Nowhere Warm

Not so many few years ago, back when I was still a practitioner in the Operating Room, I’ve gotten the precious opportunity to assist in my first major OR case. Prior to any surgical case, the scrub nurse should:

(1) Eat inasmuch as many foods as you can, as very simple procedures could last a lifetime;

(2) Be prepared for catapulting instruments and projectile objects either from infuriated, impatient surgeons, or from the patients themselves (blood, pus, skin staples, ligatures);

[There was one time when an intolerant surgeon mishandled a scalpel and pierced my gloved hand (and my hand as well). Though she profusely apologized, I was infuriated by her behaviour that I almost send an Incident Report and a Letter of Complaint to the Medical Director. It didn’t happen though as her pleading touch the good-natured-ness in me.]


Source: http://www.biojewellery.com/images/oral-surgery/dscn1852-s.jpg

(3) Be familiar with, and prepare the OR suite, including the OR table, the instruments, glove sizes of surgeons, their preferred kinds of sutures, etc. etc. and;

(4) Be intellectually prepared (as congruent as possible to the surgeon’s line of thinking) as some first-time surgical interns or medical clerks have the (alarmingly frequent) propensity to mental block during surgeries and one thing a surgeon loathe in an OR suite is an unreciprocated question, or a dumb question to an easy query.


Source: http://cache.eb.com/eb/image?id=82676&rendTypeId=4

Usual co-nurses of mine would be very proud and pompous in bragging about their first cases—some of them have assisted in craniotomies, thoraco-cardiovascular surgeries, abdominal surgeries and the likes, while, I, myself, am mourning that on my first OR suite, the first case of the day, I got to assist in an AKA, not “also known as,” but an above the knee amputation.

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Most scrub nurses do not personally know the patient when they are wheeled and transferred to the OR table. That was one thing that delineates the practice of Medicine and Surgery. In Surgery, one is not required to personally know the patient. All that matters are the patient profile, the knowledge of his diagnosis, the plan of management, and the operative details. It is not unusual for surgeon to feel detached from their patients. The less their emotional involvement over a particular patient, the more objective their practice becomes. While in Medicine, a strong sense of interpersonal relations is always imperative.

When this particular patient was wheeled to the suite, I browsed over his records and found the following pertinent history:

The following may be too graphic for certain readers. Continue if you feel completely secure of what you're about to see.
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READY?

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Source: http://whyquit.com/joel/buergers.jpg (No promotions implied).

Chief complaint: Non-healing (ulcer) wound, dorsum of left foot.

Medical History: (+) Diabetes Mellitus, 5 yrs, poorly-controlled, (+) Hypertension, app. 12 yrs, poorly controlled, mean BP=140-170/90-110

Pertinent Social History: smoker, 30-pack-years; alcoholic beverage drinker, 100-ounce-a-day.

Clinical Impression: Buerger’s Disease


Source: http://www.uhn.ca/Media/image_gallery/images/buildings/or_equipment.jpg

Buerger’s disease is an inflammatory condition of the small arteries and veins of the distal extremities with subsequent clotting and terminal occlusions. It results in ischemia (decreased blood flow) to the distal limb, progressing to gangrene (cell death), ulcerations and necrosis. The etiology of this disease is unknown but is almost always associated with constant tobacco use. There is no definitive medical treatment, and surgical amputation is almost warranted in late, intractable stages.

More information about Buerger’s disease here, (for laypersons) and here (for paramedical professionals).



Source: http://movies.yahoo.com/movie/1808412006/photo/485443

The surgery went uncomplicated. I have repressed the images of opening the skin, slicing the subcutaneous layer, cautering the muscles and fascia, and slicing the bone using the furious giggly saw back in my unconscious memory. It was like watching Texas Chainsaw Massacre only cleaner, and in this scene, the surgeon and yours truly, are the one slicing the leg off. (Though I was tempted to take the amputated leg home, I guess I’m still too sane to do that).

When the surgery was over, I visited him in the ward for the completion of some requirements. The initial meet-up was excruciating. When he asked me what job he should try now that one of his legs got amputated, I was dumbfounded. It was then that I knew that he used to be a jeepney driver.

"Surgery is the only specialty where we don't waste time getting to know the patients. They're slabs of meat, we're butchers” said a character in a surgical show. Perhaps there is truth to this saying. Separating the dictates of the heart from the expertise of the hands is probably what keeps most surgeons sane, particularly this surgeon who makes her own living cutting limbs and installing metallic rods on bones.


Source: http://www.uhn.ca/Media/image_gallery/images/buildings/or_no_person.jpg

Suchman and Wolinsky, in their Theory on Stages of Illness Behavior, believes that one of the principles involved in the aspect of sick role is that one is not responsible for his illness condition—that the person did not cause his illness.

When I first learn about this theory, I thought that people who take their health for granted had indeed found a good excuse in Suchman. Though this theory will still be subjected to endless biomedical debacle, and though I still believe that people do not really intend to get sick, the multidimensionality of health, and its personal nature dictates a personal responsibility to it. Ultimately, the course of our health is dependent not on other external factors, but on how we manage to preserve it despite insurmountable odds.

Perhaps that patient is still alive by now. Maybe he had found another way of making a living, to support his family and to provide for their needs. Perhaps he had stopped drinking and smoking… or perhaps not. God forbids that when I enter another OR suite, all I will see is a familiar face, whose other leg needs to be cut. And when that time comes, I’ll be more than willing to assist in one.


Source: http://www.movieweb.com/news/80/14880.php

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