In my nursing course this semester, I get to go to "off-units" which basically mean that during certain assigned weeks, we get to go to a different experience in the hospital from our usual clinical floor. This week I went to OR (Operating Room - surgery) on Thursday and I hung out with Rapid Response (the code team) Friday.
My OR Experience!
When I first arrived, I had to change out of my normal scrubs into sterile scrubs. The sterile scrubs were arranged by size (XS-XXXL) in what can only be described as a scrub vending machine. My preceptor was to the point and stated, "I will introduce you to the nurse at bedside and after that you're on your own." Basically telling me that I had to talk to everyone to figure anything out. No worries, I am good at talking.
When I got to my patient's bed in the pre-surgery room, she was an obese woman with endometrial cancer. She was going to undergo a total abdominal hysterectomy bilateral salpingo oophorectomy(removing the uterus, fallopian tubes, ovaries) or TAH-BSO. I felt bad for her because I knew it was a scary procedure and she was going to be under for quite awhile. I asked her about her family. She told me that her mom had died of lung cancer the month before and it had been diagnosed earlier in that same month, so it progressed hard and fast. She had anxiety and was visibly nervous about the procedure. The perioperative nurse, "D", got her boyfriend from the waiting room and he helped to comfort her at bedside.
The anesthesiologist and the intraoperative nurse came to my patient, asked her the same questions that everyone asks (this is what we do to double check that you are the same person with the same history and to decrease errors) and provided their own encouraging words of comfort. I introduced myself to them - the anesthesiologist was a rather sexy man in his late 20's named "J" and his superior was a woman with beautiful eyes named "Dr. D", and the intraoperative nurse also had fantastic eyes and she was "L". They were all very kind to me during the whole thing.
The reason I make reference to eyes is because when you work in the OR, you get used to wearing masks and head coverings, and as a result most of your face isn't visible aside from the eyes. I got to wear these fun little items as well. It's interesting how you get used to looking at people's eyes and after awhile you are surprised to seem them without the whole getup.
My patient was rolled into the operating room at 0728. The room was completely sterile with blue sheets and paper over anything that could not be touched by someone was not sterile (basically, I was not supposed to touch anything until I was told).
They immediately began to prepare her for surgery. She was given general anesthesia and put under with a breathing tube down her throat and a respirator helping her mechanically breathe. These precautions were necessary because she was paralyzed and could not breathe on her own. With my little eyes bright and wide, I placed my glove-covered hand over her throat and pressed her cricoid cartilage while they stuck a breathing tube down her throat. This move I made is known as the Sellick maneuver and it blocks off the esophagus during intubation, preventing aspiration (breathing into the lungs) of gastric reflux.
After she was under, they prepared her body by using a sponge and orange sterile disinfectant. The surgeon, "R", was rather animate and willing to explain anything she was doing. R explained that she would be doing a midline incision in the abdominal cavity as she dripped orange solution in the patient's belly button. Meanwhile, the anesthesiologists worked on getting her CO2 and pH levels within normal limits and her body properly paralyzed. Another doctor shaved her genital region and sterilized it, then inserted a catheter. They then marked a line down her abdomen, with a little deviation around the belly button. The final preparatory step was the placement of blue paper over her body with only a little rectangle where her incision was to be made.
The surgeons gathered around her body on the table, turned up the lights, and the incision was made at 0801. I got to stand at the head of the bed, peering over the blue sterile sheet, perched upon a little stepper with the best view of the action. The incision was sure and deep, with the use of a cauterization tool to burn the edges and decrease bleeding. They always say that the smell of burning flesh bothers students. It didn't really bother me, I saw it as being a really good thing that they could decrease her bleeding.
Once they made the incision, they began preparing the area by moving the guts out of the way and pulling the incision apart with retractors which looked like long metal handles which could attack to a circular open disc around the incision site. I could go into all the details of the surgery, like how her adipose tissue looked like pure yellow chunky lard. I don't think I'll get those images out of my mind soon - and they were so damn cool. I was a bit disappointed that her guts did not come out onto the table, but I suppose that it's better that they did not.
Around 0915, they cut out the first ovary, which gives you an idea of how much prep work they had to do first. Digging deep into the left side of her body, they pulled up a piece of flesh and began cutting. A small white round object was pulled out. "Was that the left ovary?" I asked R through my mask. "Yes." By 1030, they had extracted the right ovary, both fallopian tubes and uterus. The uterus was small and purple in color, interestingly tiny in such a large woman. I saw R go down deep and cut out a little piece of flesh, squish it in her hand and hand it to the bedside nurse. "What was that?" I asked. "Her cervix." I may have drove them crazy with my questions. A couple of times, they poured saline solution into her abdominal cavity and used suction to clean it out. It was an interesting sucking noise when the suction got stuck on a piece of tissue.
They recreated her belly button by cutting out a size of pure adipose tissue the size of my fist. Considering her size, they did not consider it a large concern to cut out large chunks of her fat. They also did some exploratory searching for cancerous nodules. Whenever there was doubt, they took it out. R expressed concern about the regional spread of her cancer, so they got on the phone and called oncology. It was a bittersweet moment to say that they had found nodules, but they were hopefully getting them out.
Around 1100, they pulled out the retractors and slowly but surely began to close up her incision site. By 1130, she was done and they began the process of cleaning and waking her up. It was a flawless surgery! Her incision site looked amazing when they were done and I can truly say that I think I got to witness some expertise on the part of R.
All of the people in the room had pretty eyes.
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