A Day in the OR

I am just now realizing that I’ve been talking about “hospital nursing” as if it’s this monochromatic, homogenous thing. Turns out it’s not. [Note: one of the fun things about blogging on a topic that you’ve been studying for oh, six months, is the frequency with which you get to read old entries and say, “oh, how cute, I had no idea.”]. I’ve spent all of my clinical time so far on a medicine floor, but the Operating Room (OR) is a completely different world within the sphere of hospital nursing.

Our first Adult Health clinical is two days a week, for seven weeks. During that time, each of us gets to spend one whole day in an operating room on another floor, as an observer. Yesterday was my day, so I reported to the Weinberg OR first thing in the morning, on the other side of the hospital from where I usually work.

I was given a whole new set of scrubs, coat, shoe coverings, a scrub hat for my hair, and a mask, all of which I immediately changed into in the OR women’s locker room. When I emerged, the hallway teemed with similarly masked and capped staff preparing for surgeries in the sixteen operating rooms. The circulating nurse walked me around the surgical suite and told me all about how being an OR nurse is the absolute best and all other nurses are suckers (paraphrased), talked briefly about how “everything they say about surgeons is true but our surgeons are the best,” introduced me to more cap-and-masked people in one of the operating rooms, and then left me there.

For the first hour, I focused on staying as far from all of the sterile fields as possible and not sneezing.

Eventually, once I got a better handle on the rhythm of the OR (and once I got used to seeing only people’s eyes above their masks), I emerged from my corner and started inserting myself wherever there was room in order to get the best view of the operating table. Folks who are focused on patient interaction: the OR is not for you. Our patient interaction was limited to “Hello! Okay, take slow deep breaths now … hello? Hello? Okay, he’s out.” On the other hand, if you’re a gear-freak who likes high-tech gadgets and you’re okay with a little gore, the OR is a pretty neat place.

I got to watch a patient’s throat get dissected, opened up from ear to ear in a cancer removal surgery. I kept waiting for the dizziness and nausea to kick in (no one asked me directly how I was with blood, but everyone checked to make sure I’d eaten breakfast before the first incisions were made). It never did, though, I think in large part because the rest of his body—upper half of face, shoulders down—was covered, making it easy to disassociate. Eventually I got to see all of the major blood vessels in the anterior part of the neck completely exposed. I watched the pulse of blood moving through arteries and veins as thick as my fingers keep time with the beeping on the monitors. Even that didn’t bother me, aside from making me nervous—it looked more vulnerable than gross. If I hadn’t stood there for four hours and watched, I wouldn’t have thought that you could take a person’s neck that far apart and still sew it back together again so thoroughly.

All in all, the atmosphere of the OR was what made it so vastly different from the medicine floor. On the unit where I usually work, we are constantly aware of our patient’s feelings, whether from a standpoint of sensitivity or just from sheer pragmatism. Morning report almost always includes a reference to mood—irritable, tired, cheerful, withdrawn, chatty. In the OR, the focus was entirely on the mechanics of the job at hand. As soon as the patients were put under, surgeons hooked up their iPods and cued up mixes of the music that would be playing for the duration of an operation. Comments that might have been considered callous in the presence of an ill patient—”Sweet! We get to use the laser today!”—went uncensored.

Before I left, I ran into a good friend who had recently been hired in the OR as a surgical technician. We traded news and talked about our respective roles in the hospital. “I’m just here for the day,” I said. “I usually work up on Osler 8.”

“What kind of a floor is that?” she asked. “Post-op? Or pre-op?”

“It’s a medicine floor…” I said. “It’s not necessarily pre- or post-op. Sometimes we just give people meds.”

“Oh, yeah,” she said. “I forget about those floors.”

At least I’m not the only one with hospital tunnel vision.

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