This week I was scheduled to work nights. As I am very much a morning person, I was not excited about this. On nights the OR is staffed to run 3 rooms with one person to give breaks (on any given weekday we are staffed to run 23 rooms including people to do breaks). So, you pretty much have to be ready for anything, and do whatever comes down. I am still pretty new, and there are
lots of cases I have never scrubbed before.
Monday night was fine...I finished a spine case that was still going when I arrived. Then I set up 5 rooms for the next day. Then I got to do a quick case (debridement of a stage 4 pressure ulcer...if you're brave you can google that for images). That was our only case the whole night, and it was over by midnight. Easy enough.
Friday night I was nervous. 'Crashes' (emergent cases that come down to the OR on very short notice) are much more probable on weekend nights, for obvious reasons (i.e. alcohol). However, it was a surprisingly quiet shift. Around 4 a.m. we finally got a case. No big deal...patient got stabbed in the abdomen, was stable, they just wanted to make sure there wasn't any internal damage. I did get to go up to the emergency department for the first time ever to do my pre op patient interview, and was amazed at the size of it. I mean, I know we're a level 1 trauma center, but had no idea the E.R. was so big (or would be so bustling at 4 a.m. on a saturday).
By Saturday night I was just so relieved to be at the end of my work week that I wasn't too worried about what the shift would be like. I am used to going to bed by 10 at the latest, and getting up pretty early even on my days off. But staying awake all night monday really messed up my schedule, and I couldn't fall asleep before 3 a.m. on my days off. Then I would sleep half the day away, and start the cycle again. I didn't really get to hang out with people very much. It was really disruptive to my body and mind; I felt nauseated a lot (eating less = silver lining!), and found myself crying for no discernible reason about once a day (depression = not good). All that to say, I was ready to get back to my normally scheduled life please. Also, I have to give props to all parents who haven't deposited their babies on a doorstep somewhere...I imagine that the sleep deprivation of new parenthood is similarly disruptive, and lasts much longer than a week.
So, Saturday night...15 minutes before the start of my shift, 2 pediatric patients were crashed down. I was going into a case that was already in progress, so I helped set up 2 new crash rooms (as soon as one gets used, another one gets set up as quickly as possible). My case finished after an hour, then I helped set up for a potluck for a nurse who's retiring, and then I gave a break. After enjoying some tasty potluck goodness, I got assigned to scrub an organ retrieval (just want to clarify that this was not one of patients who crashed down earlier). I've never done one before, and they are sort of weird cases because the surgeons that do them come over from a different hospital (or several different hospitals), and then there's a team of 'organ people' (as I think of them) who bring all the supplies for preparing/packaging the organs once they are removed. One of the organ team people told me that the case was likely to get a little crazy as there would be four teams of surgeons working at the same time. Okaaaay.
Stop reading if you get squeamish. So there was a scrub person with the organ team who helped me set up, and who was super helpful during the first part of the case in passing instruments to the four people at once who were asking for them. In one sense, this was a fascinating case to scrub. Normally in surgery, the incision made is as small as possible; for less tissue trauma/better healing outcomes, etc. In an organ retrieval, everything is exposed. It was incredible to see the heart beating (we don't do many cardiac cases, and I've only scrubbed 1 thoracic case ever), and watch the lungs expand, and see the peristaltic waves of the intestines. There's a process of exposing the organs they're planning to take and making sure they are viable, then dissecting away as much tissue as they can, and tying off nonessential vessels. All the lead-up to the moment when they cross clamp the aorta, and then the organ team has all kinds of fluids that they flush with, and lots of ice gets packed in around the organs, and then they start taking things out. And I think that's when it stopped being clinically interesting to me. Because looking into the empty body cavity, I was struck with the wrongness of a life ending. Even though five other people around the country had the most hopeful day of their lives, this life was over. Once the heart had stopped beating, it all suddenly seemed so gruesome.
I still firmly advocate organ donation...I just don't look forward to being part of the process. I also have a better understanding of why many families refuse it as an option for their loved ones. It used to make me angry that anyone would refuse organ donation. Don't they understand the need out there? Don't they understand how many very desperate people there are waiting for a chance? Can't they see what a waste it is to let healthy organs die when they could do so much good? But I have a little more empathy now.
So that this isn't the most depressing post I've ever written, this is today's verse on www.verseoftheday.com:
"Whom have I in heaven but you? And earth has nothing I desire besides you. My flesh and my heart may fail, but God is the strength of my heart and my portion forever." Psalm 73:25-26
