Tag: Operating Rooms

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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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Hawkeye

“Oh no, not 5 AM, and I’m getting called in again?” This was a dream fragment that woke me a few days ago. I don’t typically hold on to dreams, but this was traumatic – as was the surgery I was getting called in to scrub on. One of the nasty aspects of working in the Operating room was on-call duty. On-call duty rotated among the nurses and technicians in as fair a manner as could be arranged. But it was at the mercy of circumstance; how many people were on vacation, sick, or otherwise unable to take the on-call duty.

The particular night that I was dreaming about happened in a Boston area hospital. A new Operating room Supervisor had alienated, fired, or caused to quit many staff people. I had been on call for a solid week straight and had helped wrap up a gunshot case at eleven PM. It had not been one of my more memorable OR experiences. There had been a steady barrage of trauma cases in the evenings and routine cases in the morning that I was scrubbing on first thing each day. 

I was beginning to feel like a crepuscular animal- active in the early hours of the evening or morning. But then I also had to overdose on caffeine to prepare for a regular daily routine.

So when this dream woke me, I was relieved to find that I could go back to sleep. But, of course, I know why I had the dream. It resulted from spending two hours watching old MASH episodes with my wife. My wife is a night shift nurse, and sometimes watching TV with her is the most time together we have. Unfortunately, we are on near opposite schedules. 

Now I regret that I’m a spoilsport and sometimes ruin her experience. We are watching the show for the comedy, but sitting in the back of my mind is the old OR hand that picks up faulty equipment, technique, or terminology. 

My wife is a loving, sweet individual who pats my knee and says, “It’s ok honey, it’s only TV.” This after some dolt has handed Hawkeye a Kelly clamp rather than a snap. A Kelly rather than a snap!!!! Who trained that dolt anyway!!!!!

No more MASH for a while, my dear wife says…calm down.

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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.

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A Necessary Evil?

I was asked: “is there such a thing as a necessary evil?” It took time for it to sink in. And when it did, more than a bit of rage and guilt struggled to coexist in my heart. This story is true, but I have omitted details that might identify people, places, or dates.


As a young man, I worked as a Surgical Technician in ORs (operating rooms). I’ve never been able to forget one tragic case in which the patient could not be recovered from anesthesia. The famous head of anesthesia and eventually his whole team migrated to the one room and this patient. Multiple checks on the airway, anesthesia record, vital signs, and equipment followed.
The older doctor who had been in charge was ejected from the room. The suspicion was that he had been negligent. The patient stayed persistently unable to be aroused and was moved first to the recovery room and later to a facility equipped to deal with the case.
Instead of tongues being kept safely quiet, rumors spread allegations of mispractice, if not malpractice, around the OR suite and eventually around the hospital. The head of anesthesia had the older doctor continually monitored every case he did. There was no respite. For him, a trip into the OR lounge for coffee met with sullen silence. As he walked down the hall, we all stared at him. We all treated him with a sort of dumb insolence. In our expressions and the clipped responses to questions, the entire staff made their attitude clear.

One day he did not come in. He took early retirement and was never seen in the OR again. We all reacted with relief. We knew that we had hurried him along. What we had done was justified. We would not tolerate such incompetence.
About two months passed, and one day the entire crew gathered in the lounge for an extended coffee break on a slow day. The chief of anesthesia walked in looking grim. We all quieted down fast, seeing the expression on his face. He announced that the patient had died and that the autopsy had shown a never-diagnosed brain tumor that was almost certainly the reason why the patient had not been able to recover from the anesthesia.
The room was silent and stayed silent as we all reflected on our role in hounding an innocent man out of practice. By silent agreement, we did not discuss it among ourselves. Each of us had to live with our guilt and responsibility.

Years passed. Every once in a while, I recalled the events and the guilt but thought no more than that. Then someone attempted to ruin my good name. The damage to my career took years to repair. A colleague confided that the woman who started the rumor thought she was doing good by exposing my supposed incompetence.
No, I don’t think there is such a thing as a necessary evil. For me, it’s not an academic inquiry. I’ve stood on both sides looking into the abyss. Try it on for size if you dare.

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Cutter

It had been a lengthy procedure. I was still new to the trade of Surgical Technician, so the circulating nurse kept a close eye on me. She made sure that I didn’t contaminate the sterile fields, properly handled my suture material, and prompted me if I couldn’t remember the correct instrument to hand to Dr. Max.
Dr. Max and his resident appeared to be finishing. He looked up at the circulating nurse and me. ” Hey, Clair, it looks like we’re doing fine here. I’ll start closing as soon as I finish up these last bleeders.”
Looking towards the anesthetist, he said, ” Harry, how is she doing?” While that conversation was going on, I was getting my wound closure sutures lined up on my mayo stand. Soon Clair and I would start needle, instrument, and sponge counts before the surgeons began closing the incision.
Then Dr. Max looked up and said, ” Hey Lou, give me your hand. Now gently. Just place your hand on this.” Dr. Max gently guided my hand, just above the beating heart of the patient. “Now you know why our job is essential.”
All I could say was a rather inane, “WOW!”

