Posts Tagged ‘Operating Room’

The other side of the OR door

May 31, 2010

I’ve often written of how surgery day is excruciatingly long. They may tell you that it will take four hours, but that is rarely true. And every minute seems to drag as you wait for news of your loved one. You just want this to be over – but nothing good comes of a short operation. The longer, the better – the doctors are still working, still fighting for you. A short operation could mean that the fight is over and the good guys lost.

It’s the same on the other side of the Operating Room door. When you are waiting, just standing there twiddling your thumbs, time drags. When surgery begins and everyone has a job to do, time flies. “Five people working as one unit,” Gene Hackman said in the movie Hoosiers, and a Surgical Unit is a team in every sense of the word. Everyone has a job to do, and when you work together long enough, you even begin to think together. In this article appearing on KevinMD.com, Dr. Bruce Campbell explains that time distorts in operating rooms, too. But it seems to act in reverse:

I look up at the clock. It seems like only a few minutes have passed since I had anxiously waited to begin the case. Five hours have disappeared like an instant.

Go and read Dr. Campbell’s work.

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A Beautiful Heart

October 23, 2009

Funky Heart has a new friend – meet Chloe, a 9 year old Cardiac Kid! Chloe has Partial Atrioventricular Canal and already fought the Battle of the Operating Room once.

But she’s going back – Chloe is scheduled for surgery next Tuesday, October 27, 2009. Her blog is BRAND NEW and Chloe would love for you to drop by and say hi! Don’t forget to wish her luck next Tuesday!

Her blog is named A Beautiful Heart – if you think you’ve heard that phrase before, you very well may have. Chloe’s parents tell us why:

Our daughter is beautiful, yes – big brown eyes and an enchanting grin. But is her heart? The name of this blog comes from chapter 5 of the book Walk on Water by Michael Ruhlman. It is a must-read for those touched by CHD, and an excellent book in general. This chapter ends with a mother standing in a hospital corridor, having just handed her baby over for open heart surgery. She is sobbing into her hands. Those of you who have been in that corridor – you know.

That walk down to the OR by your child’s gurney is the longest walk you will ever take. And once you’ve said all there is to say and the gurney rolls past the door with the NO ADMITTANCE sign, it marks the beginning of the longest day you will ever live.

And it will be much longer than you think.

When the door closes and you’re left alone as the nurse points out the Surgical Waiting Room, a clock starts in your head. The doctor said four hours, you think.  Four hours from now will be…

But things aren’t happening yet. If you could go through that door, all you would do would be to wait. The surgical suites are usually occupied; and nobody is going to tell a surgeon to hurry up, his next patient just rolled in.  The staff is still taking care of pre-op details and doing their safety checks: Correct patient? Correct diagnosis? Correct procedure planned? Correct surgeon? All these questions have to be answered before the patient even enters the OR. When I was being prepped for my second operation in 1977, one of the nurses leaned down and asked my my name and my birthday. Then she asked “Do you know what they are planning to do today?”

You mean you don’t know? I thought. It must have been obvious on my face, because she smiled and patted my shoulder. “I have to ask, it’s the rules.”

And we aren’t even in the Operating Room yet. Meanwhile, over in Surgical Waiting, a lot of people are watching the clock.

Perversely, you want the operation to take longer than you expected. The battle has been joined. Our side  may not be winning yet, but we’re still in there fighting and by God, we aren’t losing.

The predicted time comes and goes with no news. Finally, hours later, almost at the point when you are about to panic, the phone rings and it is the OR. Surgery’s over; they’re closing. In about half an hour we’ll bring them down to Recovery and you can see your child.

As you leave Surgical Waiting you see another couple enter and glance quickly at the clock. And you know exactly what that glance means:

Four hours from now will be…

TMI!

July 18, 2009

You’ve always wondered, and now Dr. Sid Schwab answers THAT question: Does my surgeon ever have to go during surgery?

These people are gonna kill me!

November 21, 2008

I don’t think I’ve written much about my second operation. It went so well, I really just hadn’t thought about it. “It went well” is relative, of course… at the time, I thought that I had been hit by a large truck! And that I was going to to be beaten to death.

After being informed that Elevator Sprints was a game that I didn’t need to be playing – even if I was one of the Co-creators – I didn’t cause any more trouble for the hospital staff. But trust me, they got me back, in spades!

