The morning started out badly. When my alarm went off I groaned and thought "20 more minutes of sleep won't kill me. I should still get to the hospital 15 minutes early as long as I only take 20 minutes to get ready." The bad thing about sleep-induced decisions?
To commute to the hospital where we have to do our OR rotations, I have to commute up the I-95 North corridor towards Washington, D.C. Surprise - backed up traffic for miles! I took a bunch of back routes and made it there on time. I went to get changed to OR scrubs, which didn't really do much for my 5'2 height.
I loved the OR. The routine, the focus, the control, the precision. The sheer power of the people in the Operating Room - a surgeon, an anesthesiologist, the scrub nurse, the OR nurses. The silence.
Basically the exact opposite of everything I'm used to in the ER and on the rig! I can think of exactly one sterile field - the surgical cric kit. Everything else has a mere hope of aseptic or "medically clean". The noise is constant, the control varies, and there always seems to be at least one agitated, annoyed, or irate person.
Would I trade my environment for a clean OR room? For a day or two, it might be nice. In the long run? Absolutely not!
I learned a lot today. Watched part of a T&A on a 4-year-old and a multiple dental restoration on a 2-year-old. The 4-year-old got nasotracheal intubation. That was interesting to observe. The child's EtCO2 went from 38 to 49 after Rocuronium. I want to study that a little when I get the time. That's a high number.
I then had an adult, 39-year-old, R ear Myringotomy (ear tube insertion). She got some Propofol, but didn't need to be intubated - just a nasal cannula for support. Her oxygen saturation stayed at 100% and her EtCO2 between 32 and 34 for the length of the procedure, which was maybe a total of 2 minutes. I usually tried to exit the surgical suite after everything got underway, because I was there to primarily concentrate on airway procedures. I wanted to get to the next operating suite before a new patient came in. This one though, I didn't even have time to extract myself before the entire procedure was done! The anesthesiologist told me she'd be gone within the hour.
The last procedure I was in for was a direct laryngoscopy and rigid esophogoscopy with a possible tonsillectomy. This woman in her 50's had esophageal cancer after never smoking a day in her life. I was surprised that her airway structures were so clear; I expected some kind of swelling or blockage or something. About 2 minutes after her Propofol and Succinycholine for RSI, she got a little tachy and her blood pressure went down. EtCO2 stayed steady around 35.
It was an interesting day; I really feel that I learned a lot. I'd like to return to the OR again.
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On another quick subject.
Something I've noticed a lot in the ER and now the OR is the relative anonymity of patients. I'm not saying that's bad, and I don't think it makes much difference to the patients. But, come on, how often to we near healthcare staff referring to the "chest pain in room 15" or "that loud baby with a cold in 20"?? You know it happens. And in the OR, they aren't even referred to by their procedure, as that would often take too much breath to accomplish. They become "the 10:30 in OR 1." And just in case you forget the time or room or procedure, it's all written on a wall-long white board right before the entrance to the sterile area. Hey, however you keep track of everything, right?
But let's us remember that while we have our patients, they're our only responsibility. They don't have to be anonymous. They're not a set of orders or a bed...they're "Mrs. Smith" from "123 Anywhere Street", that beautiful old house on the corner. They're just not feeling well tonight and want to go to the hospital for a nice checkup. And, by the way, did you notice all the afghans on the living room couch that she made herself?
Give them their time to be the only focus and responsibility before they become a hospital statistic.
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