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Dr. Max

Dr. Max was one of the first surgeons I ever scrubbed for in the operating room. As a total green hand, I was prone to confusing instruments. Dr. Max took my errors in stride- no screaming, no grabbing instruments from my Mayo stand. Just calm advice: “no, Lou, I want that retractor there.” After an incredibly long hard case, I asked him how he kept so focused and unperturbed. Here is his answer:

“I was a machine gunner in the First World War. The machine gun was one of the game-changing weapons of that war, like tanks. When the war ended, I had all the violence I ever wanted to see. So I trained as a surgeon. But history had other plans for me. I had just finished my Residency when World War II broke out. I enlisted and eventually found myself in a mobile army surgical hospital – what you would call a M.A.S.H.

We worked under awful conditions, saved countless lives, and learned to handle whatever was handed to us with little or no preparation.

By comparison, almost all my civilian work is leisurely. I have to prepare and think in advance. But the experience of the operating room in wartime makes you ready for the unexpected. The keys are experience, preparation, and not being afraid of the unexpected.”

His advice to us was the same as General Eisenhower’s – “Plans are worthless, but planning is everything.“ In his private life, Dr. Max started to learn the piano at age sixty and was an agile hiker into his seventies. He was one of the people who convinced me that lifelong learning was not just important but essential.

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Operations

<p class="has-drop-cap" value="<amp-fit-text layout="fixed-height" min-font-size="6" max-font-size="72" height="80">The Operating Room is a different sort of place to work in, and the people who work there can be different too. I spent about nine years all told working in Operating Rooms, and a substantial bit of my education money came from working there. It was by turns the friendliest, and most stressful environment I have ever worked in.<br>When I left graduate school, It took a few years to find work as an anthropologist. I spent most of that time working as an Operating Room Technician and scrubbing on a wide variety of cases. I'd have to say that the people I worked with and the experiences I garnered made a lasting impression on me.<br>My last year in the OR provided me with an enduring memory. Around Christmas, only the most necessary surgery gets booked. Nobody wants to convalesce from elective surgery during the holidays. Things slow down in the OR, but work continues with jobs that always need doing to keep the OR a safe environment. Still, there is time for a bit longer coffee breaks and lunches, and a party or two. Being an emergency could roll through the doors at any time, parties tend to be careful affairs. Wilder activities are for after hours and outside the confines of the hospital. This is about one of those events.The Operating Room is a different sort of place to work in, and the people who work there can be different too. I spent about nine years all told working in Operating Rooms, and a substantial bit of my education money came from working there. It was by turns the friendliest, and most stressful environment I have ever worked in.
When I left graduate school, It took a few years to find work as an anthropologist. I spent most of that time working as an Operating Room Technician and scrubbing on a wide variety of cases. I’d have to say that the people I worked with and the experiences I garnered made a lasting impression on me.
My last year in the OR provided me with an enduring memory. Around Christmas, only the most necessary surgery gets booked. Nobody wants to convalesce from elective surgery during the holidays. Things slow down in the OR, but work continues with jobs that always need doing to keep the OR a safe environment. Still, there is time for a bit longer coffee breaks and lunches, and a party or two. Being an emergency could roll through the doors at any time, parties tend to be careful affairs. Wilder activities are for after hours and outside the confines of the hospital. This is about one of those events.

So close to Christmas, no cases and everything buttoned up our OR supervisor “Miss Piggy” ( hey, she selected the nickname herself!) decided that the troops deserved to leave a bit early. After discussing what we wanted to do, it was agreed to take in an afternoon movie, and then head over to Boylston Street and our favorite restaurant ( the Half Shell). By unanimous vote, we all agreed we wanted to go see the Bob Guccione film, Caligula. For those not familiar with the film, it was definitely X rated.
Dutifully we all trouped into the theatre. Somewhere about five minutes into the film, my friend May starts talking about the physical improbability of the acts being committed. To my other side, Miss Piggy begins to suppress her laughter, which results in loud sniggers from Rob and Karen. Eventually, a very risque commentary, not suitable for discussion in this setting, starts accompanied by howls of laughter. Before we are ten minutes in, we are all commenting on the actor’s performances and anatomy.
At this point, theatre management intrudes, telling us that we’ll be asked to leave if we can’t quiet down. We calm down, but you can still hear snickering. Then, something so outrageous happens on the screen that we can’t contain ourselves. We all break out in howling laughter and obscene comments. That did it, we were expelled from watching an X rated movie. I’d like to say that we sulked out of the theatre in shame for our bad behavior, but we didn’t – we laughed and made pointed comments all the way to the exit.
We didn’t want to get booted from the Half Shell, so we kept our discussion to a quiet roar.

The last few days before Christmas were quiet, but at a hospital-wide New Year’s Eve party, the OR had the single most outrageous story to share of all the stories told that evening.

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