Sunday, December 9, 2018

Is Surgery A Spectator Sport?

Observers in a sanctioned overhead viewing site 
advancing their surgical acumen. Serendipitous 
snoopers were another story.
Vintage hospitals went to great lengths to provide surgeon and/or nurse wannabes the opportunity to observe surgeries. European hospitals even referred to their operating rooms as "theaters."  I once worked with a charming British surgeon that affectionately  referred to  us "theater nurses." This soft spoken man actually  thanked  us personally after a case was finished even if our performance was not up to snuff.  A different breed of surgeon compared to his American colleagues.

Surgical spectators were all different and the most interesting  involved the serendipitous observer who happened to be in the right wrong place at the time of the surgical experience.  Don't get me started on those whippersnapperrns who freely use that confounded "experience" word to describe a planned operative  anatomical alteration, but I figure if you can't beat 'em, join 'em. Who says you can't teach an old dog new tricks?

The operating rooms where I toiled were on the very top floor of the hospital and offered a beautiful view of Lake Michigan which was 8 blocks due East. Large picture windows offered surgeons and nurses the opportunity to feast their  weary eyeballs on a  tranquil visual treat of sailboats and sparkling blue water far off in the distance. A welcome reprieve from eyeball stinging Bovie smoke and squnting to thread fine needles with 8-0 white silk while a surgeon hollered at you in the background for being too slow for his speedy needle plunges.

Everything was fine and dandy until the esteemed members of the hospital board decided to erect a high rise employee housing palace  next to the hospital. Nurses were agitated because these were luxury apartments and unaffordable for all but the most privleged office sitters. We were stuck in our 3rd floor walk ups where heat was a rarity even on the coldest winter nights.

Various members of Chicago's building trades toiled on the construction crews erecting this palace for the medical center moguls. They were a cast of colorful characters to say the least. Ironworkers in particular were a flamboyant, in your face sort of personality. I think it had something to do with their performing hazardous work at elevations where one false move meant falling many stories to a colorful  death.

As the building began to rise, we eagerly watched the progress while standing at the scrub sink which was probably less than 50 feet away from the ascending steel I-beams. You  could hear the ironworkers incessant babble before you could see them.   We joked with the surgeons that the ironworkers must be afficionados of expensive German automobiles just like them because they bantered constantly about "beamers" while guiding the gigantic steel beams into place.

The merriment came to an abrupt halt when the ironworkers ascended to the level of the operating room windows. This rag tag bunch of haggard workers acted as though they found a visual paradise. They glared and made contorted expressions as they avidly observed the goings on in the operating rooms. If they found the proceedings in one room not to their liking a short stroll along the steel beam provided a different procedure to observe. Legitimate surgical observers were limited to viewing the proceedings in just one room while the ironworkers enjoyed a virtual cafeteria of surgical sightseeing.

Their ringleader with his distinctive orange striped  hardhat led his merry men along a steel beam parallel to the OR windows until they found a procedure to their liking. The cysto room was the least popular after a worker nearly stumbled off a beam while observing a meatotomy. That procedure shivered my timbers too, so I could empathize with their revulsion.

The most popular room for these happenstance journeymen observers was the orthopedic room. A hammer is a hammer whether the one doing the hammering is a surgeon or an ironworker. The orthopedic surgeons were kept busy reducing and stabilizing bones just as the tradesmen were with steel beams. Both used lag screws and plates in their work. A brotherhood of sorts was established.

The surgeons took little notice of these nosey nitwits, but nurses thought the activities bordered on voyeurism and should be halted. Plan "A" was to scare them off. Sponge racks were crude, nasty looking devices ostensibly designed to facilitate counts, but really served to provide the surgeon of a visual reminder of blood loss. These morbid contraptions were wheeled, so positioning loaded sponge racks dripping with blood  in front of the windows worked to frighten off the men of steel. Some nurses took to displaying suction bottles full of blood on the window sills, but gradually the men of steel acclimated to our repulsive displays.

Alice, our beloved supervisor came up with the ultimate solution to the problem. Being an ultimate Killjoy, she used autoclave tape to suspend surgical drapes over the windows. some problems work themselves out with benign neglect. The observation opportunity ended with our move to the new operating rooms in the Stone Pavilion. Windowless operating rooms were very popular in the mid 1970s and put an abrupt halt to all the fun.


  1. I've never known an operating room that had a window! And yes here they are still called Operating Theatres and the term Theatre Nurse as far as I know is still in use. "Scrubs" was a term never used until recently - you wore "Theatre Blues", the dark blue coloured clothing that identified you as someone working in the Operating Theatres - and nobody, but nobody, else in the hospital wore Theatre Blues (nobody wore "scrubs" either - we all wore uniforms).

