Observing a surgery - how to be professional & not make an ass of myself?
July 7, 2011 7:29 PM Subscribe
Observing in the operating room - fantastic! Now, how not to act a fool?
I'll be observing in an operating room for the very first time this week. I am a nursing student, but I will not be assisting, only observing. I do not know what type of surgery I'll be observing, but have been told to expect to be busy from 8am to 4pm. I'll be with the patient from pre-op until PACU, so I'm assuming the surgery itself will be 3-5 hours, max.
For those who've observed, assisted with, or performed a surgery, what can I expect? What shouldn't I do? Seeing blood, bodily fluids, and so forth doesn't bother me, but I'm a little susceptible to nausea from strong smells. Any way to counteract this?
I'm familiar with the sterile field and know not to touch, reach over, cough or breathe on, etc. anything sterile. I also know not to chat or ask questions of the surgeons unless invited to. Beyond this, what else do I need to know to make this a great experience?
I'll be observing in an operating room for the very first time this week. I am a nursing student, but I will not be assisting, only observing. I do not know what type of surgery I'll be observing, but have been told to expect to be busy from 8am to 4pm. I'll be with the patient from pre-op until PACU, so I'm assuming the surgery itself will be 3-5 hours, max.
For those who've observed, assisted with, or performed a surgery, what can I expect? What shouldn't I do? Seeing blood, bodily fluids, and so forth doesn't bother me, but I'm a little susceptible to nausea from strong smells. Any way to counteract this?
I'm familiar with the sterile field and know not to touch, reach over, cough or breathe on, etc. anything sterile. I also know not to chat or ask questions of the surgeons unless invited to. Beyond this, what else do I need to know to make this a great experience?
I'm with you on the smells. I can look right into brain and not be bothered, but the whiff of a floater and I'm gagging. Your options there include noseplugs, acclimatization, or the old "Carmex under the nostrils" bit.
posted by adipocere at 7:34 PM on July 7, 2011
posted by adipocere at 7:34 PM on July 7, 2011
I was in the OR with my wife for her c-section, and there was some strong burning flesh smell when they cut her open. Amazed I remained conscious. If you're not in there for the cutting you'll probably be okay. In any case, the room is sure to have an exhaust fan. Try not to be between the patient and the exhaust fan, and offending air will probably not come your way.
posted by holterbarbour at 7:43 PM on July 7, 2011
posted by holterbarbour at 7:43 PM on July 7, 2011
Response by poster: Ok, chiming back in just once, and then I promise not to thread-sit.
I've gotten some basic guidelines and information already from my instructor. I'm really looking for tips, advice, personal experience, things you didn't realize until you got to the OR, etc. I do know to stay out of the way. :)
Adipocere, thanks for the tip about Carmex - that's exactly the kind of thing I was hoping to find out. Making a note to bring some along that day.
posted by pecanpies at 7:45 PM on July 7, 2011
I've gotten some basic guidelines and information already from my instructor. I'm really looking for tips, advice, personal experience, things you didn't realize until you got to the OR, etc. I do know to stay out of the way. :)
Adipocere, thanks for the tip about Carmex - that's exactly the kind of thing I was hoping to find out. Making a note to bring some along that day.
posted by pecanpies at 7:45 PM on July 7, 2011
Oh, this one is a little off the wall, but ... opera glasses? You can stand well out of the way of the "action" while still getting a good look. It's a trifle unusual but would be practical. And the greater distance means less intense smells ...
posted by adipocere at 7:52 PM on July 7, 2011
posted by adipocere at 7:52 PM on July 7, 2011
I hate the smell of the bovie! My solution is to suck on an Atomic Fireball. Your mouth will be so occupied that your nose will forget all about the burning flesh. It's cold in an OR. Wear nice thick socks and an undershirt under your scrubs. Some OR directors will let you grab a warm blanket or a paper jacket, but others policy is to suck it up. Ask the nurse if you're not sure.
posted by PorcineWithMe at 8:01 PM on July 7, 2011
posted by PorcineWithMe at 8:01 PM on July 7, 2011
Best answer: Wear your most comfortable shoes and expect to shift your weight a lot from standing. Wearing and breathing through a surgical mask for a long time makes you hot. Ask the circulating RN for a step stool to stand on so you can stand back but still see--there will be a couple available. It's kind of part of the culture that if you're not scrubbed in to hold your hands behind your back if invited to get close. You'll see more on the TV screen for an laproscopic or microscopic surgery than an open cavity surgery that everyone's crowded around. If you have questions, ask the circulating RN in between when he/she's taking counts or pulling supplies--their brief lulls will be obvious. I wouldn't worry about smells--you'll mostly smell your own breath in the mask and ORs are cold and well ventilated. You may, as a student, be asked if you want to cath the patient once they're under. Do it--jump on it before the med student does. Similarly, the circulating RN may give you a task, so keep your ears and eyes peeled--this is true even if your prof said you won't do anything. Mostly, it's hard to stand and do nothing, trying to see, getting hot from the mask and gown for hours, but it's still a singular experience the first time (it's super fun once you are actually in on the action, by the way. Keep studying hard). To close, eat a good breakfast and don't lock your knees. Have fun!
