7 Awful Things I Learned About Surgery By Helping Surgeons
WARNING: The following is gross and terrifying and is not for the faint of heart.
The operating room (or the "chop shop," to use the official name) is where doctors rearrange your bones, play with your toes, and replace your flesh with evil machine parts. It's a room of pain and death. And it's decorated with puddles of all sorts of human goo.
We wanted to learn more about the inner workings of the place, but all the surgeons we approached were too busy counting their money or drinking alone. So we spoke to a surgical technician, and she told us ...
It Takes Remarkably Little Education To Get This Job
Before we get into some horrific details that may very well give you nightmares, let me introduce you to the job. First, I'm not a surgeon, or a doctor. I haven't been to medical school. But if you come in to the OR with a spurting wound, I'll be there.
An operating room is chock-full of depressingly educated surgeons, who've spent maybe a dozen or more years in college, med school, and residency. But the other folks in the OR are the surgical technologists like me, otherwise known as the scrub techs, who need no education beyond high school. In my state of Oklahoma, you don't even need any certification, though my hospital encourages it. There's just a quick entry course on surgical technology (20 percent "Here's what the body looks like" and 80 percent "Go to the hospital and watch people"), and you're in.
Learning on the job works fine most of the time. Most. But, every so often, outside surgeons will arrive for something like organ harvests -- stressful, urgent affairs that always for some reason happen in the dead of night -- and start throwing instructions back and forth in the OR. That's when I suddenly realize I don't know the actual names of the instruments.
The problem is that everyone has different slang names for the tools, so what this guy is calling "the lion's jaw" is something I just know as "the lobster claw" (the standard name, it turns out, is the heavy point-to-point reduction forcep -- you can see why they invent nicknames). Then there's the instrument I eventually learned is a periosteal elevator. I just called it a wooden handle and only decided I better find the real name when a particularly dirty doc started winking and confusingly asked about his "small woody." Plus, there are a bunch of tools I still can't name. I'm convinced a few of them are literally just someone's soup spoons. I just call them "Dr. Smith's forcep" or "Dr. Jones' bone hook," after whichever surgeon likes them most.
And yet, us scrub techs, with all our inexperience, are often tasked with ordering the surgeons around. When a surgeon wants to amputate a leg in under 10 minutes so he can get to a haircut on time, it's my job to talk him down. It's my job to understand how to flash-sterilize instruments, and when a resident drops a cautery to the ground and tries to pick it up and keep going to save time, it's my job to intervene and send him to stand in the corner because sterility is a difficult concept for some baby doctors.
Apparently, medical school isn't keen on teaching the first rule of the OR: Protect your patient by staying sterile. But it's a rule you later have trouble ever forgetting, because ...
Sterility Freezes Your Hands In A T. Rex Pose
Before things get gross, let's talk for a moment about how hard it is to keep everything neat.
You see doctors on TV hold their gloved hands in front of their chest, like they're entering a boxing match reserved for very clean people. This is true to life, and maybe you haven't considered just how long we have to keep that pose. I've had to stay like that for 12-hour marathon sessions, nonstop. If you stretch up or down, you're "unsterile" and need to go rescrub and regown. Everyone outside your sterile field can contaminate you or your instrument. This was one of the hardest things to learn, because it's so unnatural to be locked that way, hands never moving above the chest or below the navel.
What happens when we feel an itch on our face (or, er, somewhere else)? Usually, we just don't scratch, but if it's really bad, we reach for a specific instrument called a hemostat, scratch with it, then drop it to the floor. There's a ton of those tools, so it's fine to waste one. I've turned the radio up with a hemostat too and pushed my glasses up with an IV pole. I've also discovered I may be eligible to play professional soccer after all the rearranging I've done with my feet. I can kick bloody sponges up off the floor and punt them smack into a bin, one appropriately called the kickbucket.
