PJ's brain unfiltered. Now with more pulp!

Posts tagged “OR

Oldie but a Goodie

[04:40:35] <@kate> In the OR, they refer to “Perfusioners” as “Slushers”
[04:41:49] <~relope> “Perfusioner”?
[04:45:05] <@kate> The person responsible for chilling/perfusing the blood during surgery
[04:45:35] <~relope> They run the Slurpee machine.
[04:45:41] <~vai> Does the blood come with crushed ice?
[04:45:59] <~relope> Wikipedia says “perfusionist”.
[04:46:22] <~relope> And people who are unreasonably uptight about it are “perfusionistas”.
[04:46:54] <~vai> your coffee culture amazes me.

Surgical Sociopaths

Paramedic school requires clinical hours at the ER and OR, the latter specifically for ventilation and intubation experience. Thursday, May 17th was my scheduled run in the OR, and I’m up at 0500 reviewing my textbooks in small degree of terror.

I want to make a good impression, so I stop at Dunkin’ Donuts beforehand and pick up two dozen donuts — one for the ER department and one for the OR. I stop by the front desk in the ER to drop off the donuts and to get a pep talk from some of the nurses and receptionists. It helps, but only a little.

My instructor’s directions only get me to the third floor of the hospital, which is apparently a giant maze devoted to surgery. I step off the elevator and have no freaking idea where to go. My cell doesn’t get signal inside the hospital (what the crap?), so I can’t call anyone for directions. Instead, I take to stopping anyone who makes the mistake of walking within five feet of me. The sixth person I stop turns out to be the right woman; she kindly leads me right into the OR lounge, shows me where to get scrubs, gives me her personal locker combination so I can store my uniform, and tells me where to go to find my preceptor. And then I never see her again. I change and store my uniform. I get accosted by a surgeon in the locker room for using someone else’s locker. I offer her donuts.

It takes me five minutes just to put shoe-covers over my stupid combat boots, and then I discover that I look like a huge dork in the long-hair surgery caps. Everyone keeps asking me if I’m a freshmen from medical school and they seem to deflate when I say I’m a paramedic student. I seem to blend in alright: I’m familiar with most of the drugs they administer, with their charting and computer systems, with the anatomy and general procedures I get to view. I hear more than a few times that usually the paramedic students are pretty dumb and that I should go into nursing; I’m a bit insulted but refrain from responding.

Surgery’s Apparent Conception of EMS:

  • No patient interviews whatsoever.
  • We don’t know what an airway is.
  • Bagging a patient? Isn’t that what the coroner does?
  • Blood pressure: two numbers that mean nothing unless they’re really high or really low.
  • Shut the hell up and drive, EMT.
  • Albuterol: the only drug EMS uses on live patients.
  • Epinephrine & Atropine: drugs given only to dead patients.
  • People go into EMS because they couldn’t make it in nursing/med school.
  • Paramedic school is a two year course that uses coloring books instead of textbooks. It’s true; I’m constantly running out of red and blue crayons.

At 0700, 100 people materialize out of thin air and converge on the narrow hallways outside of the lounge. Somewhere in the chaos is my preceptor, and I find him, but I don’t realize who he is until much later when I see him sign some paperwork. No one introduces themselves. No one addresses you before speaking to you. People will just spontaneously walk away and you stand there wondering if you’re supposed to follow; sometimes you are, sometimes you’re not.

I never see any of the anesthesiologists do much; their CRNAs seem to do it all for them: patient interview, chart research & review, intubation, IV, ventilation, medication prep. The CRNA attaches the four assorted syringes required for general anesthesia to the IV line, the anesthesiologist pops in for 45 seconds to push the plungers in and to watch the intubation. Then, like a ninja, they disappear.

Two of the CRNAs kindly take me under their wings and let me follow them around as I’ve long lost contact with my preceptor. They hunt down a few patients for me to intubate, which is an unfortunate few simply due to that day’s scheduling. I wait for the next series of surgeries by watching a spinal fusion. A surgeon with a fiberoptic tail screws metal into an old woman’s spine, using 2-D x-rays to develop a 3-D map in his head. One of the CRNAs explains to me that the patient still experiences pain, they just don’t realize it. However, their body reacts to it — every time the surgeon does something that makes me cringe inside, the patient’s heart rate and blood pressure increases. I’ve known this fact for years, but there’s something to be said about witnessing it.

There are 26 ORs on this floor. Surgeries are scheduled within tens of minutes of each other. As soon as one finishes, the patient is quickly wheeled out, the cleaning staff swoops in and sanitizes the room, and the next patient is soon wheeled in. The staff appears to be mixed and matched randomly for each surgery; I don’t see the two of the same nurses in the same OR more than once. Only three hours pass and it feels like seven. I have no idea how these people can maintain this seemingly frantic assembly line for 12 hours straight.

At 0900, I declare that I need a calorie recharge and slip downstairs to the cafeteria. I have some sort of magical timing because I just happen to come across one of my fellow paramedic classmates doing clinical time in the ER. I’m so overwhelmed that I run up and hug her; I don’t even know her name, but I’m so happy to finally see a face I recognize. She gets a free favor in the future for letting me unload on her.

I stick around after my last intubation to watch the full surgery from start to finish. I help move the patient a bit and assist with basic surgical necessities. It feels nice to help instead of just stand there watching. By noon I’m completely exhausted and resigned to the obvious fact that I’m going to have to come back another day. I get two endotracheal intubations and one LMA out of the experience. At least I finally realize what I’m doing.