posted by rumposinc at 8:10 PM on July 7, 2011 [5 favorites]
posted by rumposinc at 8:10 PM on July 7, 2011 [5 favorites]
From a patient point of view rather than the pros you were asking, but bedside manner is still relevant since you mentioned you'll be with the patient in pre-op. The tip: don't assume ANYTHING when talking to a patient.
For example, the guy accompanying your male patient might be his brother, his best friend, or a lover. You may think you can guess based on body language, but you really don't want to be wrong. Or you're seeing a woman who's in to get a retained placenta removed, and your congratulations might be inappropriate.
If you have an assumption, try to coax the patient to talk about him/herself, so you can respond correctly.
Using the same examples, you might say, "It's so nice that someone could be here to support you today." This would prompt many people to introduce the other guy. And for the second example, you might say, "so you were just here in the hospital recently?" Most people will use that as an invitation to elaborate, either with a smile and "yes, my son is two weeks old" or without a smile, and maybe with little information, which tells you it wasn't a happy situation and they might not want to talk about it.
posted by nadise at 8:15 PM on July 7, 2011 [2 favorites]
For example, the guy accompanying your male patient might be his brother, his best friend, or a lover. You may think you can guess based on body language, but you really don't want to be wrong. Or you're seeing a woman who's in to get a retained placenta removed, and your congratulations might be inappropriate.
If you have an assumption, try to coax the patient to talk about him/herself, so you can respond correctly.
Using the same examples, you might say, "It's so nice that someone could be here to support you today." This would prompt many people to introduce the other guy. And for the second example, you might say, "so you were just here in the hospital recently?" Most people will use that as an invitation to elaborate, either with a smile and "yes, my son is two weeks old" or without a smile, and maybe with little information, which tells you it wasn't a happy situation and they might not want to talk about it.
posted by nadise at 8:15 PM on July 7, 2011 [2 favorites]
Don't block the light! I stood in on a surgery once, and was really good about staying out of the way. (I was up on a stool like rumposinc suggests, which is a really great idea.) However, at one point, I craned my head forward just a liiiiitle bit too much, which cast an almost imperceptible shadow on the patient. The surgeon had to ask me to move back a bit and I felt like a dweeb.
Other than that, just breathe through your mouth when they cauterize stuff. Burning flesh smell is not cool.
posted by phunniemee at 8:17 PM on July 7, 2011
Other than that, just breathe through your mouth when they cauterize stuff. Burning flesh smell is not cool.
posted by phunniemee at 8:17 PM on July 7, 2011
The OR will have little vials of scent (peppermint, usually) that you can smear on your mask if a smell bothers you. Just let the circulating nurse know if you think you may need it while s/he isn't busy (which may be a trick, just use your best judgement). Bovie smoke never bugged me, and some people suck the worst of it up with suction, but if you're very odor-sensitive, be proactive.
The room is going to be a little chilly if you're not gowned and gloved.
Will you be scrubbing in? If not, your roll is going to be an extremely passive one, so I'm not sure what to tell you. You've got the basics down.
A slow-moving, minor, quiet surgery or a relaxed turnover would be a good time to ask questions of the surgical team. Speaking for myself, I always loved answering questions, and appreciated being asked.
Any corrections given may come across as brusque. Remember them, but don't take them too hard.
Plus everything rumposinc said.
posted by moira at 8:23 PM on July 7, 2011
The room is going to be a little chilly if you're not gowned and gloved.
Will you be scrubbing in? If not, your roll is going to be an extremely passive one, so I'm not sure what to tell you. You've got the basics down.
A slow-moving, minor, quiet surgery or a relaxed turnover would be a good time to ask questions of the surgical team. Speaking for myself, I always loved answering questions, and appreciated being asked.
Any corrections given may come across as brusque. Remember them, but don't take them too hard.