What if we have to pee? We hold it in, and I now find international flights easy because I never need to get up and head for the bathroom. I've gone whole days at home without peeing because it's just second nature to hold it in until I absolutely can't anymore, and if that means I get UTIs and kidney stones, like a bunch of scrub techs do, so be it. What if we have to eat or drink? Food is out, but on one 10-hour case, I got dizzy when my blood sugar dropped, so one of my nurses found some grape juice and stuck the straw in the side of my mask. I was able to sip grape juice while staying totally sterile, which felt as big a victory as whatever life-saving bullshit we were doing on the side.
See? It's all just lighthearted fun! Maybe you want to stop reading now.
Addicts' Bodies Fall Apart In The Weirdest Ways
Let me tell you about my most horrifying surgery. Actually, let me tell you about my three most horrifying surgeries. Maybe you'll spot a common theme.
One heroin addict had blown out just about every vein, so she injected directly into her muscles. When she came into the OR, her leg had swelled up to twice its normal size. We sliced it open, and 3-4 liters of blood and pus plopped down into the basin below her. Afterward, the hole in the leg was so big I could put my whole hand in it. Instead of sewing the patient up, we filled the cavity with betadine-soaked sponges so the wound would try healing from the inside out.
Another addict got his toe amputated, and that was just the start of his adventure. He then went home with a sponge on his wound to vacuum up the pus and an IV port for pain meds. He put some of his own "meds" into the IV bag at home and suddenly concluded that he didn't need the sponge, so he removed it. He then further concluded he didn't need all that dead skin on his foot, so he cut it off. He finally returned to the hospital, where the ER staff found his foot now infused with live maggots. Assuming maggots don't grow overnight, he'd hung around quite a while with his extremely smelly dying foot.
We chopped off both those patients' legs. But that's still not my worst surgery, which was on a meth cook whose brew exploded all over him. His shirt melted into his back. The surgeon used a high-pressure water blade to strip all the dead skin until we could watch the blood flow through his vessels. We then used a nitrogen-powered blade to peel healthy skin from his legs and buttocks. I put these strips in a "meshing machine" to increase their surface area (to minimize the amount we have to remove) then we all played hours of skin Tetris, covering his exposed muscle with the grafts. By the end, everything around the OR table was covered in blood and bits of dead, slimy skin. I felt like no shower could rid me of the burned-skin smell.
Yet that's just an extreme version of what happens all the time ...
You Get Covered In So Many Body Fluids
Surgery techs take general precautions to protect themselves from getting splashed with too much body stuff. We wear scrubs, of course, masks, shoe coverings, and then sterile gowns and gloves. Sometimes, we wear goggles -- occasionally, even a full-head hood (or spacesuit, as it's sometimes called):
But even with over 90 percent of your body totally covered, things land on your exposed skin. I have lots of experience with various fluids on my face. Most, like tissue fluid and lymph, feel thin and greasy when they splash you. Synovial fluid, which surrounds joints, feels thicker and is yellowish and clear.
But, of course, blood is the most familiar fluid to a scrub tech, and it's the fluid most likely to get really intimate with you, thanks to the pressure it's under -- during one vascular procedure, arterial blood spurted out and hit me, going under my goggles and mask and into my mouth. We fixed the hole in the artery first, so it was probably five to 10 minutes before we were able to scrub out and take little mini showers. Luckily, the infection screenings came back negative.
I also get hit by tiny bone chips during orthopedic procedures if I'm not wearing my spacesuit. They nick my face and are always sharp and just pretty disgusting. And, occasionally, skin lands on my cheeks, and because it's so slimy and greasy, it's by far the worst. This last bit isn't always accidental ...
The Atmosphere's Somewhat Less Than Professional
Those bits of tissue and skin I talked about? The surgeons and techs regularly fling them at each other. We rub the stuff on each other's gowns, and when someone's wearing a hood, it's common to smear blood all over their face screen at the end of the surgery, to blind them. This doesn't risk infection, but it's gross, so the prankster finds it hilarious. We always make sure our patient is safe, but we still like to have some fun in the OR, so you don't know whether the next slimy thing you touch will be prank K-Y Jelly stuffed in your gown or a patient's severed chin.
