Theatre Musings

In the US, the operating theatre is known as a place where surgeons can “get away” from their patients. I know this sounds funny, but once the patient is anesthetized (put to sleep), and draped, to the surgeon, the “person” isn’t there anymore. What you have in front of you is a small window of skin, a canvas, if you will. This is why after the initial shock of seeing blood in the OR, that revulsion simply disappears for most people, as the blood doesn’t seem to be coming from a person who is in pain, but rather from a sterile field. I’m not saying that surgeons don’t still feel a great deal or responsibility for the person whom they saw in clinic, or with whom they discussed the risks and benefits of surgery, etc., but there is a certain remove once in the OR, as the patient is not conscious (there are exceptions, but this is the general rule).

In the OR where I’ve been working, very few cases are done under general anesthesia; most are spinal, so the patient is wide awake. This is something that I’m slowly growing accustomed to as I practice drawing blood and placing IVs on conscious patients; it’s strange to knowingly inflict pain on another person. However, the idea of being deep inside of someone’s abdomen while chatting with him just bizarre.

During some surgeries, especially ones with a lot of organ manipulation, the patient will actually moan in pain or give an “oww!” in Swahili! This usually encourages some sedative to take the edge off, but because the patient is lying on their back, there’s no opportunity to give more spinal anesthesia. There’s a real intimacy in knowing that a patient can hear everything that you say while you’re operating, and in being able to speak with and comfort patients at the same time.

This is something that we take for granted in the US. I’ve seen surgeons throw instruments across the room because the sedation was too light and the patient’s leg moved once or twice, though was still completely unconscious. Surgeons tend to let conversations wander; from “Hey Suzie, can you please call my wife and tell her that I talked to the plumber and he’s coming over this afternoon?”, to “I can’t believe that the Bachelorette chose Mark!” to things I cannot write in mixed company. I participate in this banter as well, and especially in urology, you can imagine that conversation tends towards juvenile jokes pretty quickly. While I’m not advocating surgery while patients are thrashing around, it might not be a bad thing to be occasionally reminded that you’re working on a person under those drapes.