Wednesday, November 9, 2011

OR

This week I had my observation day in the operating room (OR) on the surgical floor of the hospital. As I mentioned before, a couple people who had gone before me got to see some pretty interesting surgeries, but unfortunately, some did not (one girl had to watch teeth being pulled all day! Probably not fun to watch...). I had to check in at the peri-surgical unit to get assigned my patient, meet the patient and family, and then follow the team into the OR. My patient was getting an aortic valve replacement due to aortic stenosis (which is a fancy way of saying that the valves separating the heart from the main artery supplying blood to the body doesn't open all the way very well, meaning blood flow to the body is reduced), so I got to watch heart surgery! For those of you interested, I found a picture on google images to illustrate this problem:
For my part, as soon as I got the unit I had to take off my usual scrubs and put on paper scrubs. They're thicker than real paper, but if you're not used to them, they do tear (one of the other nurses putting hers on tore her shirt). I also had to wear a mask, goggles, a bouffant to cover my hair, and little booties to cover my shoes. This is probably what I looked like (also found on google images, link):

I am going to do my best to explain the rest of the day using my best non-nursing vocabulary possible. As soon as we got into the room, the surgeon marked the patient (marking means they draw on the patient in sharpie where the incisions will be - which helps to reduce the risk of performing the wrong surgery on the wrong patient), and then they oxygenated the patient, put the patient under anesthesia, and intubated (intubation means they insert a tube down the throat to create an artificial airway so they can control the patient's breathing). The rest of the procedure I spent watching from behind the surgeon, running notes between the anesthesiologist and the circulating nurse (the nurse not scrubbed into the sterile field) and talking about the procedure with the rep that sells the valve they were putting in the patient and the other OR staff. It was fascinating!

Anyway, if you are easily grossed out, do not read this paragraph, because I'm going to describe what happened in surgery (to the best of my observation powers, which probably contains a bunch of inaccuracies, so sorry in advance)! Surgery: First the scrub nurse prepped the patient and set up the sterile field, which shockingly, took at least an hour. As you can imagine, there's a lot of prep-work for heart surgery. Fast forward a bunch...a few lines are placed (one through the femoral artery, which is in your pelvic area) and the surgeon made the first incision in the patient's chest, the length of which was already marked out earlier (maybe around 2-3 inches). The surgeon was explaining that he calls this surgery "minimally invasive" (it isn't), just because they don't open the patient's entire chest up (the chest is opened only in the area of the sternum). After they cut through the skin, the anesthesiologist deflated the lungs and they used a saw to cut through the sternum. Then they clamp open the incision/sternum and cut through the pericardium (a layer of tissue that surrounds the heart), and all the sudden I was staring at a beating heart! Crazy... As soon as the pericardium was cut, another line was placed coming from the heart out of the incision area itself and the patient was placed on bypass. Bypass was actually really interesting to watch because what happens is that they stop the heart using a combination of ice and medications, clamp the aorta and let the body's blood run through the lines they placed earlier. So the blood is flowing out of the patient's body through clear tubing into a machine that circulates and oxygenates the blood (so the patient does not have to breathe and the heart does not have to beat) and then flows back into the body. As soon as bypass was started, things kicked into high gear because the surgeon said they try to minimize the amount of time a patient is on bypass. The surgeon made an incision in the aorta below the clamp and exposed the aortic valve (which he announced so everyone could take a quick look). Then they cut out the valve's leaflets (see picture above - the aorta has three leaflets) and started stitching in the new valve. Basically they place sutures around the circumference of the aorta, then pull the sutures through the circumference of the valve, and when that's done, they just slide the valve down the sutures until it's in place, tie them, and cut them off. After the valve is in place, they stitched up the aorta, took the patient off bypass (bypass lasted for just over an hour), restarted the heart by using paddles placed directly on the heart, and then checked to see if the valve was working based on an ultrasound-like image taken from a camera they had put down the esophagus during intubation. Since it seemed to be working fine, they used a talon (pictured below) to close the sternum, stitcheded up and sent the patient to the ICU to come out of anesthesia. 

This is very, very similar to what the OR I was in looked like (also google images):

All-in-all, the surgery took about 4.5 hours. I followed the patient up to the ICU and then went back down to the surgical unit. I found the surgical nurse from my procedure and since they were just finishing cleaning up the room, she then took me to watch a total knee replacement and a total hip replacement (orthopedic surgeries). We only stayed for about 30 minutes in each. Those surgeries were much more like a construction side with saws, drills, fragments flying, and blood everywhere. Compared to the cardiac surgery I had witnessed earlier they were disaster zones. These surgeons were rocking out to music and were more than friendly and happy to explain everything they were doing as they did it. The atmosphere there was a little more relaxed since the procedure wasn't as rapid and fast-paced as the valve replacement.

It was an incredibly interesting day and I was glad to have the experience to see heart surgery. I definitely never thought I would watch heart surgery, but I guess you never know what life throws your way. Also, shout-out to my Aunt Janet, who I believe works in cardiothoracic surgery with pediatrics. Before I went to the OR, while I was waiting with my patient for the team to show up, I saw a surgeon come down into the next room, and he came out carrying a toddler down to surgery. My heart just about broke when I saw the red, puffy eyes and the hospital crib being wheeled out after them. I hope everything went well!

Last thing: the surgical team I was with was discussing a surgery planned for this week to separate conjoined twins. I just saw this article online - guess it was successful!!

9 comments:

Erika said...

wow, so jealous you got to see CPB! Could you see the deflated lungs at all? That part fascinates me.

Katie said...

It fascinated me too - I didn't realize that they deflated them so they don't nick them when using the saw. I couldn't see the lungs - almost wish the whole chest had been open so I could, but that would cause a lot of unneeded pain for the patient!

Elizabeth said...

great description--i'm glad you got to see some interesting cases! the only thing i miss about surgery is having super clean hands :)

Patty said...

Coolest post ever!! You are so lucky! Thanks for all the great detail - awesome!!

LA-jan said...

I'm so glad you got that terrific experience! Just sayin'. . . CTICU is where it's at!

jennie said...

wow! i am amazed at both the human body and the ability of people! this is incredible- also that conjoined twins story is crazy too- sounds like you are in a good place to be!

Ashley said...

Eeek this is crazy!! I'll admit, I didn't read the details of the surgery (my brother got the strong stomach in our family), but I can't believe the sorts of things you're getting to do - very impressive!!!

Dorothy said...

What a fascinating day! So nice of you to share the details - so throughly too! I am so amazed at how much you experienced in one day!

kayla said...

This is so, so cool, Katie! really wild, and really impressive! :) haha also, can you do your best to smuggle out some surgery scrubs so you can reenact that picture??