Plus everything rumposinc said.
posted by moira at 8:23 PM on July 7, 2011
I've found that by the anesthesiologist often yields the best view and affords the opportunity to watch intubation and see what anesthesiologists do. If you decide to try this, make sure you ask the anesthesiologist if you can stand there. YMMV, and it may mean fewer opportunities to ask the circulating RN questions.
posted by honeybee413 at 9:01 PM on July 7, 2011
posted by honeybee413 at 9:01 PM on July 7, 2011
Eat breakfast and when there's a slow point, eat a snack or go get lunch. Nausea and lightheadedness are worse on an empty stomach.
Don't lock your knees - even if you're not in any danger of fainting, "soft" unlocked knees let you move your leg muscles, which promotes venous return, thus reducing the fatigue and lower extremity edema that come from unaccustomed hours of standing.
posted by gingerest at 9:53 PM on July 7, 2011
Don't lock your knees - even if you're not in any danger of fainting, "soft" unlocked knees let you move your leg muscles, which promotes venous return, thus reducing the fatigue and lower extremity edema that come from unaccustomed hours of standing.
posted by gingerest at 9:53 PM on July 7, 2011
It doesn't sound like this is a procedure where the patient is awake, but if the patient is awake, everyone should be keeping their mouths shut about anything that hasn't to do with the surgery.
posted by zizzle at 12:02 AM on July 8, 2011
posted by zizzle at 12:02 AM on July 8, 2011
Eat breakfast, oh dear god eat breakfast. And try not to sympathize with the patient. (My only near-fainting in nursing school was watching a screaming baby have a circumcision after not eating breakfast, pressed tightly up against a wall with my knees locked.)
posted by IndigoRain at 12:45 AM on July 8, 2011
posted by IndigoRain at 12:45 AM on July 8, 2011
When I had surgery rotation in nursing school, I was so surprised by how much I loved it! I got to hold a spleen even. Just be enthusiastic with the nurses, they usually like a happy student. Don't be offended if a surgeon gets pissy, they seem to trend that way. If you feel at all faint/ill just step outside. They'll probably remind you about that several times. Wear a sweater, put the booties on correctly ( I didn't and felt like an idiot), smile! Have fun!!
posted by yodelingisfun at 1:06 AM on July 8, 2011
posted by yodelingisfun at 1:06 AM on July 8, 2011
The only real advice I was given when a colleague decided to bring me into the OR was: if you feel faint, go to the wall and let yourself slide down it. Other than that: have fun, watching someone get operated on is kind of awesome.
posted by sciencegeek at 3:25 AM on July 8, 2011
posted by sciencegeek at 3:25 AM on July 8, 2011
Our nursing instructor's advice that has always stuck with me was, "Stand like broccoli." You know, don't move more than you have to, don't get in the way, don't do much of anything. This advice kept me amused during the less exciting moments of surgery.
Since everyone has covered asking for a step-stool and not locking your knees...
As a nursing student I was able to watch several different surgeries on my OR observation day, including coming into the middle of a TRAM flap breast reconstruction. I stood and watched in panic for about 10 minutes trying to decide whether to tell the surgeon that there was a huge long hair in the surgical field, before I realized that it was a super-thin suture he was using to reattach blood vessels. I know there's a lot of big talk in nursing school about how anyone should feel comfortable speaking up if something doesn't seem right, but man was I glad I kept my mouth shut that day.
Also, I found that being too warm was way worse than being too cold. I wore the hospital-provided short-sleeved scrubs and they also offered a papery scrub jacket because the ORs were freezing, but when you're standing there feeling a bit iffy from the smell or the look of things or (in my case) from just standing still too long, being warm is the worst. Those masks and caps trap a lot of heat. I wouldn't layer any extra clothes underneath, personally.
posted by vytae at 4:17 AM on July 8, 2011
Since everyone has covered asking for a step-stool and not locking your knees...
As a nursing student I was able to watch several different surgeries on my OR observation day, including coming into the middle of a TRAM flap breast reconstruction. I stood and watched in panic for about 10 minutes trying to decide whether to tell the surgeon that there was a huge long hair in the surgical field, before I realized that it was a super-thin suture he was using to reattach blood vessels. I know there's a lot of big talk in nursing school about how anyone should feel comfortable speaking up if something doesn't seem right, but man was I glad I kept my mouth shut that day.
Also, I found that being too warm was way worse than being too cold. I wore the hospital-provided short-sleeved scrubs and they also offered a papery scrub jacket because the ORs were freezing, but when you're standing there feeling a bit iffy from the smell or the look of things or (in my case) from just standing still too long, being warm is the worst. Those masks and caps trap a lot of heat. I wouldn't layer any extra clothes underneath, personally.
posted by vytae at 4:17 AM on July 8, 2011
Beyond what other people have said - and don't assume any amenities will be available - what I took away was twofold: don't even go near anything blue or people will freak out that you might have touched the sterile field, and second, if you're not used to being masked up, remember to breathe. I got dizzy because I realized I was keeping my mouth closed and trying not to breathe in during parts of the surgery, which is dumb, because I was two feet away and my face was protected from theoretical splashes.