I left my room one day to walk up and down the halls (one of the few things you can do when stuck in a hospital) and next to the door was a gurney. Someone had written on the plastic cover

Steve C****

Bed 3, Rm 406

Surgery 3/17/77 0800

Oh, boy. I don’t think that it had “clicked” in my head before that that these people meant to cut my chest open! I ran back into my room, jumped into my bed like Pete Rose sliding into second base, and cried my eyes out. Not a manly thing to do, but I was eleven years old, so I’m pretty sure that it was OK.

The day of surgery was kind of strange, too. The operation was scheduled for 8:00 AM, but when I woke up in recovery, I was in for quite a surprise. I was facing a large plate glass window that overlooked the city, and it was night! Exactly how long did that surgery take?

It turns out that it lasted about as long as they expected it to last – but there had been a serious accident on the interstate. I never heard exactly what happened, but a lot of people came into the ER at about the same time, and a good number of them needed surgery. All the “routine” surgical patients got rescheduled while the critical patients went first.  Since I had already been sedated, they just kept me under a very light sedation until my turn came. Thankfully my parents had heard about the delay so they weren’t climbing the walls.

When my turn finally did come, the operation went smoothly. I was supposed to have a Blalock-Taussig Shunt, but they were worried about finding a vein that was large enough to act as the conduit. (No MRI scans in 1977!) Thankfully, it was big enough to do the job!

I didn’t get a Cough Bear after my surgery. I didn’t even get a pillow – remember this occured in 1977, and no one had thought about using a soft object to brace against when you cleared your lungs yet. In fact, the accepted practice for cleaning your lungs out will make most modern cardiac patients cringe.

Two nurses would come into your room and help you sit up. Then they would get you to lean forward as much as you could, and when you couldn’t go any further, one of the nurses would take you by the shoulders and lean you over another few inches. Then the other nurse would cup her hands and pound on your back – HARD!

After you were beaten like a tough steak you were told to cough into a cup. The purpose of this form of torture was to prevent mucus from building up in your lungs and causing pneumonia. I was hoping that there would be a river of mucus – enough to get these nurses (literally) off my back!

You could always hear echos of their slaps as they worked their way down the hall. To hear them getting closer and closer caused more fear than any movie Wes Craven ever made. But once, they reversed their usual pattern and started at my end of the hall. I was number one on the list. These ladies were warmed up and ra’ring to go when they hit my door.

After a particularly ferocious lung clearing series of smacks, I coughed up my liver and gasped, “I don’t know what I did to make you ladies angry, but I sincerely apologize!”

Two Clocks

November 12, 2008

“How long has he been gone?”

“Five and a half hours… maybe a little longer.”

“I’m getting worried, they said it would take about four hours.”

“I was just thinking the same thing.”

Heart Moms and Heart Dads, have you ever had that conversation? Who hasn’t? Whenever your child is taken from you for surgery, time seems to slow down. The first hour may actually be the hardest: the more time that passes, the more sure you can be that something didn’t go wrong at the outset. To quote Tom Petty, “The waiting is the hardest part.” Then as the operation goes on longer than we expect, the tension level moves to an incredible high. It’s taking too long. There’s a problem. We would have heard something by now.

For our loved ones, the goodbyes come to a climax when we reach the door with the large WARNING! sign. Where they can go no further with us, because beyond is a sterile area that only hospital staff and patients can enter. Where they turn us over to the surgeon and his team with no guarantee of what may happen next. They tell us that they love us, and everything will be OK, and they’ll see us later, and hope all they’ve said will be true. And then it’s really time, and I’m sorry but we have to go now. And when that door closes behind us with a loud click, real time stops and waiting time begins.

Start the Clock.

But while Mom and Dad are being shown to the Surgical Waiting Room and being told that someone in the OR will call with updates, there’s a whole lot of…. nothing going on. More than likely we’re just on the other side of the WARNING! door, waiting. A surgeon who is worth his salt – and he wouldn’t even be here if he were a slacker – is not going to be rushed; he’ll take just as much time as he needs, thank you. And besides, “the operation” is the entire process, not just the act of cutting and stitching. Records are being checked, double checked, and even triple checked to make sure that the patient and the scheduled procedure match. We’ve probably been lightly sedated (no one wants to chase you down the hall if you change your mind at the last minute) but we are still awake. The Anesthesiologist may stop by for a few words and to reassure us, one of the surgical assistants may lean over our gurney to say hi, and he may even ask us who is our surgeon and what are they going to do to you today? You mean you don’t know? you think, suddenly worried, but don’t fret. It’s just another safety check.

