Anxiety, panic, drama: life in the operating room (1)

The morning I got off the elevator on the 8th floor of the Montreal General Hospital and headed toward the operating theatres, I hadn't slept a wink the night before and for all I knew, I would never sleep again. Anxiety had never been an issue for me but I was starting my affiliation as an operating room nurse and, as a second-year student, I had reached a whole new level of near-panic.

I can't remember being with anyone although the six members of our affiliating group were mostly close and usually travelling together. My memories of that morning are that I was completely alone as I walked down that long hall to meet the nurse in charge.

We had heard about the nurses in charge of the operating rooms. They were legendary and all the stories were scary. Some of the top nurses were from England and they had brought with them not only those frilly pill-box caps — some of them with the short veil attached in the back — but utter disdain for frightened students and a fairly obvious joy in being able to intimidate so easily.

I looked for stock photos of nurses of that era to help you picture what I was facing but all the nurses in the pictures I found looked too kind for my purposes. This is the closest I could come:

(Yes, you're right. It's Agnes Moorehead from Magnificent Obsession. She's got the expression though.)

I think there were 12 or 14 or 16 operating theatres. I honestly don't know how many there were but my memory is that there were favourites that seemed to be in use constantly and then there were the others — for some reason, just not up to surgical standards.

In this picture, pretty much dead centre, you can see a floor extending from the tall wing on the left to the short wing on the right that has no windows. There are two windowed floors above it. The floor of no windows is the 8th floor.

So there was no natural light on the theatre wing of the 8th floor and it was kept at a very cool temperature at all times. There was something disorienting about working there all day, in the cold under bright lights.

At least two of the theatres had galleries, where spectators — medical students usually and sometimes nursing students although if we were on affiliation there, we were more likely to be down on the floor — came to watch the big surgeries. Some of the surgeons were showmen (always men in those days) and they loved an audience.

The memories I have of the time spent there are vivid, vague and jumbled up. I have no idea of the order things happened in but I do remember some of the things we learned.

We had already learned, in other circumstances, the principles of sterility and the method of preparing a sterile field. That remained the foundation of our duties but there was so much more. We learned the name and function of hundreds of surgical instruments. We learned how to clean and sterilize them. Most importantly, we learned how to set up the basic surgical tray.

The instruments had to be placed in the order the surgeon was going to use them. The lay-out had to be the same, every time. I so remember the stern unapproachable nurse who was teaching me this task telling me that if I were blindfolded, I should be able to locate the instrument immediately when the surgeon demanded it.

I can't remember the exact order of the instruments but this looks like it could be close:

There were several people around when an operation was about to get underway but on the nursing side, there were the circulating nurse and the scrub nurse. In our lowly position, we had to do a lot of scut work before we got to either of those roles but eventually, we made it to circulating nurse.

I always thought the circulating nurse was not accorded nearly the respect she deserved. She performed a number of essential, important tasks throughout the surgery but sadly, she never had the status of the scrub nurse. She was the theatre's Cinderella and a lot of her job before the operation began involved getting the Princess Scrub Nurse ready.

Fortunately, we students had been well-schooled in humility and this was right up our alley.

The circulating nurse was ready and available as the scrub nurse was getting scrubbed. The water faucets and soap dispensers were foot-controlled but when the 10 minute scrub was finished, the circulating nurse was waiting with sterile towels. She then dressed the scrub nurse in sterile gown and tied it at the back, never touching the front or the sleeves. She capped and masked the scrub nurse, then opened the sterile folded cotton package that contained the gloves.

When the scrub nurse reached the patient's side and the circulating nurse opened the draping on the instrument tray, the scrub nurse was immaculate in all the areas that were anywhere near where the surgery was going to happen.

During the surgery, the circulating nurse was in charge and in control of the room — who came in, how they were dressed, how near to the patient they were allowed. Before, during and after the surgery, she — along with the scrub nurse — was responsible for counting and recording all instruments, needles, blades, sponges.

She would anticipate needs throughout the surgery and be ready at the end with a selection of suturing materials and then, of course, be ready and responsible for the big clean-up.

I came to enjoy the role of circulating nurse. It was busy and challenging and required constant responsibility and accountability but even with all that, it didn't come close to having the tension and the drama of the lead role: the scrub nurse.

I still remember my first time. I'll be back to share that story — and maybe more — soon. (Part two here.)