Surgical Observation (3-12-2008)

Wow…what an amazing opportunity we were given to observe! To begin with I was surprised to learn that the woman conducting the pre-operative interview was an R.N. I suppose the job just seemed primarily clerical in nature and so I presumed that she was not a nurse. Silly me! Although this woman was fairly young, I can see where this would be a great job for a nurse nearing the end of her career or a nurse who had a health issue that prevented her from being able to pull 12 hour shifts on the floor. Any nurse could choose this field of course, but the pace seemed more relaxed and the office chair pretty cushy! =)

The patient she was interviewing had quite a history. She explained to me after the interview that she had given him the abridged version because he was what they term a “frequent flyer” at the hospital. He is 56 years old, 5’4″ and weighs 269 lbs. He has diabetes with an insulin pump installed. He has a portable wound vac attached to the non-healing surgical wound on his abdomen he was about to have a skin graft done on. He has had 3 hernia operations. He has hypertension, high cholesterol, COPD, lung cancer which led to 2 of his right lobes being removed, “bowel cancer”, severe back pain, knee pain, sleep apnea, heart murmur, Hx of Congestive Heart Failure, edema in his arms and legs, sensory neuropathy in his hands and fingers, constipation, and depression. To top all of this off, he lives alone with his cat who recently scratched his thigh leaving a 4 inch open wound which isn’t healing either. *sigh* And yet this man who hobbled into the room short of breath with the aid of his cane, lugging along an insulin pump and wound vac….was surprisingly pleasant. He was chatty and polite. He was patient with the nurse who dismissed his concerns in the beginning of the interview and yet advocated for himself until she addressed the issue to his liking. He was happy to see me there, and applauded my career choice. He encouraged me to pursue my goals and said if I ever got to work with his doctor I would be extremely fortunate because he was the best in town. Somehow, he was making me feel good and I hadn’t done a thing except observe quietly jotting down notes in the corner. By all accounts, this man should be (and probably is) miserable. And yet his attitude was remarkable. He was grateful, patient, pleasant and polite. What a great example of the difference an attitude choice can make in a person’s life! I know I won’t soon forget him.

The first procedure I observed at the surgery center was a 50 yr old man having a routine colonoscopy. He was a little nervous of course, but his nerves came across in chattiness and humor. He is a single gentleman and a lifetime Navy sailor. During the nurses history it soon became apparent that he was a heavy drinker. He confessed that he used to drink 4-6 glasses of hard alcohol a day but had cut back when his doctor told him he had pancreatitis. The nurse very professionally asked how long ago he had cut back…”oh, it’s been about three weeks now I guess.” I watched her “nurse face” come on and she calmly said “o.k…and how much would you say you drink in a day currently?” “Only about 4 or 5 glasses of wine now.” He replied proudly. Her nurse face stayed glued on, but he began to get defensive as her questions continued. She very non-judgmentally explained to him that she needed the information only for anesthesia and medication concerns. He calmed down and soon the anesthesiologist came in to introduce himself and do his information gathering. He described the medication regimen he would be giving as a “cocktail”. Later after he left, the patient expressed concern to the nurse about having to drink the meds. He had just drank all the awful medications to clear out his colon and wanted nothing more to do with drinking medication for a while! Again, I saw her extremely professional “nurse face” come on as she explained that when the doctor said “cocktail” he didn’t literally mean a cocktail!

 

 

Lesson 1 of the day; How important it is to put on your “nurse face”! All I could do was envision the anesthesiologist bringing the patient (who was already lounging in a recliner not altogether dissimilar to a beach chair) a coconut drink with a little pink umbrella and some curly straws…”That’s it…just drink the yummy medicine and you will feel good in no time!” Fortunately for me, the patient had a good sense of humor and laughed at himself allowing me to crack the smile I had been squashing.

 I observed the colonoscopy which was somewhat interesting and then accompanied the patient to recovery. This is where I learned Lesson 2 for the day; Honesty may not always be the best policy. As he was becoming more oriented he began to ask me questions. Did I have fun? Did I see …um…you know…anything embarrassing? Like his rear end? (I assured him I saw nothing more than his leg) Then he asked me how long the scope they used was? I answered truthfully with a pleasant smile on my face…eager to be of service, that it was about 4 feet long. I think if he could have fallen out of a recliner, he might have. He jumped back in his seat, grabbed the arms of his chair and gasped. “REAALLY???”  I immediately began to explain that there are about 20 feet of intestine and so 4 feet really isn’t as far as it sounds. And that the scope has to follow the twists and turns of the intestines so it is not really going straight up as it might seem. He calmed down after that but I sure felt terrible. In retrospect an answer such as, “oh…not that long.”, would probably have sufficed. Fortunately, given his history of alcohol abuse he had to be given four times the amount of normal medication to be sedated, therefore I doubt the Versed will allow him to remember my oh so honest answer!

