It is often said that one either loves or hates the operating room (OR), with nothing in between. Some say that our roles are too dependent on others and that the OR is boring because of this. If you are preparing to shadow someone, visit as a student, select surgery as a career, or have surgery yourself, we hope that this book will provide you with enough information to have a meaningful and safe experience in the OR. If we’ve done our job well, it might even be fun.
To feel prepared, you need to understand the basic flow of how a patient comes to the operating room. The exact details, order, and process of the operative experience will vary by location, policy, and individual patient situation. We have tried to generalize as much as possible. If you have questions about your experience, please discuss these with your physician, instructor, or an OR staff member. Just as some of our photos are blurry (patient privacy, you know), we’ve tried to paint the OR experience in broad brushstrokes. Every experience is unique.
WHAT DO YOU KNOW ABOUT THE OPERATING ROOM?
Many people gain what knowledge they have about the OR from watching medical dramas on television. If you are someone who has relied on television depictions, let me be the first in this book to say it: that’s not how things really work. Some people gain knowledge of the OR from their experience as a patient. Personal experience can be valuable but it is likely you don’t remember much after rolling into the room.
To start you off on a realistic foot, we do not always operate in the dark (this is only done in certain cases), scrub without our masks on, or see the OR as the prime location for romance to develop (although it does happen on occasion).
On the other hand, we do:
Joke around with each other
Get a little choked up from time to time (we hide it well behind our mask)
Feel moments of high anxiety for our colleagues and patients
Wipe sweat from, or scratch the brow of others
Expose ourselves to dangerous situations (you won’t get any closer to bodily fluids than in the OR)
Count more often than the Count on Sesame Street
Get a bird’s eye view of the amazing things that the body is capable of
Of the many tips and suggestions throughout this book, please remember the most important concept: it takes a team to function optimally in the OR.
Every aspect of care that we discuss involves and impacts more than one person. When everyone works together, the OR is a well-tuned symphony. We each have our solo moment(s) to be in the spotlight, but even when it is not our turn, it is impossible to provide complete care without the full dedication of each individual. When a person resists the work of others on the team, feels that they are not part of the team, or refuses to recognize the role and purpose of others, the symphony falls apart and the care and safety of the patient begin to hit out-of-tune notes.
WE NEED TO OPERATE
The decision perform do surgery is not always an easy or straightforward one. Surgery can be performed to diagnose, rule out, repair, prevent, start, stop, or enhance a condition. Sometimes a surgeon will not know what he or she is dealing with until they do surgery. Sometimes surgery is planned and scheduled. Sometimes, such as in a trauma situation, the decision for surgery is made in the blink of an eye. Although there are consistencies in similar operative cases, no two cases are ever alike.
DO YOU UNDERSTAND WHAT WILL BE DONE?
Although the patient may ask their regular physician, friends, or Google for answers about their upcoming operation, it is critical that they discuss the details with the surgeon and provide informed consent (Figure 2.1). The surgeon explains the procedure and reviews any potential side effects or problems that could occur, and what these might mean for the patient. The surgeon also will discuss alternatives to surgery with the patient (even when those alternatives aren’t necessarily realistic options). This discussion occurs in the office or immediately prior to surgery. The consent is a legal document and this conversation must take place when the patient has not had any medications or is otherwise influenced—the patient must have “capacity” to make decisions about their care. This is a great chance to ask questions, and surgery can be declined if a patient is against it. Consent forms come with a large amount of fine print. Patient questions are welcome during a robust consent process.
SO YOU’RE GOING TO HAVE AN OPERATION …
Once the surgery date has been set and everything is scheduled, the patient receives very specific preparation instructions. These vary depending on the type of surgery but can include directions on eating, bathing, shaving, medications, and so forth.
One of the most inconvenient surgery preps involves cleansing of the bowels for abdominal surgery. If you are having a surgery that requires a bowel prep, you will need unrestricted access to a functioning toilet. If you question whether you truly need to choke down the unusually large prescribed amount of the cleansing agent, just remember, it is always safer to have clean bowels at the time of surgery.
Sometimes this can be the most difficult preparation of all, especially for small children or impatient adults. Nothing should be eaten for a certain number of hours prior to surgery if the patient is going to have sedation or a general anesthetic. Make sure the patient understands when to be NPO (taking nothing by mouth). Many don’t realize how significant this instruction is, but if there is anything at all in the stomach there is a chance it could inadvertently enter the esophagus or lungs. Ignoring the NPO instruction will result in postponed or cancelled surgery. If the patient is on medication, they will be given specific instructions about how and when to take those medications prior to surgery.
TAKE IT ALL OFF!
The day for surgery has arrived and the patient checks in. If the patient is coming from home, a family member or friend should bring them to the pre-operative area of the hospital or surgery center. Once the patient is checked in, they will be asked to change out of their street clothing into a surgical gown and tuck their hair into a shower cap-looking hat. If you think finding a hair in your food is nasty, we’re pretty sure you don’t want to find one in your surgical site. Don’t worry—everyone who goes into the OR gets to model this look.
This is also the time for personal items to be taken off and packed away (Figure 2.2). These items can get lost or present safety hazards: fingers swell during surgery from the fluids that are given, so rings pose a threat to circulation. Your patient may be fine taking off their wedding ring and handing it to a family member for safekeeping. If they’re removing eyeglasses or hearing aids, the anxiety and discomfort level significantly increases. Take extra care to help them stay comfortable, involved, and informed.
In order to instill fluids and other necessary medications, an IV must be started. A word of caution: before beginning an IV, it is a good idea to ask family members or friends if they want to stay. If so, make sure they are seated. Always make sure your patient is lying down or seated when beginning an IV. You never know how they might react to seeing an IV start or a little bit of blood. The last thing you want is for someone to pass out.