Just like what you see on T.V.? No, I think not.

A real OR is not like what you see on Grey's Anatomy. We don't spend hours in between cases sitting around chatting about our lives or hooking up in On-Call rooms. Our job is not that much different then yours. We have scheduled surgery's that we try very hard to complete on time. Our turnover time between cases is short-we have maybe 15 minutes to clean the room, pull in the supplies and equipment for the next cases and get setup. It's not a gravy job by any means.

This past week has been particularly challenging for me. Maybe it's because this is my last week of being on the morning shift. I'm not at all a morning person so getting up at 5am to be at work at 6:30 is not exactly ideal for me. Next week I start working the 3pm-11pm shift which I'm very much looking forward to. So it very well could be that I'm just done with these early mornings and it's making me drag a little knowing I just have a couple days left of it. Or maybe the stress of working two jobs for the last six months has finally caught up to me. Either way it's been a difficult week.

Every day I've been in a different service and most of the procedures have been fairly new to me. That in itself is pretty stressful for me. But I've also been with some pretty demanding doctors. Don't get me wrong, they're great doctors. But they've been very fast paced and very particular. Normally I'm really good with these kinds of doctors. My attention to detail is always on point, I'm very organized,and my technique is very good. All things doctors like in a tech. But it's all just added to my stress level so I've been pulling my hair out a little.

Yesterday I spent the day in ortho. My first case of the morning set the tone for my day. It was a knee arthroscopy which is a pretty simple procedure. The doctor makes a small incision in the knee and inserts a trocar into the knee.

A scope connected to a camera that transmits the video onto a tv screen is inserted into the trocar so we can see what's going on inside.

This is much less invasive to the patient and we can fix a lot of problems without having to open their leg up completely. When I've previously done knee scopes it's been with a doctor who has a PA (Physicians Assistant) with him so there wasn't too much for me to do. Yesterday I was working with a new doctor and it was just me and him. This meant that I had to perform my job and the job the PA usually does.

What does the PA usually do? They have to hold the leg in very awkward and unnatural positions so that the doctor can see in all the nooks and crannies of the knee. It's a labor intensive job under the most ideal circumstances. Yesterday was not under ideal circumstances. The patient's leg was pretty big and the doctor was having a hard time seeing the problem area. Which meant I was holding this leg very high and pulled to one side very tightly for a good hour. My arms were shaking by the time we had finally finished and I was exhausted. It was only 9 in the morning. And for the rest of the day he was moving so fast-I don't think I sat down until 1pm. By 3 my arms felt like Jello.

On Tuesday I was on GYN service. I really like GYN surgery so I was excited. The doctor I was working with is pretty great but he likes to move very quickly. So for him it's important that you plan ahead as much as you can and have all the equipment and supplies at your fingertips. This makes for a tiring day simply because you don't have any down time. But all was going well until around 1pm. That's when a newer doctor came into the room to assist him. The surgery was routine and towards the end the newer doctor put in a Foley catheter and asked me to hook up the drainage bag. "Of course, no problem." A couple minutes later she says, "Oh, I have to unhook that drainage bag for a second." Um...okay go for it. I wasn't paying too much attention to what she was doing because I was trying to keep the table running smoothly.

I looked up just in time to see her struggling with the bag. Instead of just unscrewing she was trying to pull it apart. Then she figured out to unscrewed but she was still pulling so when it came apart pee flew EVERYWHERE. Including in my face and worse, it got behind my eye protection and directly into my eye. Oh yeah, pee in my eye.

I freaked. And yelled (but only a little). And as I'm breaking scrub to run to flush my eye out the original doctor says to me, "Lisa, you better hurry up and flush that out! You don't want to get a UTI." (Get it? UTI. U-T-EYE) Yeah, he thinks he's pretty funny.

They don't show that on Grey's do they?

Always,
Lisa Marie

Rules- made to be broken or good to follow?

Before I write my next full length post I wanted to take a second to share with you guys something I think is pretty important. So here's a  short post to tide you over.

Every patient that comes in for surgery gets a list of things that they need to do to prepare for their procedure. Depending on what the procedure is it might be to temporarily stop taking certain medications, they may need to bathe with a special soap, or do a bowel prep (drink some nasty tasting stuff so that they poop alot). But there is one preop rule that you can count on being there. If your procedure requires general anesthesia you will be require to be NPO (nothing by mouth) for at least eight (sometimes twelve) hours before your surgery.

NOTHING by mouth. Nothing. No food or drink (not even water), no chewing gum, you're not really even supposed to brush your teeth. Why? Because whenever you put things in your mouth that sends a signal to your brain that you need more gastric acid in your stomach to aid with digestion. That's a bad thing when you go under general anesthesia because there is a real risk that the breathing tube could trigger your gag reflex and cause you to aspirate (breathe in) the contents of your stomach. That's bad news folks.

We don't tell you can't eat or drink to be mean or to torture you. We tell you that to save your life. So it's important that you follow the rules and even more important that if you break them you come clean about it. Yeah, it's probably going to delay your surgery for a few hours and you still won't be able to eat but at least you'll be alive.

Yesterday I was working in pediatric dental surgery. The kids that come through are very young, a lot of times under six, and need to be under general anesthesia so that we can fix or pull their teeth. Because the patients are so young we have to rely on the parents to make sure that the rules are followed and we trust that they will be honest with us.

We had done three cases and was about to start our fifth when a preop nurse called into the room with some news. She had caught our next patient drinking out of the water fountain. Uh oh! So the doctor went to talk to the mom and tell her that we would have to postpone the surgery. The mom was outraged and said "Why is the water such a big deal? I mean, he had a bag of chips on the way here!"
Oh really? Well in that case the surgery is cancelled. And the mom just couldn't understand why we were being so strict and mean. I'm sure it must be hard to not feed your kids when they're hungry but eating before general anesthesia could kill them. We don't just tell you not to eat because it makes our job easier.

So please listen carefully to all the instructions your doctor gives you before surgery. And if you slip up, come clean before hand. It could save your life.