this past wednesday i started my new job in the operating room. there are three ORs on the anastasis...room 1 is currently plastics, room 2 is usually maxillofacial (maxfax) but is right now in the middle of a two week general surgery stint and room 3 is ophthalmology. ideally, each room would have an anesthesia provider, a circulating nurse, a scrub tech and an assistant in addition to the surgeon. however, right now we're extremely short-staffed in several areas...most drastically sort of anesthesiologists. there was a four week gap in the schedule where mercy ships had no volunteer anesthesiologists scheduled so they've sort of piecemealed a group together...we currently have one CRNA from the US and one local ghanaian equivalent of a CRNA. the US guy is working rooms 1 and 3 (ophtho does not require much in the way of anesthesia) while the ghanaian guy is working room 2. apparently the OR director did not feel extremely confident in the ghanaian guy's airway skills because she is allowing him to do only spinal anesthesia.
the other shortage is in nursing and assistant staff. i have been assigned to room 2, which up until wednesday only had one qualified scrub tech (fiona from australia), no assistant and no circulator (they had been pulling a nurse from the wards to circulate). so needless to say they were very happy to see me...however, i was a little bit nervous as a) i am not terribly familiar with general surgery cases and b) i have never worked as a circulator or scrub tech...! fortunately for me fiona is one of the nicest, most patient people i have ever worked with in my life (sort of a female version of kevin sexton...they both should be nominated for sainthood) and she did an amazing job of putting up with my inability to remember certain details even after i'd been reminded three times.
so that's where i found myself wednesday morning...part of the motley crew of room 2, with fiona as the only sane, experienced one of the group. i quickly realized why the OR director had been keeping the ghanaian CRNA on a short leash...he does a terrific job of administering spinal anesthetics but then seems to sort of blank out for the rest of the procedure (i.e. fails to take notice when oxygen sats suddenly drop to 80%) so fiona and i have to keep an eye on the monitors in addition to our duties. we had four hernia repairs scheduled on wednesday which in the US would be about as boring a day as i could imagine...but not in africa. these hernias are gigantic...at least as big as cantaloupes...and the sacks have proven to contain all sorts of interesting things such as inflamed appendices...we've so far done two combined hernia repairs/appendectomies (Amyand's hernia) which are very rare. also there are no laparoscopes here, so these are all done as open procedures.
for the first few cases fiona was the scrub tech and assistant (we don't have enough staff right now to have a dedicated assistant in our room) while i circulated. under normal circumstances i would have been quite enjoying myself as a circulator but i have neglected to tell you about one important detail...on tuesday the ship had to shut down it's air conditioning system for repairs...as we are in fact in africa that meant that the temp on board quickly shot up and by wednesday morning room 2's ambient thermometer read 95 degrees farenheit. therefore a great deal of my circulating duties involved wiping copious amounts of sweat off the faces of fiona and dr. ralph (general surgeon here for 2 weeks from the US...it is mercy ships tradition to call doctors by "dr. first name") as to avoid literally showering the open wound with sweat. normally i would have been itching to scrub in but in this case i was thankful not to have the extra layer of clothing on as i too was sweating through my short sleeved scrubs. however, in the afternoon the tables turned and fiona decided to train me to be a scrub tech while she circulated...
let me tell you, i now have a whole new respect for scrub techs as their job is no joke. i consider myself a mildly intelligent person but i felt completely incompetent during that first case...and it was complicated by the fact that i was trying to both assist and do the scrub tech thing at the same time...at one point i was trying to do a count on the ten zillion raytecs i had open while holding three retractors, loading up suture and desperately trying to differentiate my allis, babcock and kocher clamps...all the while the patient's HR was down to thirty-something (ended up getting two doses of atropine), the surgery had gone on so long that the spinal anesthetic was in danger of wearing off and i was dripping (no, make that
gushing) sweat from every pore on my body.
but don't let me fool you...i'm having a blast. by my third hernia case i had finally gotten all of the instruments down, had streamlined my scrub tech approach and was deftly (sort of) tying off vessels left and right. and the OR staff here is awesome...there's this very positive vibe that you don't always get back home. i think it's because the type of people attracted to medical missions are generally pretty selfless, caring folks...have yet to hear a surgeon make a fuss about anything.
thursday and friday were a little more calm, thank goodness. friday also brought restoration to the air-conditioning...now room 2's thermometer reads 65 degrees...aaaah.
as far as i know i'll be in room 2 for the rest of my time here which i'm really excited about because dr gary (the long-term maxfax surgeon who did peace's surgery last month) is coming back from vacation in two weeks and he's a great person to work with...very inspiring on many levels. i think that they are expecting the arrival of more operating room staff soon at which point i will switch to full time assissting (my favorite job)...am glad to have the experience of seeing things from a circulator and scrub tech point of view though.
plan to take my camera to the OR sometime soon...will post pics as soon as i have some.
# posted by Jenn @ 1:34 PM