The other day I had the opportunity to observe a number of surgeries in the operating room. It was quite the experience. The morning started off a little bit tumultuous because the lady at the front desk was expecting students from another program that day. After showing my identification, assignment and dropping my clinical teachers name she realized the mistake. She handed me a swipe card for OR scrubs (we have to do this because people were going home with OR greens too often). The card didn’t work, so the lady sent me down to another part of the hospital to retrieve a pair from the uniform department. After a short adventure trying to find this place, I ventured back to the operating unit to get changed. By this time I was late and the preconference had already taken place. I walked out into the unit and was overwhelmed by the people buzzing around everywhere. I approached someone and told them I didn’t know where I was supposed to be, but explained that I was a student observing for the day. The person quickly found the clinical instructor who was expecting me and we rushed to the operating theatre while I was trying to throw a mask and cap on. I walked into the room, all the nurses where busy organizing the room and various instruments for the procedure. The surgeon sat in the corner relaxing. He was scrolling through his IPOD to find the right music. He would be performing a WHIPPLE procedure which I have heard can take up to 10 hours to complete.
A WHIPPLE procedure (pancreaticoduodenectomy) is quite an extensive surgery from what I understand. It involves the removal of a portion of the pancreas, part of the duodenum and stomach. Surgeons will often take out the gallbladder at this time too because it is convenient. I believe this surgery was being performed as a palliative measure for cancer. I also discovered that they don’t perform this procedure very often, so you can imagine all the eager medical students trying to get a peak. From my point of view (the surgeons back) I couldn’t see very much. The medical students couldn’t really see much either because the attending surgeon and his two residents were huddled quite closely over the patient for this procedure. We relied mainly on the overhead monitors to get a closer look. What struck me most was how they prepare a patient for extensive surgery. A resident performed an epidural and the upper year medical student put in his 5th IV. They also inserted a central line (for the quick administration of fluids) and an arterial line for monitoring blood pressure etc. After the patient was asleep the doctor let the medical student intubate- which he also did flawlessly. Apparently, on the admission of the med-student, intubation is actually easier on a live person compared to the dummies they practice on. I couldn’t help but think about how scary this must have been for the patient. The nurses were great; as the doctors and med-students were performing all of these tasks (quite well I might add) the nurse was explaining and reassuring the patient about what was going on. The patient was very brave.
I learned a great deal about the nursing roles in the operating room from this experience. There were two roles in this operating environment, scrub nurse and circulating nurse. The scrub nurse was responsible for working within the sterile field. The scrub nurse also organizes, anticipates and provides the tools necessary for the surgeon to complete the procedure. The two other nurses in the room were circulating nurses. These two were responsible for retrieving supplies outside of the sterile field. These nurses also anticipate the needs of the scrub nurse and monitor/record counts. This is an important task because you wouldn’t want to forget a sponge in someone.
This experience was definitely a highlight of my clinical time so far… I can’t wait to do it again someday.