    I did have lectures in the old Operating Theatre of Sydney Hospital (the first hospital ever built in Australia) and it had a stained glass window in the ceiling and a viewing gallery for onlookers. By the 1970s when I was attending lectures there it had been converted to a lecture theatre (we use that term too).

    Interesting stuff, thanks OFRN. Sue.

  2. You just KNEW I'd look up meatotomy while eating breakfast, didn't you?!

  3. Poor Off. Cynical!!! The best part of orienting to work in a CVICU was getting to scrub up and go watch a CABG from start to finish. All our sawbones loved to teach...
    The only thing I couldn't stand was the stench of cautery! I could never have been an OR nurse!

  4. Hi Sue, almost all old school operating rooms had windows or a skylight. Surgeons believed that natural daylight was the optimum color temperature of lighting for surgery. It was also nice to be able to focus on something off in the distance after all that close up work. I never really got used to modern windowless ORs and was lucky to be able to retire soon after they became popular. "Theater" sounds so much nicer than operating room.

    Officer Cynical, this is getting to be a bad habit of mine. I think I ruined your breakfast with that "Not On MY Back Table" post with that really nasty looking teratoma illustration.

    The meatotomy procedure was small potatoes compared to what came next. Common descriptions of the procedure suggest the practice was limited to urethral strictures, but back in the good old days (if you could call them that) a cystoscope with the caliber of a cigar was ram rodded up through the sliced organ. Luckily for me the neuro room where I usually scrubbed was at the most distant location from the cysto room where the barbaric urology procedures were done. I would much rather scrub on a 6 hour crani than spend 15 minutes down at the other end of the hall. Nightmare central..indeed!

    Bobbie, President Clinton had the best suggestion on how to deal with Bovie smoke, don't inhale.

  5. One of your best OFRN!

  6. Totally off topic OFRN and I don't even know how I found this - I was trying to date it but at the end it's identified as 1952. You know I can't resist these old films and I don't often find an American one. This is called The Navy Nurse (YouTube) Cheers, Sue.

  7. Apologies OFRN but this one came up straight after - is this the same state as you are in, ie. Pennsylvania? At about 3.44 they weirdly briefly switch to British nurses (Royal Birmingam Hospital), but then go back to Latrobe USA. Just sending it out of interest in case you know of this hospital? Cheers again, Sue.

  8. Hi Sue and thanks so much for the video tips. I really enjoy watching them. Latrobe Pennsylvania is about 25 miles due east from where I live. It's a small world. Western Pennsylvania used to have lots of independent small hospitals but today they have been swallowed up and corporatized by a big business behemouth known as UPMC (University of Pittsburgh Medical Center) This big business entity even had their corporate logo displayed on the tallest building in Pittsburgh. Times certainly do change.

  9. I thought the Pennsylvania one might interest you OFRN - that elderly lady talking is rather wonderful I think - a lifetime of nursing! It's the same here - individual teaching hospitals incorporated into giant colleges now with students coming out owing plenty of money in fees... such different times we saw! Sue

  10. I was a patient in 1 of those old operating rooms back in the early 70's when I was 16. I went in for an emergency appendectomy. It was a good thing they gave me "something to help me relax" before they wheeled me in there cause I would have freaked out. All those lights, machines, instruments. And all those people watching you from the theater. When they got me on the table the first thing they did was take off the sheet and there I was, bear ass nude with pubs shaved off. This nurse went right to work painting me with this red stuff all over my stomach while I was watching the people in the theater sitting in chairs watching me as they drank coffee. I was waiting for them to serve popcorn. Whatever it was they gave me to relax was a blessing because I really didn't care about anything. The anesthesiologist told me to count backwards from 100 and I only remember 100, 99, 98. Out cold.

    1. I hope your surgical procedure had a good outcome and you are doing well. That anesthesia induction with the countdown sounds like a classical cyclopropane experience. There is a post somewhere on my blog about this antiquated anesthetic. Just google cyclopropane if you are interested. All the best to you and I appreciate you reading my foolishness!

    2. I think overall it was successful. I did have children :) I read your post on the sedation. I do remember the mask so I would guess that was what they used. The going out was fine, waking up took longer than expected, 6 hours. My sister said they were a little concerned but not overly concerned. An orderly that came in told me he tried slapping me to wake me up but nothing doing. It was actually not a bad experience. The RN's and aides all wanted to come in my room to hang out. I guess I was a charmer, that or it was because I smoked and they could get a quick smoke break in. They probably fought over who was going to take my temperature. Either way I didn't care, it was company so they were welcome.

    3. Ahh..That's an old school nurse's trick-bumming cigarettes from patients was quite common. Smoking was allowed everywhere in vintage hospitals, there was even an ash tray on the medicine cart.

      Smelling salts were used in old school recovery rooms to help "bring patients around" from general anesthesia. I cannot imagine the misery of waking up with post-op pain and someone waving smelling salts under your nose. The good old days were not all that good!

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