I've been to Paris. I've experienced the deepest, truest kind of love with my fiance. I've held a new life in my arms. I've lived, and I've learned. I've done quite a lot of really, really amazing things and had a few truly life-changing experiences. Last Wednesday, I had to add a new experience to that list when I had an opportunity to do what I've really been wanting to do... be a nurse in the operating room (yes, a real OR!!!) for the very first time.
First, to dispel all falsehoods that may be lurking in your mind, no, it's not like it is on Grey's Anatomy, folks. While I guess there are hot surgeons, I sure didn't see any. (But there was a hot nurse.... I think she was a student... wink wink) Instead of a massive group of doctors fist-deep in someone's abdominal cavity, try a doctor or two working on the patient surrounded by a few highly-skilled, highly-specialized, highly-experienced nurses. The atmosphere is a little more informal and the dramatic banter and solemn-music would be considered lacking. I did learn, however, that things really depend on the surgeon and what type of surgery is going on. It seems as though younger surgeons prefer an iPod or CD playing, while older surgeons prefer silence. During most surgeries, the lights are not dimmed and dramatic as you will see in Seattle Grace's OR. Think about it - would you rather operate on a human heart in the dark or under high-quality, beautifully illuminating bright lamps? That's what I thought. And in Grey's, you'll notice there's never an anesthesiologist diligently working on machines and monitors, continually infusing high-potency drugs to keeping the patient safe, comfortable, breathing, and ultimately, alive. Notice how the patient is always flat on his or her back, arms to their side? Never in a real OR. So just know not everything you see on Grey's is real. Ask me about my opinion on how they portray nurses when you have a few hours to spare...
So OR day began by my instructor taking me down to the inpatient OR, from where a nurse at the control desk took me to the locker room and showed me how to get surgical scrubs out of a vending-machine-like contraption. I changed out of my white nursing scrubs (hooray!!) into stereotypical-surgery's ceil blue scrubs (which, by the way, are comfier than you would ever believe). Since my shoes don't stay in the unit, I had to cover them in blue booties, and since I didn't have a super-cute scrub cap just hanging around, I had to wear the regular blue surgery hat. I topped it all off with a protective sterile mask, and then I was good to go! Parrrr-tay in the OR! The scrub nurse showed me the board and asked me to choose an OR. There were two available ORs that had surgeries going on at that time, and neither had anything too exciting going on, so I just said the hernia repair was fine. The nurse took me there, opened the door, introduced me to the OR nurse, "This is Amanda, she's going to be the student in OR 6 today," and that was it.
Inside the OR was the patient, the surgeon and his resident, the nurse anesthetist (CRNA), the scrub nurse, and the OR/circulating nurse.
The doctor and his resident were about halfway through a laparoscopic femoral hernia repair. It was pretty neat how the surgeon repaired the hernia and stapled mesh to the roof of the cavity to prevent it from coming back down. All of this was done through just a few little holes in the patient's umbilicus and abdomen. The end. It was a little boring for me because I hadn't met everyone yet and was still observing everything that was going on. After the patient was taken out and we were preparing the room for the second patient, I asked the anesthesiologist if she was a CRNA. I was so happy to find out she was, and I told her that I was considering a career in nurse anesthesia. She told me she had been a RN for a long time and just recently graduated from Case with her MSN-CRNA. She knew firsthand what being a student was like, and she took me under her wing and let me shadow her for the remainder of the day as she taught me all about her duties and even the nursing rationales behind a lot of the interventions and meds we had to deal with over the course of the day.
The second patient was a man who needed a cholecystectomy, or gallbladder removal. The surgery was very cool - the surgeon removed the gallbladder from the liver, being careful not to puncture the extremely venous organ, and then she extracted it through his umbilicus in a tiny basket that almost resembled a teeny-tiny fishing net! She stitched him up, applied steristrips, and that was that...
...but the best part was what *I* got to do!
CRNA and I had gotten to know each other pretty well in between patients as we took the first patient to the PACU (post-anesthesia care unit), waited on the second patient to be brought down from the floor, etc. We did the pre-op assessment on Patient 2 and were concerned with his tracheotomy. We had to consult the anesthesiologist (MD) on call who said we should first try to maintain patency of an airway through the trach, and thankfully, that worked. Often in anesthesia, muscles must be paralyzed, and a machine must breathe for the patient. A trach, however, is essentially a tube into a patient's airways, so while most people would just be intubated through their mouth, a trach patient possesses different concerns. Patient was very nervous about all of the rushing going on around him, so I told CRNA and we were able to give him some antianxiety agents. With no problems at all, we were able to hook Patient up to our air machine through his trach, so we didn't have any complications. I held his hand as CRNA gave him gas and O2 through his trach and meds IVP, and he went under just fine... safely and as comfortably as possible. CRNA let me work closely with her during the surgery. I was able to change IV fluids and help monitor vitals, and she taught me how to feel for twitches to ensure Patient's muscles remained paralyzed throughout the surgery. I can honestly say I was really surprised how fast, busy, and intense a simple surgery is for a CRNA. Not only are the good ones emotionally compelled to allay the fear of the patient pre- and post-op, but for every second of the surgery, it is the responsibility of the CRNA to keep the patient safe and "asleep." One wrong move and the patient can code, develop a serious overdose or reaction, or die. One forgotten question pre-op, and you could easily kill the patient by administering a drug he cannot tolerate. During the course of the surgery, charting, monitoring, and vital regulation is constant. While acting on what the machines say the pulse, BP, respirations, or heart patterns are, you must plan for optimum recovery post-op, as well. You must be quick to sort an influx of information - keep it, or toss it. Predict. Also, it's really a creative art, with powerful drugs as the medium. It's a science full of skill and experience. It's a crucial, dangerous, careful role, yet the more I learn about it, the more I think it's the perfect fit.
During the surgery, our patient's systolic BP rose past 200, so while we closely watched and treated it, CRNA taught me all about the meds we used, their expected effects, correct dosings, timings, etc. She was a great teacher... she even repeatedly covered neurotransmitter acetylcholine in her little "lessons."
Over the course of my super-wonderful way-great never-ever-gonna-forget day, I learned so much. I love learning so much, and I dreaded having to go back to post-conference when I knew more good surgeries with an awesome CRNA were going on a few floors below me. Ultimately though, I learned that being a nurse in the OR, whether the scrub nurse, the circulating nurse, or even the CRNA, is not only about doing your assigned duties, but it's about ensuring safety, intervening for optimum healing, and even maintaining patient dignity. It's about coordination, patience, understanding, safety, acute observation, and an extreme amount of critical thinking. I learned how beautifully intense life as a CRNA is, and it renewed my dream of achieving such a high position.
It was the best experience it could ever be, and I'm glad I had such an opportunity. Without things like that, it's hard to stay grounded amidst impossible exams, never-ending classes, huge projects, long clinicals on a geriatric floor when I never in a million years want to work in geriatrics, etc... It's nice to go back to areas I know I enjoy and also to experience new areas that I discover I love... Experiences like this help keep a nursing student from getting too jaded.
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