Surgery!

No pictures in *this* one, guys!

So, on Monday I was allowed into surgery, not scrubbed of course, but in. I got there at 6:30 am (Aiiieeeeee!!!!) so I could oversee the entire process including the preop. I was given a temporary locker in the nurse's locker room, where I could change into the surgical scrubs, a surgical cap (which I already had), and a pair of booties over my shoes.

The patient was already in the pre-op room, gowned and capped, but wide awake.

I talked to the patient for a good long time, who had avascular necrosis (this is where the blood supply is interrupted or terminated, causing death of the tissue, in this case, bone) causing a need for a knee replacement. The location of the necrosis was pretty rare, and the doctor had shown me an article on it at the office when he initially saw the patient.

After a while, the anesthesiologist showed up and immediately began drilling me on anatomy as he was doing a nerve block. Whoops!!! I did all right on the order of vessels through the femoral triangle, but I need to do the innervations below the knee better, because I completely screwed up what the femoral nerve does below the need (just provides sensation to the strip of skin down the front of the shin), so sorry SGU!!! I was studying for biochem at the time I was supposed to be refocusing on lower limb!

Though I initially got flustered at having questions shot at me and struggled to find the answers to questions I actually, for the most part knew, I was grateful for it as well. The guy was really nice and it gives me some preparation for my rotations and residency when people, that will probably be far less nice, will be shooting questions at me left and right, so I like being quizzed. It's harder than I would have thought. I also found myself overcompensating for what I don't know by overexplaining the stuff I do know (like where a femoral hernia goes), so I'll watch that.

Over the scrub sink, I grabbed my mask (no gloves), and wandered into the OR suite, watchng them set up. It's fun to see the sterile versus nonsterile, and I watched the scrub tech (sterile) scrub up while the circulating nurse (who runs the show and isn't sterile), opened up packages, being very careful not to touch the sterile stuff with in. It's like an antibacterial little dance.

They brought the patient in, swapped him/her (HIPAA rules, no identifying information) to the operating table and chose ME to try to wheel the large gurney out the door by myself. I've operated these things a dozen times, but for some reason, when you're trying to force one out a door that's not supposed to stay open for any length of time, you do stupid things like get the doorknob stuck through the rail. D'oh!

But no nasty comments from anyone there, fortunately, though I did get told to close the door where upon coming back (having been let back through the doors to the surgical wing by the surgeon, who was arriving in time to watch me lock myself out), I went through the wrong door (the one I'd gone out). D'oh again!!! Heh heh. Hey, first time in surgery; cut me some slack.

The anesthesiologist gestured for me to stand next to him, and answered a lot of my questions as I leaned over to see. There's a drape that separates the nonsterile head of the patient (and anesthesiologist) from the sterile body where the surgeon and scrub tech are working. I was constantly worried whether I was in the anesthesiologist's way, but he just chuckled and said "Just don't lean on the drape or touch anything blue and you'll be fine".

The surgery was pretty cool. There are so many individual important orthopedic tools, sizing, and such, plus the surgery itself, as far as motion is concerned, is pretty violent, with hammering and drilling and all, but with the tourniquet and suction, it was virtually bloodless, which I hadn't been expecting. What was really strange was when I was watching the patient's knee, which was completely open, and I could see both the end of the femur and the head of the tibia, with the kneecap pushed out of the way, the patient, due to the type of anesthesia, wasn't on a breathing tube and was snoring away in happy slumber! Bizarre! But cool.

Everything was closed up, with the surgeon having a much greater aptitude than I have for stitching (I really need to work on my stitches further; I'm not great, though I've only worked on cadavers). I went with the patient, who, upon waking, was feeling no pain, and talked to him/her for quite a while before wandering off to see if there was any place I was needed. I ended up hanging out in the surgical lounge with a couple of the anesthesiologists, the surgeon, and the sales rep from the company that makes the knee replacements.

During replacements, a rep from the company often comes, since that representative is an expert in the materials used, oversees the operation (though not sterile), and helps with things like sizing the implant. This makes talking to the reps fascinating since they've seen it all and really know the product as well as the operation, and since they aren't having to scrub in and do the pre-op medical stuff, if they're interested in talking (and this guy was), they have the time to tell you all sorts of cool stuff.

I didn't do the preop on the second patient, and got into the OR when they were doing the first incision. I stood next to the rep, which gave me a really good view of the whole procedure, which they were doing with a "uni", an implant they do for the medial (inside) of the knee if the outside is fine and all the ligaments are intact, so that the entire knee joint isn't loss, and the scar is smaller.

The rep answered a bunch more of my questions, including what all those scary tools were, and again, awesome experience.

After that, it was lunch time! Yummy! Drumsticks anyone?