The second surgery I observed was not very interesting until I got to the recovery unit. I was unable to witness the pre-op portion and was told to go straight in to the OR with a different surgical team. I did as I was asked and throughout the procedure, which only lasted about 10 minutes, it was as though I did not exist. The surgeon and the anesthesiologist were, as cliché as it sounds, chatting busily the entire time about travel plans, preferred airlines,  and the best restaurants to choose once at the destination. I know this is not uncommon but to my eyes it seemed very nonchalant and crass. I was perfectly o.k. with them ignoring me, but it seemed they were ignoring the patient too and that really bothered me. I just stood quietly making a mental note to myself, (as the surgeon was suctioning blood out of the patients nasal passage and chatting about restaurant views) never to choose this surgeon should I need a procedure done. In the recovery room however, I met a wonderful nurse. She has been a nurse for 37 years and I really enjoyed watching her work. When she had done the most of her documentation, and the patient had begun to regain consciousness she asked me if I had any questions. She was kind enough to answer my questions and then she asked me if I had ever seen A-Fib on a heart monitor, and when I said no, she tore me off a piece of the paper strip and drew a normal rhythm at the end so I could compare and contrast it to the patients. She was also wonderful about letting me actually do small things to assist the patient. I helped her lift the head of the patients bed, get the patient water, hang his IV bag etc. While they were small tasks I think she knew that it made me feel better to do something rather than to just stand back and watch all day.

My final surgery of the day was a breast lumpectomy. It was here I learned the most. During the pre-op portion the patient continually referred to the wire in her breast and how miserable the insertion had been. I had never heard of the procedure so I was very curious what she was talking about. After entering the OR I got to see the scrub nurse setting up the sterile field and the anesthesiologist doing his work to help sedate the patient and make her comfortable. When he was not busy I asked him about the wire. He was eager to show me, and brought me to the light box to see her films. What I saw was breast tissue, a wire running through it, and a drawn on circle at the deepest portion of the wire. What I expected to see, was a lump, a dot, a white spot…something indicating the lump they were removing. The anesthesiologist said, “So, you see that?” I said I did, but really I didn’t know what I was supposed to be seeing at all. I felt so foolish. He then said, “See how the breast tissue all looks the same? How you can’t see the lump?” “OH, yes. YES I Do!” Whew! Was I relieved! He then explained the need for the wire so that the surgeon could find the exact location of the lump. Lesson 3 for the day; Don’t ever claim to see something you don’t!  The surgeon entered shortly after that and I was standing off to the side, behind the scrub nurse. I was trying to stay completely out of the way and yet still see something of the procedure so I repositioned a time or two. The anesthesiologist noticed my predicament and placed a stool at the patients head and brought me back to stand on it. He lowered the sterile drapes so I could lean over them carefully and look down on the surgery. It was amazing! I am so grateful to him for giving me that opportunity. The doctor then began to talk me through the procedure telling me what she was doing, and why she chose each technique. She could have taken short cuts but preferred to take a little more time to ensure as much as possible that the patient would be left with minimal scarring and dimpling from the removal of tissue. She showed me the lump as she took it out and explained how it looked benign to her. The circulating nurse immediately passed the specimen on to the proper staff who walked it next door to the lab as we watched out the window. While waiting the doctor asked me how many surgeries I had observed. I told her this was my first day, and really the first procedure where I had really witnessed a surgical technique. She said she was impressed that I had not fainted while standing on that stool. Personally I was thinking, if this makes you faint, why would you be here, in an operating room wanting to be a nurse? Lesson 4 for the day; Take compliments where you can get them. (Go me! I didn’t faint). She asked me if I wanted to be a surgical nurse, and I told her that while I do find it interesting, I want to be an oncology nurse. She remarked that it really takes a special person to work in that field. I was thinking, it really takes a special person to do what she does all day. The scrub nurse said she could never do anything like that, she was only suited for surgery. Lesson 5 for the day; It takes all kinds of nurses to provide complete care. Within minutes the lab had called to confirm the specimen was sufficient and upon first testing appeared to be benign to them as well.

I thanked the doctors once again for taking the time to teach me. I am so grateful for the kindness of everyone I encountered that day. My experience at the surgery center was very positive. From the warm greeting I received at the front desk, to the way the pre-op team made me feel like a part of things rather than an outsider, to the anesthesiologist who welcomed questions, to the surgeon who took the time to explain her technique and the rationale behind it as she worked, to the nurses who encouraged me and gave me advice in the recovery unit, I felt like a welcome participant the entire day. I found this was my best clinical experience by far!

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