Written by Krishan Banwait (class of 2017-2018)
First, I would like to thank Lucy and the amazing OR staff for the opportunity to observe surgeries and learn about how the OR functions. I learned a lot and I am eager to return for future surgery observations. I observed two surgeries, the first involved the insertion of a screw into an elbow joint, and the second involved the removal of a gallbladder.
In the first surgery I entered at around 11:15am for the start of the surgery and watched as a team (two nurses, a nurse anesthetist, an anesthesiologist, and an orthopedic surgeon attempted to calm an 89-year-old man. The man spoke Mandarin and had dementia. One of the nurses attempted to translate what the team members wanted to communicate to the patient since she was the only Mandarin-speaker in the room. The patient was very uncomfortable and due to his weak heart he had an ongoing myocardial infarction (blocked blood flow to the heart). The team decided not to intubate the patient, since this would increase his chances of death. Instead they sedated him and covered him with the blue sheets (which indicate sterile areas) and then created a hole for his right arm to go through the sheet so they could operate on it. In addition, they had already inserted a urine catheter (to gather his urine and avoid him accidentally emptying his bladder) before I entered the operating room.
The patient’s right elbow was badly cut and skin was torn off the back of his right hand. The surgeon at first considered doing a skin graft by taking skin from his left calf, but decided it was not necessary and could create a higher risk of complications. Thus, the surgeon did two things: 1) physically pick out any debris in the back of the hand and in the elbow area and 2) inserted a screw in the elbow since the bone had been damaged.
After painstakingly removing every small fragment that could be found the surgeon drilled a thin hole in the patient’s right elbow into the humerus bone and then inserted a single 7 mm screw. The surgeon used a thin drill bit and tools that a carpenter would use. After he finished inserting the screw, the doctor took an x-ray to test that the screw was in the proper place and the humerus was not damaged. Next, the surgeon sutured up the elbow with three long pieces of thin wire and used water to wet plaster wrap and create a cast. The reason for using plaster was because the cast would adhere to the sutures better than alternative materials. The plaster cast was meant to be temporary, thus fiberglass was not a good material to use. After finishing the cast, the doctor wrapped an ACE bandage around it.
The anesthesiologist and nurse anesthetist laced a central line (or central venous catheter) into the patient’s neck vein. They had me read out to the nurse anesthetist when the computer monitor’s readings dropped below 300 mL/minute, since her view of the monitor was blocked while she helped the anesthesiologist place the central line. A reading below 300mL/minute indicated catheter dysfunction. After placing the central line, a nurse noticed the patient had dentures and his lower ones were coming loose. Thus, the nurse pulled the lower ones out and put them in a container.
I joined the nurses and nurse anesthetist when they walked the patient over to the ICU. I watched for about 10 minutes just outside the room as a group of doctors and nurses from the ICU rushed into the room to learn about the patient, monitor his vitals, and decide what to do next. They also decided they would remove his upper dentures, which were firmly stuck in his mouth.
One good piece of advice- you will find the booties and hair covering in boxes in front of the administrative office on the right after you enter the first double doors into the operating room area (just past the OR board, which lists the surgeries and is located on the left of the hallway right after passing the first double doors). In the men’s locker room (and likely the women’s too) you can put all your items in your backpack and leave it on chairs in the locker room (other backpacks were there) since the lockers may all be full and locked. Plus, you can hang up a jacket, if you bring one, on the hooks besides the locker. Do not forget to grab your jacket before you leave, like I did. My jacket was still hanging on the hook when I returned two days later, (so you should be fine if you accidentally leave something in the locker room for a couple days).
In addition, do not forget to grab a face mask (you can use the pink-colored/clear droplet masks that are also stocked in the SDU and Med-Surg departments). They are located just outside the operating rooms, at the sink attached to the main hallway, (before you turn right in the hallway to go towards OR #1 and #2). These droplet masks will provide a clear plastic visor that protects your eyes, and are recommended although most of the staff will likely wear the yellow-colored masks that only cover the mouth area. If any x-rays are taken, remember to grab some lead-containing vests that have Velcro straps and wrap around your chest. They are necessary to limit the effects of radiation. (They are more bulky and heavy duty compared to the typical vests you wear in a dentist’s office when you get your teeth x-rayed and can be found outside OR #2 in the hallway. Do not grab one that has a doctor’s name printed on it).
The second surgery involved the removal of a gallbladder. I walked into the operation in OR #2 in the middle of the operation. It was a laparoscopic surgery and involved three small holes made in the patient, two holes were for tools and the last hole was for a small camera that snaked in on a thin, long wire. One of the two tools inserted had a clip on the end that held a piece of tissue away from the gallbladder so the camera had a clear vision of sight and the gallbladder could easily be accessed by the second tool. The second tool was a hook (a bent tool that had nearly a right angle) that was used to pull at loose tissue of the gallbladder and it also created a heated spark that would burn tissue and create a small stream of smoke. The hook tool was used to pick apart at damaged gallbladder tissue with the aim to create several holes in the gallbladder to help slowly break down the organ and create easy removal.
The surgical team inserted metal clips that held sections of the gallbladder together. There was a damaged thin line on the gallbladder that resembled bacon. The line was brown/white and looked dried/crusty. The team was working to separate the gallbladder from the liver to aid in removing of the gallbladder without damaging the liver. It was interesting to see the different organs and the similar reddish/orange color that each of them had. I watched the surgery for about one hour and did not get to see it finish, but I was very intrigued by the meticulous, slow process that involved using small tools to slowly snip away at the relatively large organ. It was also interesting since there were two monitors showing the same camera image and a few residents that were discussing the steps of the surgery with the attending and the chief resident.