Music always plays during surgeries. Surgeons say it helps them relax, but the volume screws with everything, keeping everyone from hearing each other when it's loudest. I switched one playlist to blare Marilyn Manson and ICP as a gag, but the joke backfired, since the surgeon pretty much enjoyed it. When we amputate a leg, I "walk" it over to the biohazard bin, pretending it's my own leg, for maximum humor. Professional? No, but when you work a job like this (that is, one in which you routinely handle severed limbs), you get laughs where you can.
Here's one of my favorite things to do: To kill time while waiting for cement to dry during a bone operation, we roll some spare cement in our hands, wait for it to stiffen and get superheated (the chemical reaction makes it red-hot), then add some human fat into a small hole in the center. The fat will entertainingly explode like a mini-firecracker.
Patients Under Anesthesia Still React
Anesthesia doesn't always just knock you right out. You've got your local anesthetics, of course, which just numb a small region, but even beyond that, anesthesia providers have a whole spectrum of anesthesia types, and patients don't always respond to them like you think they would. With skin grafts, for example, the patient is majorly sedated when they come in because of the massive trauma, but no matter how much propofol (or whatever the anesthesia provider uses), they still moan and tense during surgery, because they can subconsciously still feel you peeling their skin off.
With some joint surgeries, patients get one drug to dope them a little and another to block the pain, but nothing to knock them out, so they still move around slightly during surgery. This is usually done so that the patient can breathe on their own and revive easier after surgery, having never really gone to sleep. They'll move their hands around, definitely snore, and sometimes even talk.
They should feel no pain (usually they have a spinal and a nerve block), but occasionally they'll feel pressure. They don't remember that, though, thanks to another trick from the anesthetist. Anesthesia providers typically administer Versed, which relaxes the patient and erases their memories. Patients will never remember me, and they won't remember plopping onto the OR table. Once the Versed kicks in, the mind just gets wiped.
Once, a patient came in from a nursing home with a busted elbow. We couldn't intubate him because he had lung issues, and the nature of the operation meant we couldn't inject his spine. Instead, we gave him other drugs. During the surgery, he screamed and cried. It was probably the only time I've felt physically like vomiting in the OR -- we were ultimately helping the man, but we were causing him buckets of pain, and I still remember him weeping and begging us to stop. He definitely received his dose of Versed. I pray it worked and he remembers nothing.
Sometimes, We Skin Penises
We handle so much dick in this job. Guys just really like sticking their penises into things. Like, a man will get stuck masturbating with a wrench and then rush in, and the ER gets that off for him (diamond drill bits work very well, for those of you who may ever encounter this issue). Oh, they like sticking things into their penises, too. People I work with have seen thermometers stuck in penises, wires, beads ... I'm sure the list can go on and on; men obviously have a better imagination than I do.
But the really strange one was the man who came in with a fractured penis -- unlike with most fractured penises, he'd waited two years with his penis bent at almost a 90-degree angle. He'd met the surgeon various times but only finally opted for surgery because he and his wife wanted to conceive and figured the bend was interfering. Obviously the man was hesitant ... and with good reason. Because to begin the procedure, we degloved the penis. That means peeling off all the skin. Cracked previously covered degloving as something that's horrifying when it happens to your hands after you die, but congratulations: We also do it to your cock while you're still alive.
Next, we used suturing to pseudo-repair the rupture -- it was impossible to fully repair it at this stage, but this was enough to straighten the organ out. The doctor had never done this surgery on an adult, but he had performed a few on pediatric patients where they were born with a malformed penis. After we finished with the suture line, we tourniqueted the penis and injected it with saline to induce an erection. Then, as the only woman in the room, it was my duty to evaluate the erection's shape and overall quality. We replaced the skin, wrapped the whole thing in a penis turban dressing, and sent the lucky guy on his way.
I never saw that particular patient again, but hopefully all is well and they're on the road to having a baby. I'm not saying I'm the best judge of penises, but I suggest requesting a female scrub tech in every such surgery. Whether or not those surgeons leave the organ in working order, we'll make sure you or your loved one's penis is looking great before you leave!
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For more insider perspectives, check out Major Surgery With No Painkillers: 5 Things I Learned and 5 Things You Didn't Know Surgeons Do With Your Body.
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