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Surgical Picture Pages October 10, 2012

Posted by therealtinlizzy in Uncategorized.
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In my quest for med school (for which, incidentally, I’ve been declined for the 2013 class, so am doubling-down for reapplication next year. Oh god – did I really just type “doubling-down?”) I’ve had the opportunity to observe a number of surgical and/or clinical procedures. These include a C-section, laparoscopies to remove ovaries and ovarian cysts, and a number of abortions. Yesterday’s observation was a laparoscopic myomectomy via the DaVinci method – i.e. removal of uterine fibroids using ROBOTS – which is both less and more interesting than you might think.

nao-robot

I’d meant to sit down and pen my summaries of each procedure to which I’ve been privy – but what can I say, I kind of suck at slowing down long enough to do so. I do all the things, then it’s off to the next thing. But today I took myself by the shoulders and said “sit your ass down and scribble your recollections into a blog post before they Etch-a-Sketch out of your head, dummeh.”

Ok, great idea, do it. However, summarizing a medical procedure as a lay person (even if, or perhaps especially if, that lay person is an aspiring med school student) in the context of a blog post seems pretty snoreworthy for anyone to actually read, and is most definitely rather snoozeworthy for me in the writing of it. So I decided I should draw it.

It actually struck me a number of times during the procedure yesterday that I wished I could photo-capture: the layout of the room, the expanded bubble of the patient’s belly (inflated with air to make space internally for the procedure), the patient skewered by 5 different ports/implements all attached to a “robot” being controlled from across the room by the surgeon who is doing the equivalent of playing a virtual reality video game, complete with 3-D visual display, hand/finger/foot controls; watching on-screen as the disturbingly-large egg-shaped fibroids were transformed into sausage whirled up out of the abdomen through what’s functionally a tubular inverse garbage disposal, via one of the ports transversing the patient’s belly.

So, with inspiration from (and apologies to!) The Oatmeal, and Hyperbole & a Half  (and Simon in the Land of Chalk Drawings, for that matter) – I bring you my Surgical Picture Pages.

First you should meet the surgical team, names changed to protect – well sensitive health info, but here’s the general cast for typical gyn procedures:

Meet the Circulator.

Her role (I’ll be using “her” in all cases as yesterday’s team was comprised entirely of women) is to well, circulate – to be the General Room Minion – particularly for tasks that have to occur outside of the sterile field. This includes (but is in no way limited to) fetching instruments from Wherever It Is The Instruments Live that didn’t make it into the scrub nurse’s inventory, making/taking calls, moving bits of equipment/lighting, taking/printing photos taken during the surgery, etc. She knows all things, and does a fair bit of scurrying. This one in particular has a scowly/frowny face above due to the sleeves of the scrub jacket she (and anyone present who’s not gowned) is required to wear to minimize molecules of oneself flitting about in the room, i.e. no baring of arms (not to be confused with bearing of arms, but those aren’t allowed either). The scowly frown is to signify the collective opinion in the room that while yes yay for keeping skin-sloughing to a minimum in the OR  – the damn sleeves of the jackets are ludicrously loose/hanging/in the way and the nurses just have to hike their sleeves up anyway to not get them caught up in things.

Oh and my illustrations would be pretty void-of-expression given everyone is masked, so I’m giving you the reader x-ray vision  through the masks so you can tell where there’s a particular happy or frowny face. I could’ve added flowing locks to make them obviously female-gendered, but hair is all up under the surg caps anyway. Also – some of us XXers don’t have particularly girl hair – it’s 2012, catch up. Also – adding long hair would have just made my drawings look like their heads were on fire or something anyway.

Next we have the anesthesiologist and the CRNA (Certified Registered Nurse Anesthetist):

No – that’s not a baker. Also – their scrubs were the same color as everyone else’s, not white – and they weren’t gowned. So my illustration is somewhat inaccurate. Obviously other than that it’s court-room sketch-worthy.

Either/both CRNA/anesthesiologist knocks you out, keeps you asleep, re-ups your IVs, administers things like muscle relaxants, monitors your heart rate, b.p. and urine output throughout. I lost track of where the separation of duties between the anesthesiologist (M.D.) and CRNA occurred, but there were one of each present at various points. They were not scrubbed in/sterile as they remain behind the surgical curtain to where all the anesthetic paraphernalia is.

Then there’s the scrub nurse:

Not sure why the scrub nurse looks as though she were doing jumping jacks, as she was most definitely not yesterday.

The scrub nurse is kind of the control freak of the room, and rightly so. It’s her job to create/maintain the sterile field(s) in the room – which surrounds the equipment table (I’m sure there’s some proper medical name for it other than “equipment table”), the actual working surgical area on the patient, and any peripheral gear that may be involved in the surgery. She gowns/gloves the rest of the scrubbed-in folks – surgeons, interns, residents (the circulator, CRNA, anesthesiologist, observers (usually) aren’t scrubbed in).

The scrub nurse glided over to me yesterday to inquire who I was and what my status/background was. I told her I was a pre-med, but have observed other surgeries so I know how to keep out of the way and out of her domain. She relaxed – “Ok good – pre-med means you still have common sense. Don’t worry – med school will zap all that.” I assume being a native control freak is both a mental pre-req for wanting to be a scrub nurse, and a functional pre-req for the complete fascist you have to be in order to be the Keeper of Sterile Fields in the operating room.

On to the intern (my understanding is that Interns are generally first year residents):

 

and the resident (that is, not-a-first-year resident):

They actually look just like surgeons in there, gowns and all, I was just running out of dexterity for tablet drawing. The intern was much shorter than the resident, so there – I accounted for that.

Then there’s the surgeon.

The surgeons I’ve seen at Fairview have those same lunch-lady kind of poofy hair-covers, but I’ve seen photos of these other sorts of surgical caps, so I took some artistic liberty for the sake of variety. Artistic liberty, people. Note that if you have ear jewelry (or eyebrow piercing in my case) the caps must cover those, because no one wants to come home from a myomectomy happily lacking their fibroids but with the added gift of someone’s eyebrow-/ear-ring in their abdomen.  Duh.

The surgeon (obvs) does the bulk of the surgical work, with the intern and resident assisting and doing routine things (like stitching up).

So that’s the intro to the surgical team. For sake of brevity (or at least to prevent ridiculously lengthiness) I’ll draw this post to a close, and save the DaVinci procedure details for another post.

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Comments»

1. MNO - October 10, 2012

I’ve always been amazed at how bright, cold, and well-populated operating rooms are. That, and the very small/narrow beds they use. And for my older daughter’s C-section, I was doubly amazed at the piped-in Lionel Richie music. But it *was* 1985.

therealtinlizzy - October 10, 2012

Eep – I think Lionel Ritchie would pretty much wreck all sterility – or wait, perhaps it actually makes things MORE sterile!

But yes – bright, cold, well-populated, with very narrow beds – sums it up quite nicely!

2. Stefanie - October 11, 2012

Wow, I had no idea there were so many people involved in surgery. I’ve never had surgery, well except for when I was 2 and had my tonsils out, and of course when James had surgery on his broken hip I wasn’t allowed anywhere near. I very much enjoyed reading about the cast and your drawings were immensely entertaining 🙂


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