And yes, near anesthesia is the BEST observation place for most surgeries - you aren't generally in the way of any surgeons or techs and you're pretty close - see if you can get yourself over by them.
(OR may be hot or cold, but I generally sweated the entire time.)
posted by cobaltnine at 4:55 AM on July 8, 2011
And yes, near anesthesia is the BEST observation place for most surgeries - you aren't generally in the way of any surgeons or techs and you're pretty close - see if you can get yourself over by them.
(OR may be hot or cold, but I generally sweated the entire time.)
posted by cobaltnine at 4:55 AM on July 8, 2011
You will be told where to stand (usually at the head of the OR table next to the MDA or CRNA) and provided a stool most of the time. The team will tell you when to take your position and where to walk as to avoid contaminating the sterile field. Eat breakfast, don't lock your knees, heed any advice given regarding the personality of the surgeon(s) and whether you are allowed to ask questions during the case. If they are decent and are told you are a student, they may pose questions to you. Don't worry, you'll do fine.
posted by Asherah at 5:31 AM on July 8, 2011
posted by Asherah at 5:31 AM on July 8, 2011
Best answer: I work in an operating room; at the head of the table no less! We get observers all the time since we are a teaching institution; I imagine the place you are observing at is similar. So they will be used to strangers with little experience in the OR. The atmosphere in the OR varies considerably; in a difficult heart surgery it may be completely quiet except for the attending surgeon and/or anesthesiologist muttering swear words every now and then, but typically it is much more light-hearted with a lot of joking around and often someone's iPod playing in the background. You may well stand at the head of the table with the anesthesia provider; if so they will let you know if you need to move or where to stand to get a better view or stay out of the way. On the other hand a couple of our rooms have various cameras and large monitors mounted in various places and they are often the best view, especially in endoscopic surgery. Some attending surgeons may take time to show you the anatomy and what you are doing if you show an interest. Generally we put observers in rooms where they will be made to feel welcome.
Lots of good advice in this thread; pay particular attention to preventing feeling faint or light-headed. If you do, back away from the field and ask for a chair or help; don't feel bad if it does happen. Most people do fine, but sometimes (usually if they are sick or something) even experienced personnel will faint in the OR; just don't do it onto the field or hurt yourself. If I think of anything else I will chime in, but mainly just enjoy yourself. The OR is a great place to work! Which reminds me, if you enjoy it a lot and/or are interested in coming back a thank-you note to the OR staff will make you stand out; we don't get many from observers, but more advanced students who spend a month or more with us regularly write thank-you notes (and sometimes bring goodies to eat, but that's overkill if you only spend a day there.
Feel free to memail me if you have any questions and come back here to let us know how it goes.
posted by TedW at 10:17 AM on July 8, 2011
Lots of good advice in this thread; pay particular attention to preventing feeling faint or light-headed. If you do, back away from the field and ask for a chair or help; don't feel bad if it does happen. Most people do fine, but sometimes (usually if they are sick or something) even experienced personnel will faint in the OR; just don't do it onto the field or hurt yourself. If I think of anything else I will chime in, but mainly just enjoy yourself. The OR is a great place to work! Which reminds me, if you enjoy it a lot and/or are interested in coming back a thank-you note to the OR staff will make you stand out; we don't get many from observers, but more advanced students who spend a month or more with us regularly write thank-you notes (and sometimes bring goodies to eat, but that's overkill if you only spend a day there.
Feel free to memail me if you have any questions and come back here to let us know how it goes.
posted by TedW at 10:17 AM on July 8, 2011
Don't stand in one position too long. Bend your knees. Squeeze your calves. If you think you're going to pass out (from either a vasovagal episode or because all the blood pools in your legs after standing for so long), STEP BACK, AWAY from the patient/OR table/sterile field, and tell someone you're feeling faint/lightheaded/I'm going to pass out. Much better to warn someone and then pass out as opposed to being embarrassed about telling someone, and then messing up a sterile field and a surgery.
WEAR COMFORTABLE SHOES.
posted by gramcracker at 1:26 PM on July 8, 2011
WEAR COMFORTABLE SHOES.
posted by gramcracker at 1:26 PM on July 8, 2011
This thread is closed to new comments.
That's really the best advice.
posted by i_am_a_fiesta at 7:34 PM on July 7, 2011 [1 favorite]