You can read part one right here.
Operations were always scheduled in advance unless there was an emergency which didn't seem to happen as often as you might think. A GI bleed, a perforated appendix, a patient from Casualty who may have come in after an accident — these are the types of cases that weren't planned ahead.
I had gone back to sleeping at night and managing with my OR routines. As we all realized at some point, the operating room bosses had nothing invested in us and it was as if our operating room experience had been divorced from the rest of our quite intense training. I've thought about it some in the years since and my theory is that if a student showed interest and aptitude, the powers-that-be would lavish attention on her and prepare her for induction into their exclusive club.
As for the rest of us, we would put in our time and meanwhile, we'd be assigned lots of cleaning jobs. There definitely were times when we thought we'd joined the housekeeping staff.
And then one day, about two weeks in, I checked the next day's schedule on my way off-duty and there was my name: scrub nurse. My surgeon was Dr. Harry Scott, already well-known just for being interesting and flamboyant, not yet a legend for being a pioneer in cardio-vascular surgery — specifically, open-heart surgery.
Don't worry. I wasn't going to scrub for open-heart surgery! Dr. Scott must have still been doing some general surgery; I don't remember what the operation was but I think it was fairly routine.
It was my first time as scrub nurse but not my last so I don't have specific memories of getting ready for that one. This time, of course, I had the circulating nurse working for me and it was a whole set of new experiences to be the one being dressed and masked.
The scrub nurse put on her own gloves. When the circulating nurse opened the cotton packet, the gloves were lying on their backs, palms up. The wrists were folded back a couple of inches. With your bare right hand, you held the left-hand glove by the fold, touching only the inside of the glove and pulled it on — leaving it folded. With your gloved left hand, you slid your fingers under the fold on the right glove touching only the outside of the glove and pulled it on. With sterile fingers on both hands, you then flipped the fold up over your wrists and voilà — gloves on both hands whose outsides have not been contaminated! Aren't you glad I told you how to do that?
I do remember the intensity and the focus required while getting the instruments ready with the circulating nurse. And then getting ready for the surgeon.
The surgeon came into the theatre gowned and masked and scrubbed but not gloved. I just described to you in a short paragraph how to get those sterile gloves on without contaminating the outside but for some reason, this was not taught in medical school. The surgeon's gloves were put on to his hands by the scrub nurse. As she was already wearing her sterile gloves, she could pick his up, stretch out the opening, point the fingers to the floor and he would lower his hand into the glove.
You may have noticed I've said nothing about the patient in all of this. The truth is, the patient — the reason we were all there — was not prominent in our preparations. At this point, the patient was heavily sedated and was the responsibility of the anaesthetist. All we did was prepare and lay down the drapery that would render the patient even more anonymous than s/he already was.
When we were ready to start that morning, Dr. Scott asked me my name. We can only see each other's eyes in this situation but he at least recognized that he didn't know me. I told him — "Miss" of course. There were no first names in the hospital, ever.
The operation started and it really is much like you've seen in the movies. The surgeon puts out his hand and you're expected to know what to put into it. The scalpel first and then, for a few minutes it gets really tense, as controlling the bleeding becomes the prime focus.
"Forceps. Gauze. Gauze. Gauze. A little more gauze."
(If you listen carefully, you might hear the voices of Mike Nichols and Elaine May.)
Once the bleeding was under control and the surgeon was working away, he would often relax a bit. In my first case, Dr. Scott asked me where I was from. New Brunswick, I said. We continued, handing the instruments back and forth. The circulating nurse and I did the count that always followed the first round of bleeding — scalpel blades, forceps, bloody sponges. They were all placed in a basin nearby — more counts to come.
When we settled back into the operation, Dr. Scott said, "Do you know where Harvey Station is?" "Yes, I do," said I. "Then you're definitely from New Brunswick!" he said, quite gleefully. I thought he said he had been born in Harvey Station but I read later that he was born in Montreal so maybe he said his father was born in Harvey Station. It was a nice memorable little exchange anyway.
As far as I remember, everything went smoothly and there was no drama in my first scrub. As always, when the operation was finished, the surgeon leaves and asks someone to "close" for him. It would generally be an intern or resident or, depending on the time of year or the day of the week, it might be a medical student. "Closing" was quite a complicated procedure, dealing — as it did — with several layers of patient and several different kinds of sutures. But we all have to learn somehow.
Dr. Scott thanked me for my help before he left and I thought that was gracious and unexpected.
There were, without a doubt, many surgeons who were not nearly as well-mannered as Dr. Scott. There were surgeons who threw their instruments across the room, causing the circulating nurse to have to duck to avoid a forcep in the eye. There were surgeons who lost their temper and swore and blamed others for their own mistakes. I was very lucky not to have had any of those experiences but I know for certain they happened.
Memory is an amazing thing. When I started writing this, I thought — in fact, I wrote, "The memories I have of the time spent there are vivid, vague and jumbled up" — that I would have a hard time remembering almost anything of the operating room experiences. I remember way more than I thought I did and the more I write, the more I remember. I could probably go on for several more pages!
Don't worry though. I'm not going to.
This is me, just after our capping ceremony — probably several months before my operating room experiences.
No comments:
Post a Comment