Friday, February 20, 2015

Tools of the Trade - A Retrospective

This view of a modern operating room is totally unfamiliar to someone of my  generation. It looks like one of those movie scenes where aliens are deconstructing a humanoid.  There are no familiar landmarks here. Where is the Mayo stand?  Why do they have their backs to the field? None of this makes any sense to me. There should be 2 discrete work areas,  a mayo stand with just the instruments in use and a back table for all the rest of the junk larger and surplus instruments.

Having all these instruments piled willy-nilly on one table is asking for trouble. It's no wonder radio frequency tags are now needed on sponges to prevent foreign body mishaps. There is so much clutter and paraphernalia on that table that it's impossible to keep track of everything This just  makes my head spin. I don't know how you young whippersnapperRNs do it. My hat is off to you.

And speaking of hats, what about that fancy head gear on the nurse and surgeon? This is
definitely non- regulation. The O.R. is not supposed to be a place for self- expression. I bet they don't have their grounded foot gear on and are about ready to ignite the anesthetist's tank of cyclopropane with a jolt of static electricity.  Did anyone measure their fingernails to make sure they did not exceed 1mm. We had strict rules that were aggressively enforced by ill tempered supervisors that were drunk with authority from years of inhaling anesthesia fumes.

You need a two work area mandate here. A mayo stand that the scrub nurse knows the position of every instrument without looking and  brings instruments like clamps and needle holders up from the back table in pairs. That way if their is an odd number of things, you know the surgeon better look behind that liver for your clamp.

I also cannot believe the number of instrument trays in play here. They are stacked up on right side of the table like some sort of high rise apartment building. I never handled more than two   trays  at a time. Even for big cases like an AP resection, two trays were plenty. Internists  have an old saying that "When there are multiple treatments for a problem, none of them are effective."  Is this the surgical corollary?  When you have several instruments for the same purpose, are none of them effective?
Back in the day our instruments were bright chrome just like the bumpers on our oversized cars.  I know those nice foreign made grey matte instruments don't reflect the light, but somehow, they just don't look right.

Finally, who gets to clean this mess up at the end of the case. From all the disposables here, there must be a dumpster outside in the hall for all those paper gowns and drapes. How can you restore order to an instrument table like this. We would have never let an instrument table get so cluttered. When you're done with something, move it to the back table.  Oops, I mean what back table.

Congratulations to the youngsters that can manage an instrument set up like this!

No comments:

Post a Comment