6
THE OPERATING ROOM
Somewhere between joy and doom,
Lies the operating room.
Many people daily work there,
And some nurses go berserk there.
And in this place of fact and fable,
Stands the operating table,
Where the surgeons work their wiles
With sharpened blades and sneaky smiles.
So if you've made the big decision,
(Watching shows on television)
To have your hernia fixed tomorrow
Go to the hospital without a sorrow.
But be sure to know that factor:
That your surgeon ain't an actor!
In my book, Comprehensive Breast Care, there is an excellent chapter by one of the operating room nurses called “The Masked Strangers,” in which she artfully describes the various people you will meet and the functions they provide. Suffice it to say that you will encounter a number of “masked strangers” in the surgical suite. From the attendant who will transport you to the surgical department dressed in his “scrub suit,” you will be introduced to the “holding room” nurse, who will answer any questions you may have. She will make sure your laboratory work, chest xray, and electrocardiogram are in order, and will assemble all the paperwork, including the history and physical examination, and make sure the consent is properly written and signed. We don't want to take off the wrong leg or fix the wrong cataract! You will also meet the anesthesiologist who will be giving you the anesthetic agent that you, your surgeon, and he, have decided upon. He usually starts your I.V. (intravenous lines) for giving fluids and medicines and will reassure you about any questions you may have, especially if you are going to sleep. We will talk more about the anesthesiologist in Chapter 21.
You will then meet another nurse, who will work with the holding area nurse and accompany you with the anesthesiologist to the operating suite (or room, if it's not fancy!), where you will meet a scrub nurse or technician. During the procedure, the scrub nurse, in sterile gown and gloves, will be handing the instruments to the surgeon; the other nurse, the circulating nurse, will be available to get any needed supplies in or outside the room while you are asleep. The nurse and the anesthesiologist will attach blood pressure and cardiac monitors to you before you are put to sleep, and once you are sleeping, may do other procedures to monitor your vital functions. These might include placing a tube in your stomach (an NG or nasogastric tube), your bladder (a Foley catheter), or a central venous or arterial line (placed in a vein or artery, respectively). Often these tubes are removed before you wake up, but usually your doctor will tell you if he plans on leaving any in place after you have awakened, so it won't be a total surprise.
After the surgery is completed, you will be brought to the recovery room, where a specialist nurse will take care of you for about an hour until you are stable enough to go back to your room. Again, I would recommend your reading Carol Metcalfe's chapter on the “Operating Room Nurse” for her comprehensive and often amusing insights.
But let us consider when and why we use a hospital-based operating room as opposed to office surgery, an outpatient surgical center, or the emergency room. The hospital may be the only fully equipped facility in your community or it may be the only one fully accredited for use by your insurance company. But, aside from these issues, the acuity and severity of the surgery will often determine where it should be done. Whereas small procedures, such as removing moles and simple biopsies, may be done in a well-equipped emergency room with a local anesthetic, hernias will need more anesthesia and a larger number of instruments, and will need a regular operating room, such as in a hospital or surgical center. Understandably, there may be some cases such as hernias which can be done in either facility, and this may be done according to surgeon, insurance, or patient preference. The hospital operating room is the place for major surgeries where the patient may be staying overnight or where there is the potential need for services only available in the hospital. Should any problems or unforeseen complications arise, it's important to have a full staff of trained experts to take care of the problem. Obviously, brain and heart surgery and complex intestinal surgery must be done in a hospital setting. There are also some procedures, as we will see later in this book, which require very expensive, high-tech equipment that can only be found in hospitals.
All operating rooms are subject to strict quality controls and must have constant checks on sterility and equipment, and the quality control is often a point for competitiveness among the hospital suppliers. If suture material is breaking or stapling machines for intestines are not working well, a competitor will immediately fill in the void with a better instrument or suture. Competition often breeds better quality. Hospitals and surgical centers have committees overseeing every aspect of medical care to bring the possibility of error or malfunction as close to zero as possible. True, mistakes are occasionally made, but most of the time they are very minor and do not impact patient health or safety. In choosing your site for surgery, you can check out its safety record and its relative scoring with an agency called The Joint Commission on the Accreditation of Hospitals. If the facility to which you have been recommended has scored poorly or has a problem with accreditation...go elsewhere. There are many fine institutions. Go where you feel safe and comfortable!
Chapter 7
OUTPATIENT SURGICAL CENTER
Hey, you need a surgery and want it done real quick
Like takin’ out a bullet or a knife that made ya sick?
Well, come on over to my place, behind Gilhooly's bar
My private surgicenter is a souped up ragtop car.
I wantcha to be paying for the service with small bills
And I can get ya any kind a mainline stuff or pills
I use a knife that's pretty clean, I cut you while I drive,
And I can vouch, some of my patients, dey is still alive.
Over the past decade surgical centers have been popping up all over the United States. They are the alternative to inhospital operating rooms when a patient needs more than a minor procedure and will require general anesthesia or anesthesia standby. The operating rooms are much the same as those found in hospitals, offering full nursing facilities and pre-operative, intra-operative, and post-operative care. The patients usually stay for only a few hours and then have a relative or friend take them home since they will have been sedated to some degree. Some surgical centers actually have facilities to keep patients overnight for observation. Frequently, the outpatient surgical center is near a hospital, so that patients who have problems during surgery or the recovery phase can be transferred to the hospital for overnight observation or more specialized care.
In today's world of cost control, many insurance companies prefer to have less serious surgeries done in the outpatient center because the cost is less and the greater requirements for hospitalization do not have to be met or are less stringent. Still, history and physical exams are required, and sometimes basic laboratory work, chest xrays, and EKGs may be needed. Most surgical centers can arrange for a pathologist to be on hand for doing frozen sections (quick stains for evaluating tissue) when a surgeon wants to remove a skin cancer and needs pathological confirmation that all the margins are clear of tumor!
The
