Bleed

There are impressions, not entirely wrong, that the operating room is a hostile place, or that surgeons are mean and play practical jokes (a la M*A*S*H), that they are silent and serious, or that there is blood spattering everywhere. There is some truth in each. Each expresses personal anxiety more than experience.

Surgeons, especially those who have gone deeply into the realms of subspecialties, say hand surgery, have spent their entire adult lives, two to three times the number of hours most of us spend at work, in class or hospitals. That is their reality, their totality. They often were shuttled into pre med early in their lives, went through college with others like themselves, med school, internship, research, residency, fellowship(s) and further training the rest of their careers. Not always, of course, but enough. That is their peer group, the ones who socialize them, the ones they compare themselves to, the ones who define normal for them. Amazes me that any of them have any bedside manner at all. This is not all, not even most, but the tendency is prevalent. The ones with intact marriages and children they make time for, are more balanced, treat staff more as teammates.

Nurses, techs, for many of them, are at least partially invisible, unless we are sick or injured. The change then is electric. Suddenly, we become 'patient', and they know how to do that, too. I asked a general oncology surgeon to explain mangled, family-relayed information about my sick aunt. He pulled it apart for me, gave me process and prognosis, and hugged me, because she was certainly dying, and fast.

I was getting a migraine, will a rare but blinding aura. I informed the anesthesiologist, so if I dropped or something... he offered IV toredol, which I rolled up my sleeve for, and was able to finish my shift.

A new nurse passed out, knocked her head on the floor, the surgeon broke scrub to check on her, while the experienced resident stayed operating. I bashed my head on a metal shelf, cut my eyebrow, and got more advice and attention from the surgical staff than I ever wanted. The compassion is there, just a matter of knowing the way in.

The sense of humor is rough, no question. And they egg each other on. I still can hear Dr. Townsend, referring to me, "She's slow, but she does poor work." By the time he retired, I knew he was mostly joking.

I have seen the sudden jerk and pull back of pain from being punctured by a sharp trocar, scalpel or needle, while the wielder of the sharp gasps in horror. Only to be laughed at for falling for that old trick. No harm done, but the lesson, intended as a joke, is that it can happen. It happens often enough for real.

During a Laparoscopic Nissen fundoplication, where the stomach is wrapped around the esophagus to act as a functional sphincter for herniation or laxity, the surgeons I worked with had the anesthesiologist slide in a flexible dilator - a Bougee, down, to work as a template, to keep the wrap from being too tight. The repair is sutured down. The bougee is slid out by the anesthesiologist, who this time looked at it, and asked "Is there supposed to be suture in this?" A beat, held breath, then laughter. Not really possible, but for a moment we all had to consider, how the... ?

Few surgeons prefer not to have music, and the techs hate having to work in a quiet room. I've come to appreciate not having to deal with other's tastes in music. Some will not start until the music starts. Shouting is rare, and disruptive, and no one shouts "Stat!" Ok, unless they are joking. "Nurse! Music, stat!" When there is unexpected bleeding, or a resident error, all get very quiet, the anger is tight and focused, insistently calm. No jokes, all attention on the problem to be corrected. Extreme impatience with any distraction, if noticed at all. When the crisis is past, the mood lightens as though nothing had gone wrong.

Yes, they are control freaks. So are OR nurses, and scrub techs. We rely on our habits, and protocols to keep us from the inevitable human laziness. The surgeons do much the same. They are all kinds of personalities, jerks and nasty bastards - annoying when they are also skilled. The kind, sweet ones, more infuriating when they are inattentive or incompetent. The geeks and the jocks, eccentrics and dullards, comedians and frustrated artists, all work long hard hours, and finish each surgery until all is as well as they can make it, before going on to the next. The best ones love what they do, and care about their patients. Not an angel or a demon among them. Always the elephant in the room, though.

Oh, the blood. It was the most surprizing part. Vast majority of surgeries have only small amounts of blood loss. Enough to be cleaned up in a small towel. This is the point of modern surgery, to tightly control the bleeding, and with great success. With a few notable exceptions, C-sections - visually worse because of all the other fluid that is stained and appears to be just blood. And amputations, usually due to cancer or trauma, large wounds that take a while to get mopped up. Even so, not as much as I imagined when I began this work.


And hostile? Not most of the time. It's a strange place, with different rules, not easily penetrated. Those hours of silent intent and fast responses bleed off a part of me that would otherwise turn toxic. Putting my anxieties to work for the good of others.