Saturday, April 15, 2017

Specialty Operating Rooms

No... this is not going to be one of those boring, braggadocio posts about our fancy sub- specialty  neuro room complete with  nonferrous ceramic surgical instruments to accommodate intraoperative MRI. This is about unique personality types that somehow managed to coalesce into a surgical team that functioned well despite individual quirks or personality disorders. These specialty  OR teams share a unique, unusual, and sometimes, unhealthy  bond. It's a well known homo sapiens trait to seek out others that are similar to ourselves and the OR was no exception.

Room "D," a combination general surgery and ENT suite  was well known for being home to providers (I hate that dumb term) healers, sounds so much better, that had problems with alcohol consumption. From the anesthetist to the circulator, they all enjoyed imbibing on a regular basis. Being trained professionals, they were very careful at monitoring their drink to sink time interval. According to this rubric, a  span of 12 hours must elapse between drinking  and standing at the scrub sink. After their case load was completed, they usually high-tailed it straight to the Recovery Room and I'm not talking about the post-anesthesia ward. There was actually a local watering hole about 1 block East on Halsted Street that used that clever moniker as a marketing ploy to lure hospital workers. As a group, they could carefully monitor that critical drink to sink time interval as well as get their blood alcohol level back to a comfortable range.

Although surgical masks could hide their large, bulbous, ruddy nose, they were still plagued with problems like fine motor tremors which led to the development of  many  clever and unique shake minimization  strategies. Most of what I learned about dealing with hand tremors came straight from the nice folks working in Room "D." Here is a link to some of the very best tips to quell hand tremors from the experienced experts. These tricks are OR tested and really do wonders for the shakes regardless of etiology. I am having trouble with the link, but the post was from March  2, 2015 and titled "Fools Foils for Fasciulating Fingers." Sorry about the lame alliteration, it seemed like a good idea at the time.

Although not a big fan of distilled spirits, my hands would sometimes develop fine motor tremors when called in for late night cases. Practiced counter bracing just like the folks in Room "D" were so adept at worked like a charm. You really can learn something from just about everyone.

Room "K" was famous for attracting over-thinkers and folks with profound OCD tendencies. The magnet for these folks was a highly unique and exotic OR table that had been imported from Germany. Unlike a traditional American OR table with limited mechanical controls operated by the anesthetist, this European marvel of mechanical engineering was electrically operated by the surgeon.

American OR tables have very  limited movements. This German surgical platform could execute very fine shifts and tilts in virtually any direction. German surgeons love to be in control of everything including the OR table. Why trust a lowly anesthetist for correct positioning when he did not even have a direct view of the field?  Practitioners (healers?) working in this room loved being in control of just about everything and were OCD at it's best or worse depending on your perspective.

The OR has ample fodder for those with a penchant for obsessional activities. It all starts with that 10 minute surgical scrub. If anyone dares challenge this hand washing activity the obsessive practitioner can invoke the asepsis Gods. "How dare you question my lengthy hand washing. do you want me  to infect the patient?"

Another obsessive desire is satisfied with the repetitive counting of sponges and instruments and somehow the number "10" always seems to come up. This starts to assume special significance and soon it just has to be 10 of this and 10 of that . This  repetitive practice really does double duty in that it satisfies the obsessional drive and is of vital importance in the OR. Every good scrub nurse is OCD to a certain extent.

Having that fancy over engineered table was like the  icing on the cake to an OCD surgeon. He could tweak table movements 1mm this way and 3mm that way. Somehow another tilt or yaw of the table was always necessary. A days obsessions are never done The surgeon tries to turn his attention elsewhere, but cannot. The harder he tries the more intense the table fiddling urge occurs.

The obsessive nit-pickers in this room were probably ahead of their time. The very fine OR table  positioning enabled smaller incisions with much less trauma inducing retraction. This was a time when big open surgeries were in their glory days minimally invasive was unheard of. The trouble really started brewing if a German table afficiando was stuck with a crude traditional OR table. The sweating and swearing were about to begin. I don't know who was in worse shape the drinkers sans alcohol or the surgeon without his fancy table.

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