Monday, September 6, 2010

This is not ok.

The sweltering OR lights dilate the vessels in my head and make me woozy. I alternate between being so overheated that I can barely stand upright, and with freezing chills from my sleep deprivation and the intermittent unbearably cold air conditioner. My face shield is fogged from my breath, my mask perpetually threatening corneal abrasion with its proximity to my fatigued eyeballs. The bottoms of my feet burn mercilessly from standing in place for 4.5 hours. I focus moreso on my duty to flex and extend my knees periodically to prevent venous pooling (and, accordingly, prevent passing out) than my duty to learn anything about surgery.

And then there's the smell of burning flesh, singed from the cauterizer. That, I pay attention to. It's grounding, somehow.

It is 10:30am. My shift was supposed to end at 7am. I've been here overnight, been awake 27 hours, and am scheduled to be back again in 8 hours. Sleep, studying, quality time with my fiance (who's been away for almost a month), and everything else that is supposed to comprise my "balanced" life is all supposed to fit in there. Yet, here I am in the OR, passively observing a 4.5 hour colon resection - with a field of vision more obstructed than the colon itself.

Ironically, this was quite possibly the one operation to which I was most looking forward to seeing on this rotation (I think the gut is amazing, and lots of my patients when I was a GI clinical research coordinator had colon resections by protocols that I only vaguely understood). I'd been able to spend time with the patient pre-operatively, who reminded me very much of a man I took care of in Maine on my medicine rotation (of whom I was very fond, who afforded me opportunities to build confidence and to be truly useful). So here we were, his abdomen sliced open with his oozing loops of bowel spilling out of his body - with so much promise to make him well! Perfect, right?

And yet, here I am: hard-pressed to recall any moments of my life as miserable as this one.

The back of my calf has a strange, sharp, throbbing pain. I am convinced that I have a DVT. I visualize it, ruminate over it. I imagine part of it breaking off and embolizing through my patent foramen ovale (a congenital hole in my heart that I conveniently learned this spring that I have), travel to my lungs and kill me. I try to make a Top 10 list of things about my present "learning opportunity" that are better than this scenario, and I truly can't come up with more than two. I instantly appreciate this as crazy. I become angry that this situation has driven me to think so irrationally.

Four times, I fall asleep while standing up. Once, I nearly fall onto the Mayo stand, the sacred base of sterility where all the instruments are kept. I resort to stepping side to side, or up onto and down from the step stool they've given this 4'11" medical student to be able to see over the surgeons' shoulders. I still can't. All this, and I can't see a thing.

The surgeon and the resident were too tired to teach me anything or engage me in any way. I wasn't being useful, I wasn't learning anything, and all I wanted to do was go home and snuggle my fiance and fall asleep for the rest of my life. And if that couldn't happen, I thought the DVT to pulmonary embolism plan was a good back-up.

The resident, the one with the scalpel in hand carving up segments of bowel, had been awake just as long as I had.

I "get" all the arguments about continuity of care, and how frequent hand-offs make for communication lapses that compromise patient care. But if the man with the scalpel feels half as dysfunctional as I do right now, there's something very wrong.

No comments: