surgery? What for?
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Surgery is one of my favorite topics. I spent years in operating rooms passing instruments and sutures, holding retractors, and eventually doing some assisting. To me, it’s a bit more than a necessary intervention of a bloody nature.

I guess it’s because of the enthusiasm that many of the surgeons I worked with had for the art and science. Trust me; you don’t want someone bored with the job standing over you in the operating theatre. You want a surgeon who lost count of how many of these he’s done, finds each one fascinating, and is interested in educating the team and the patient.

Another thing you don’t want is someone who grows incensed with inquiries. They may be skilled, but a knowledgeable surgical team and a patient with an understanding of what’s coming make for better outcomes. And that’s what it’s all about.

Over the past twenty years, I’ve had several operations caused by the inevitable wear and tear the body accumulates with age. The surgeons who care for me were first amused that they had a patient who had a grasp of the anatomy and procedures. But they soon slipped into teacher mode when they found I hadn’t scrubbed since 1980. The pre-surgical visits turned into teaching sessions on how my procedure would differ from the ones I had scrubbed on in prehistoric days—smaller incisions, less blood loss, and utilizing better surgical materials and implants. It was encouraging and a bit daunting.

 I admit my enthusiasm for technique may be a way of distancing myself from the fact that it would be my body going under the knife. But I can’t help myself. I left the OR to have a career in anthropology, but I never lost my affection for what we achieved in the OR.

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A Trip to the Vets

Mother took father to the vet today. When he came home, we walked with a big thingee and limped. The dog and I actually had a conference about it. Sometimes he isn’t as stupid as he looks. Max said that he stunk of shots. He hoped that they hadn’t “fixed” him. I heard Mother say something about his sleeping downstairs.

The gall! How am I going to nurse him back to health with licks, kisses, and fur therapy? Loud purrs are clinically proven to be a valuable tool in promoting healing.

The dog and I worry that Mother took him to a vet for humans rather than our doctor; Dr. Balderelli is the best. I hope that where he went is OK.

But they must be foolish. They forgot to put the Collar of Shame on him: incompetence, just plain stupid incompetence.

What if he attempts to bite his stitches?

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First Time

We all remember our “first time.”
Get your mind out of the gutter, please. That’s not the first time to which I refer. However much, it has outsize importance to some people. But, no.

I remember one night at a boat show. We were out having dinner- our little clique of builders, boaters, riggers, and me- the carver. The topic of memorable first times came up. We had a pretty impressive group of far travelers, so many recollections of sunrise or moonset at exotic locations got related. Then there were the boating-related stories: European canal trips and the fine wines and eateries visited. Finally, one or two of the group chimed in with hilarious anecdotes from boat shows past.

Through this, I made the rare comment, laughed or grinned with amazement and amusement but did not share any of my own experiences. I couldn’t think of anything. I had traveled in the Navy, but being very young – and under the influence of fellow reprobates, I was more familiar with the interior of barrooms in port cities than with their cultural glories.

At last, I recalled something that I was sure the others had never experienced. So I told this tale:

” I belong to an exclusive club open to only a small segment of the population in any country. If you are not a member of this club, but have participated in this, you are probably a member of one of the outlaw sects still practicing human sacrifice.” Now I had everyone’s attention. “As a young man, I served as a scrub technician in surgery. My typical duties included preparing surgical instruments, passing them to surgeons, holding retractors, etc. But not all surgery is routine, and sometimes I’d play a more active role. Near the end of one procedure, deep into the thoracic cavity, the surgeon looked up at me and said, ‘Lou, have you ever touched a beating human heart?’
He then took my right hand and gently instructed me to touch the heart. For just seconds, I held the heart under my hand. It will always be one of my cherished memories.”

It was hard to gauge the group’s reaction because it was so varied. Some looked squeamish, others tried to process what I had said but had nothing to add, and a few looked at me as though they were reevaluating what they had previously known about me.

At last, one of my friends smiled and said, “it’s time for another drink!” The next safer topic was interesting boats we had seen at the show.

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Operate

Part of the joy of being a long-term member of an operating room crew is knowing who has you back in any situation. The OR does not work well when significant trust issues exist within the team. Starting in OR’s in the 1960s and departing in 1980 for professional anthropology work, I saw a wide selection of OR’s. My favorite was the last Boston area, OR I worked in from late 1978 -until early 1980. It had affiliations with major hospitals and medical schools. Among the things that patients and surgeons never saw was the intense internal accountability level in the OR. Everyone participated in preparing instruments, surgical drape packs, and sterile goods for procedures in my day. Items for sterilization got sealed with a special tape that had marking bars on it. These turned dark when the article had been through a complete sterilization cycle in an autoclave ( a steam sterilizer). On each tape were the initials of the person who prepared it and the date sterilized.
The fight against bacterial contamination was constant. We did not have a separate team for cleaning. We cleaned our own assigned rooms between cases and prepped for the next day after the OR schedule ended for the day. Idle moments were spent in idle conversation – while we checked crash carts, sterile supplies, and equipment. There was an extraordinary amount of checks and counter checks to ensure that our surgical outcomes were good.
It’s not mawkish to state that while we had each other’s backs, we also had the surgeons and the patients. think about that next time you are wheeled into an OR for a surgical procedure.