Chaos in the OR

Pin-Chieh Chiang -- It was just another day at the hospital, and I came early to pre-round and read up on surgeries for the day. Then I went to the O.R. for a surgery that was scheduled for 11 am. The patient was there and the surgery room was being set up. I went to write my name on the board, introduced myself to the scrub tech, and pulled on my gloves and gown. When I went back out to check on the patient, I found out the surgery was going to be delayed an hour. There were no anesthesiologists available; they were all tied up in surgeries that had started at 8 am.

I wasn’t getting a very good vibe from all this. It felt like déjà vu; just a week ago we had a surgery that ended up being delayed 3 hours, and my preceptor had to reschedule all her afternoon office appointments. Once again, just like the week before, we ended up waiting on two surgeries. We had office appointments starting at 2 pm. I was afraid that a 1-hour delay would become two hours and then 3 hours. My fear ended up being right.

In the meantime, my preceptor told me to observe other surgeries. I saw another surgeon scrub out and back in 3 times to grab tools that he needed but hadn’t been pulled for the surgery. Just recently, a new card system had been installed as an upgrade. However, for some reason or another, all the cards were coming out wrong and surgeons like this one were not finding the tools they needed when they needed them. I heard later from his medical student that this surgeon had gotten quite pissed off at his staff in the O.R.

At one point I also witnessed another surgeon blow up at the front desk because a certain device he needed to be implanted in the patient had not even been sterilized yet. He cursed and screamed and then stormed off. He left all the nurses scrambling to figure out where the system went wrong. One of the nurses quickly remembered that the patient had just been wheeled into the O.R. and was being put to sleep. She ran in to tell the anesthesiologist to stop since it looked like that surgery was going to be delayed as well.

Finally at 1:30, an anesthesiologist came to take our patient in. When I saw my preceptor’s face as she came stomping into the surgery area, I could tell she was extremely angry from all the waiting. The intensity level was at an all-time high. I felt like something was going to explode if it hadn’t already. Then, my preceptor saw that the anesthesiologist had used the perm-cath instead of starting an IV, and she asked if he had remembered to withdraw the heparin.  Perm-caths used for dialysis are normally heparin locked. When he said he had forgotten, that’s when my preceptor really exploded.

“You just gave the patient a bolus of heparin! How many times do I have to tell you people to withdraw from the perm-caths first? Do I need to supervise everything myself?”

In my head I’m thinking, “just stay out of the way” and “don’t get noticed.” I was just hoping my preceptor wasn’t so mad that she would change her mind about letting me scrub in. As it turned out, she didn’t, and she was able to quickly calm herself down. I was even allowed to assist and close. By the time we walked out it was already 4 pm and we had long missed our patient appointments. Our whole day had been spent on a 2-hour surgery. As I passed by the surgical front desk, I could hear the nurses muttering, “Just another day in the O.R.”