We’re still conscious when we are wheeled into the operating room. First they aren’t sure what they have planned and now we’re going into the OR awake? That’s normal. The Anesthesiologist can put you under at any time, and they would rather wait as long as possible. The less time you’re knocked out, the better.

Finally you are unconscious, the surgical team is ready, we’re certain that this is the right patient, all the equipment is functioning, and we have a backup available in case anything malfunctions. Scalpel, please.

Start the (real) Clock.

You don’t rush a surgical procedure, especially heart surgery. Surgeon Sid Schwab has written of how at a critical moment, he stops and double checks everything. Extra blood, more clamps, IV fluids ready. Music off, and everybody make sure your brain is online and functioning. There are also various safety rules that are followed, such as the “two sponge” rule. You count your sponges before you start and you always place two sponges in the body – even when you only need one. By using two, anytime you count sponges and get an odd number, STOP! One’s missing, and it could still be in the patient’s body.

Operation finished, you’re stitched up. Someone is on the phone to Recovery, making sure there is a bed open and alerting the people there another surgical patient is coming down. Another call goes to Surgical Waiting, where they tell your family that everything went well and the surgeon will speak with you soon.

“Good to see you,” your family says, leaning over your bed. You can’t speak because of the breathing tube pushed down your throat. “You had us a bit worried, it took longer than we thought it would. But everything went great.”

(Don’t) Follow the Plan

October 28, 2008

First, a quick update on two of our friends: Colby is home! As it says on his blog, he went before the Doctor’s Parole Board and they released him on good behavior. As of this writing Katie is still scheduled for a Glenn Shunt tomorrow. Keep this young lady in your thoughts.

If you are putting together a heart book, a good starting point is a copy of the surgical notes. The surgical notes are written by the surgeon (or one of his assistants) after an operation; basically they are a “play by play” description of the operation. Modern operating rooms can be outfitted with recording equipment; the surgeon describes the operation as he works. A boom microphone above his head picks up his words and the tape is transcribed later. (Modern operating rooms are amazing, a surgeon can pause long enough to say “Please replay the MRI from last Monday” and it will appear on a video screen. Usually there is a computer tech controlling the system, but more and more often the computer can do it automatically!)

Surgical notes are very detailed, as operations have become more and more complex the level of detail in the notes has increased. Alfred Blalock’s notes on the first Blalock-Taussig Shunt are an incredibly short two pages. (Page One, Page Two) In surgical notes being written today, you may read a page and a half before the first incision is made.

Reading the notes are very difficult: they are meant for the official medical records. Normally you won’t receive a copy of them, you will have to ask. If you or your child are still in the hospital, getting them could be as simple as asking “Say doc, can I have a copy of this for my personal health records?” If you’ve recently been released, make an appointment with the surgeon. You’ll probably have a follow up appointment anyway, let him know beforehand that you’d like a copy of the surgical notes… and for him to go over them with you. Surgical notes are written in “Medical Talk”. If you don’t speak Doctor and have a good working knowledge of Anatomy, you’re going to be lost. That’s why you want an expert to review them with you – and who better than the person who performed the procedure? (It would help to give the doctor ample warning and to discuss the notes during a regularly scheduled appointment, even if you have to make an appointment just for the discussion. Extending your “usual” appointment really isn’t fair to his other patients.)

If you had your surgery a long time ago, you will have to contact the hospital where the surgery occurred and request the notes. Be prepared for a wait. You will have to fill out a form to release the records (even though they are your records)… the HIPAA laws require it. And then… be patient. Your records may be stored somewhere away from the hospital, and someone’s got to dig them out. That might take a while.

You really need a copy of all your surgical notes, if you can get them. Surgery is like Chess – everything starts from the same point, and there are a limited number of opening moves. All Bi-directional Glenn Shunts, for example, start the same way. Surgeons are the Grandmasters; they have the ability to think three steps (or more) ahead and they know when it’s time to deviate from the accepted course. You can’t learn this skill by reading a book, it only comes with training, repetition, and an inborn skill. They just know what they need to do next, how it is going to affect the body, and how to react if a crisis develops.

Every surgery is different, because your surgeon is reacting to what he finds inside of you. So even though we may share the same defect and the same surgical procedures, our insides may be totally different. So get those surgical records, having them could save your life!