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December 29,2016

 

Written by Olincia White (class of 2016-2017)

My first day in the OR was very exciting. I woke up early and anxious to arrive on time. I showed up to AO2, nervous but excited. After reading all of the journals, I could only imagine what the topic of the discussion would be. I arrived at about 6:55am to find the light off and the room empty. This made me very nervous and tons of thoughts went through my mind. Was I too early? Surely everyone wouldn’t magically appear at 7am sharp. Luckily there was a nice lady sitting quietly in her office, across from the room. She informed me that there were no meeting on Thursday and that although she didn’t know much about the program I should probably head to the OR. More confusion set in. How would I find a resident? How will they know who I am? I made my way to the 5th floor and asked the first person I saw to help me. He was very kind and walked me over to the nurses station. I was greeted by a nice nurse, Wendy, who informed me that all surgeries started at 8:30am on Thursdays. She recommended that I go have breakfast and return. I returned at 8:15am, got changed and made my way to the board. I noticed that the board only had 3 surgeries. Hesitant to stare at the board for long, I picked an OR but I didn’t just want to walk. Luckily Wendy reappeared and helped me pick a surgery that hadn’t yet started. This allowed me to introduce myself to the female resident at bedside and the surgeon, Dr. Geoffrey. I introduced myself and we proceeded into the OR.  

Procedure #1 Left Breast Abscess Excision

The staff explained that it was uncommon to see a lot of procedures scheduled at the end of the year and that it was superstitious for patients of Asian cultures to have surgeries before the new year. This patient was having a small abscess excised from her left breast. The patient reportedly works out at the gym 5 days a week. They suspect that the abscess is a result from sweating and daily wear of her constricting bra. After sedating the patient, the resident made a small incision, cut down to healthy tissue and excised the abscess. Dr. Geoffrey stood at bedside, giving minimum instructions on what to do next. After the abscess was removed, the empty space in the breast was “stuffed” with healthy tissue (tissues in the breast were rearrange to make sure there weren’t any empty pockets) and the incision was nicely sutured. During the procedure, Linda the Nurse Anesthetist, showed me how to insert an Esophageal Tracheal Stethoscope! I have never seen one of these used and Romello, teased her for only showing off her toys when guests were there. Either way I was excited and she complimented me for my enthusiasm. The ET stethoscope went direct into the patients airway and had a small earpiece connected to it that allowed Linda to listen to her lung sounds and heart rate. From a nursing standpoint I thought it was pretty cool.

The entire procedure took about 45 minutes. After the patient was sutured up, Linda, the Nurse Anesthetist, prepared her to be extubated.

The circulating RN, Romello, was very nice and immediately began asking about my career goals and interest in the medical field. I explained that I had recently graduated as an RN and word traveled fast! Linda was made aware and welcomed me with open arms. During the procedure she schooled me on her every move and explained why she was adjusting the ventilator, what numbers she was paying attention to and what to do if things didn’t go as planned. As soon as she extubated the patient she began quizzing me in front of all the MD’s (there were 3!). We begin discussing nasal cannulas vs. simple face mask. She asked how much oxygen would be delivered via face mask.. my mind said 40-60% but I was so intimidated that I uttered 40. SMH, always go with your first mind and be confident. We then talked about the Fio2 and what percent we all breathe on room air, 21% of course. Where was my mind. I kicked myself all morning for not being the sharp me that I know I can be. It was humbling to say the least. Once the patient woke up, we wheeled her to recovery and I thanked everyone for their time.

Romello recommended that I check out OR #2 so I headed that way.

Procedure #2 L5 Laminectomy

I entered OR 2 to find a patient lying supine with a cushion box over his face. He was being prepped for a Lumbar Laminectomy. The cushion was going to provide comfort for his face once he was turned over into the prone position. He had cancer in his spine and the surgeons figured if they removed L5 the tumor would have more room to expand and would not compress on the nerve endings as much, saving him from further complications down the road. Without this he could become incontinent and lose his ability to ambulate. This OR was much more crowded, Romello was there so I felt like I knew someone. I was immediately greeted by Larry, the PA, who I absolutely adore! He was a lot of fun, had a lot of jokes but just as much knowledge to offer. He explained the procedure and pulled up the patient’s X RAYS to help me get a better understanding. Larry explained that we were waiting on the surgeon, Dr. Castro-Murell, which he said in a funny tone. He prompted me on how to say it so that “He would be my best friend” and sure enough Dr. Castro-Murell and I hit it off well. He was also full of jokes and laughter. I also had the pleasure of meeting Dr. Thurman Hunt who is the anesthesiologist and supervised both procedures.This entire procedure was scheduled to take about 4 hours but I only had about 2 more to spare.

The Rep

I spent a lot of my time with the representative from the company that offered a machine that would be used in surgery. The rep was super nice and really enjoyed talking with me. Every chance he got he was showing something else on the machine or making small talk about his previous experiences. He was there to ensure that the doctor could accurately align the prons on the device he was using (poor description but I can’t recall what it was called, and had never seen anything like it). The device had  sensors that were facing a camera. Dr. Castro-Murell made 21 virtual markings on the patient that he would later be able to use as reference points. The rep had a machine that had a 3D image of the patient’s lumbar spine. The goal of the machine was to help the doctor find the proper trajectory. Without the device there would be lots of x rays needed. There were cameras on the end of each point and it was up to the doctor and the rep to ensure that it was aligned correctly. Dr. Castro-Murel had no problem with this and things continued smoothly. Unfortunately I had to leave shortly after.

Reflection

Just watching the patient lie face down with his entire lumbar spine revealed was shocking and interesting. I wish I could have stayed longer but my toddler needed my attention. I felt so fulfilled by it all that I was beaming from ear to ear and signed up for the next earliest day available. I am looking forward to going back.

One thing that was really cool is that a lot of the staff noticed how many pins I have on my badge, (a total of 5) and thanked me for my service!! How nice is that? I absolutely love Highland for days like this! It started off rough but ended well. I am very grateful for the opportunity. Thank you!

 

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