This week, I had my Operating Room rotation at school. As part of our assignment, we have to write a journal about the experience which addresses certain questions in the prompt. So, I’m cutting and pasting here! It was a very neat and surreal experience. I literally was a couple of steps away from the table looking over the surgeon’s shoulder in one case, and by their side in the other two. Fascinating stuff!
For my first day in the O.R, I watched two cases that were very similar to each other. Both cases were being performed as treatments for breast cancer and both clients were given general anesthesia in the supine position. The first case was a simple mastectomy and sentinel node dissection along with a removal of a benign lesion on the forehead. The second case was lumpectomy with a sentinel node dissection.
Before the beginning of the first case, I met my circulating nurse, Miss B., while she was setting up the room and the patient. I was extremely nervous at the beginning because I felt in the way and as though I had no control since I couldn’t do much. When I came in the room, the patient was already there and getting transferred. The mastectomy involved removing the whole left breast along with some of the axillary tissue due to abnormal cell growth. They also performed a sentinel lymph node dissection. For this, a special dye was injected into the breast and spread through the lymph nodes mapping out the cancerous ones in blue. It was very surreal to see the tracks of blue inside the body. That level of technology amazed me. During the procedure, the circulator got more supplies as needed and did her charting. After the surgery started, I was able to observe my circulator charting in the computer and saw how their form of charting is a lot different from the floor. When the lymph nodes were removed, they were passed off to me so that I could go tube them to the lab to see if they were cancerous or not. It was a very strange feeling to know that I was holding potentially cancerous lymph nodes in my hands.
The second case was a lumpectomy which was nearly the same as the first which was a relief to me because I felt more prepared on what to expect. The difference in this case was that instead of removing the whole breast, an incision was made along the side and the tumor was cut out from there. It looked more like a breast reduction than a full-on mastectomy. This patient also had the sentinel node dissection which required the tracking of blue dye. This time around, I felt more like a nurse because I was able to go out and talk with the patient beforehand and establish a rapport with her. I truly felt like a comfort to her before she went under the anesthesia and when she awoke- that was one of the most rewarding parts of being in the OR. This time around, my circulator had the mentality of “see one, do one”. As a result, I got to write everything on the board, strap my patient down, apply SCDs and warming blankets, hook up equipment, tie the gowns of everyone scrubbing in, answering pages and more. It really gave me a feel for what the circulating nurses do and what all they have to keep track of.
The second day started off slightly jumbled. The patient for the first case of the day never showed up. As a result, we had to quickly get supplies and change the set up from an ankle fracture case to an orbital fracture case. This patient was getting a repair of a right orbital fracture with an implant and repair ectropion on the right lower lid, repair retractor on the right lower lid, and right myocutaneous flap. He was getting this because the hardware in his eye was broken and coming through the skin which caused the ectropion and faulty retractor. This patient had previously been homeless and unable to receive care until now so it was in really bad shape. The procedure took 3 hours. This case was a lot different than the two from the day before in the sense that it was more specialized. As a result, the circulator had to get a lot more supplies throughout the surgery. I was able to do all the things on this day that I did in day one which helped to reinforce what all the circulator had to keep track of.