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

I guess it really is a miracle.

I'm still a fairly new surgical technologist so there are plenty of procedures that I've haven't done and there are some that I've never seen or even heard of. During my clinicals I was fortunate enough to get into a ton of surgeries that my follow students never had a chance of scrubbing in on simply because the hospital I was at was a trauma one teaching hospital. I rotated through all the usual services like General, GYN, and Ortho but I also got to Neuro, Cardio, Trauma, and Plastics. By the time I finished I was pretty well rounded in most services so I knew that I would be very marketable when it came time to find a job.

Like I said, I was lucky. Most students don't get that opportunity. At smaller hospitals there are surgeons who do not want students in their room under any circumstances. And trust me, a student doesn't want to be in a room with one of those surgeons. It can be pretty scarring. So often those students don't even get a chance to see the inside of a heart or neuro room. And you can forget about a trauma room.....they don't want to waste time letting the students learn how to handle an emergency.

And I get why they might think like this. Students mess up. Sometimes a lot. They might forget that they can't let their hands fall below their waist level or that they can't scratch their nose when it itches. They also might hand up the wrong instrument or forget to replace the surgeon's sponge when it gets full of blood. For an experienced tech or a doctor, this can be the most frustrating thing in the world. But I think it's important to remember that this is how people learn. If a student never gets to scrub in on an Ortho case how can they be expected to know all the extra things that go along with that service when they finally graduate and get a job? And I also think it's important to for all those doctors, nurses, and seasoned techs to remember that they were students once too. There was a time when they didn't know everything there is to know about surgery and they made mistakes. It's hard to be a student and it's hard to be the new person. So let's try not to make it any harder.

A few days ago I got the chance to scrub in on a procedure that I had never seen or done before. And I can't tell you how excited I was! I've always wanted to do one but the hospital I trained at had their own separate team on an entirely different floor so I never got the chance. This now strikes me as funny because a c-section is actually ranked as the second most frequently performed major surgical operation in the U.S. So that morning when I saw that I had been assigned to my first C-Section I was ecstatic. Because I had never done one I was in the third assist role, which meant that I was to stand beside the surgeon and retract the tissue to aid in visibility. And this was just fine with me because it meant that I got to learn without having to worry about pass instruments.

The patient was brought into the room and was put onto the O.R. table in what we call Fowler's position (sitting). This was so that the anesthesia provider could administer the epidural. Once the epidural was in the patient was quickly laid down on the bed because it doesn't take long for them to totally lose sensation from the midsection down. Then the patient's skin is prepped and they are draped.

The surgeon I was working with wasted no time. He made a pfannenstiel incision (a horizontal cut below the bikini line) and dissected down to the muscle layer. Once he reached the rectus and pyramidalis muscles he put down his knife and told me that it was time for me to help. He grabbed one side of the muscles, instructed me to grab the other and he yelled "Pull!" We both tugged the muscles in separate directions to expose the underlying transversalis fasica and peritoneum.

I'm sure this strange to you. Why in the world would we pull the muscles apart instead of cutting them? Well there are actually a few advantages to this method. First of all, there is less postoperative pain for the patient. Also, because the blood vessels are being stretched instead of cut there is less bleeding. And healing time is much faster this way.

After the surgeon opened the peritoneum he moved the bowel, omentum, and bladder out of the way so that we could access the uterus. He palpated the uterus to determine the size and presenting part of the fetus and then opened the uterus with a knife. Um....at this point I was glad I had decided to wear the booties over my shoes because fluid went everywhere! You really don't realize just how much there is. It was now time to pull out the head. The first assistant then aided by putting pressure on the fundus of the uterus and pushing down.

When the head had been delivered all time kinda stopped. There it was...this brand new little human. I grabbed the bulb syringe and handed it to the surgeon so that he could aspirate the nose and mouth so that the tiny little being could breathe. Once he cleared the airway, little man started to cry and it was the sweetest sound in the world. The doctor carefully pulled him out the rest of the way and rested him on top of his mother. He clamped the cord twice and cut in between. Then things got really exciting.

He lifted the baby, turned to me, and said "Put your arms out". Hesitantly I did and he said "You are not going to drop this baby. Okay? You're not going to drop him. Take him over and place him on the blue drape." He handed me this brand new baby! I really wanted to just cry. Here I was holding this brand new person.....he had only been here for a few seconds and I was holding him. Amazing. And no, I did not drop him!

The rest of the procedure was kind of a blur. We closed the new mommy back up and took the baby to NICU to make sure he was okay (and I checked later, he was perfect).

I have to tell you I don't usually get overwhelmed about a surgery. I have had a few that have almost made me sick (I promise I will tell you all about those) but never one that touched me in that way. I love kids but I've seen a vaginal birth and there was nothing beautiful about it. But this......was just something else.

He was covered in goo and grossness but I was so happy that I got to hold him and carry him for those few seconds. He will never remember that I was the very first person to hold him to my chest and welcome him into the world. But I sure will.


Always,
Lisa Marie