Jesters Of The Operating Table
>> 24 July 2008
The other day, I enjoyed browsing and reading a blog that reminds me of my college days in nursing school. I remembered my first clinical exposure at the city hospital, a dead investment of the local government but as a whole all went well there. Exposure to specialized areas were supplemental although 4 other nursing schools were fighting for the chance to be expose not only to the specialized area but to infectious diseases as well. Private hospital experience was of great help for a little touch of the close-to-ideal setting. The much anticipated, by a student-nurse, psychiatric (in Manila) and orthopedic center affiliation. Photos were all lost by a careless computer technician. All I can do is reminisce on them but no matter how I try to describe every detail of the experience, the primitive human mind cannot quantify the quality of a memory without a mere image of it. Yet a very unusual experience might haunt you.And again I won't be talking about all the cheery happenings and the awe of the marvels of the human body and its vulnerability but rather I will be sharing the realities of health care in the third world. After the heated Vicente Sotto Hospital (Cebu City) Scandal early this year, the world made a different view on medical and allied health education in the country. The world saw a substandard, unethical, scandalous health provider. A jester of the operating table. Since childhood, I always want to become a physician but during my exposure at the clinical area I have seen too much bias and it seems I don't want to be like them. Does med school teach equality among the rich and the poor patients? Patients should recieve equal non biased quality health care no matter the variables are.
One incident of last year in X Medical Center, we were trying to complete our operating room cases for the board exams, a 14 yr. old mother was scheduled for a c-section due to dystocia and cephalopelvic disproportion, she was less than 5 feet, small women are at high risk of having this during labor. Probably an indigent from the outskirts of the province, she was too reluctant to climb the gurney for a short trip to the OB-Gyne OR. Our group was assigned at the Orthopedic OR. We've been there for ages assisting a bone doctor to amputate a bad leg. To suffice, first, the muscle tissues were transected then the bone was sawed through a oscillating saw. You can even feel the vibrations and see bone fragments thrown away by the saw. I feel my enamel ache as the surgeon sawed through the femur.
I was a student-circulating nurse at that time. My role was to conduct a sponge count from time to time and get what the surgical team needs outside the sterile field. I was asked to get a bag of IV in the main OR as I walked through the OB-Gyne OR the teenage mother was strapped on the operating table. Crucified and cut alive they say. The anesthetist had already run the anesthetics through the spine and the surgeon, an OB-Gyne had don her gloves. The way to the main OR was just a couple of meters away but I needed to slow down to keep me away from the sterile field. The scrub nurse passed the scalpel to the surgeon she took it and held it like holding a candle. And like a flame from a candle, it glistened as she twist it between her thumb and index finger.
Under a spinal anesthesia, in a c-section or any procedure that requires it, a patient is normally conscious. It blocks nerve transmission below the diaphragm thus, eliminating pain, motor signals and sensation. She already received spinal anesthesia a few minutes ago but something happened, an event that contradicted my personal values. The surgeon transversely swish the scalpel unto the patient's abdomen, sorting the skin from the fatty tissue. Surely, if I try to examine it with a tissue forceps jagged edges of fatty tissue possibly reveal the muscle tissues underneath. The patient was screaming in pain, she was hysterical. Then immediately, the anesthetist administered general anesthesia through a face mask to fully sedate the patient more likely to stop her from screaming and writhing. Her head dropped and loss consciousness in a matter of seconds. I was left dumbfounded. Confused. My mind was battling with the images I've seen in the OR. I stared at the newly born neonate in disbelief. My thoughts were gathered after receiving a pat on my shoulder. I wasn't frightened with the pat but rather the coldness of the hand touching my nape. It was my clinical instructor. That was the nastiest operation made by a licensed physician.
The neonate was in perfect condition after an hour of extra-uterine life. Finally, we took off our patient's leg and ready for closure. Right after the surgery, we cleaned all the instruments, mopped the floor and made our documentation. I remained silent for 2 hours of the entire shift. We took our dinner then I started to share what I saw earlier. My colleagues made a lot of assumptions about what I saw. Some said that the physicians might be upset or resentful for the 14 year old girl. Another colleague on her mid 30s said that she deserved that for being a slut, an ungrateful daughter to her parents. I never said a word during their argument. No matter what were the circumstances she's into, she deserved to be treated with dignity in her surgery. I always want to become a doctor but I don't want to be like them. Even right at this very moment, I can hear her screaming in excruciating pain. We've seen such scenarios like in House, M.D. but a patient has their rights. Nursing and medicine is humanity. We should maintain that notion for our profession is noble for its cause.
One incident of last year in X Medical Center, we were trying to complete our operating room cases for the board exams, a 14 yr. old mother was scheduled for a c-section due to dystocia and cephalopelvic disproportion, she was less than 5 feet, small women are at high risk of having this during labor. Probably an indigent from the outskirts of the province, she was too reluctant to climb the gurney for a short trip to the OB-Gyne OR. Our group was assigned at the Orthopedic OR. We've been there for ages assisting a bone doctor to amputate a bad leg. To suffice, first, the muscle tissues were transected then the bone was sawed through a oscillating saw. You can even feel the vibrations and see bone fragments thrown away by the saw. I feel my enamel ache as the surgeon sawed through the femur.
I was a student-circulating nurse at that time. My role was to conduct a sponge count from time to time and get what the surgical team needs outside the sterile field. I was asked to get a bag of IV in the main OR as I walked through the OB-Gyne OR the teenage mother was strapped on the operating table. Crucified and cut alive they say. The anesthetist had already run the anesthetics through the spine and the surgeon, an OB-Gyne had don her gloves. The way to the main OR was just a couple of meters away but I needed to slow down to keep me away from the sterile field. The scrub nurse passed the scalpel to the surgeon she took it and held it like holding a candle. And like a flame from a candle, it glistened as she twist it between her thumb and index finger.
Under a spinal anesthesia, in a c-section or any procedure that requires it, a patient is normally conscious. It blocks nerve transmission below the diaphragm thus, eliminating pain, motor signals and sensation. She already received spinal anesthesia a few minutes ago but something happened, an event that contradicted my personal values. The surgeon transversely swish the scalpel unto the patient's abdomen, sorting the skin from the fatty tissue. Surely, if I try to examine it with a tissue forceps jagged edges of fatty tissue possibly reveal the muscle tissues underneath. The patient was screaming in pain, she was hysterical. Then immediately, the anesthetist administered general anesthesia through a face mask to fully sedate the patient more likely to stop her from screaming and writhing. Her head dropped and loss consciousness in a matter of seconds. I was left dumbfounded. Confused. My mind was battling with the images I've seen in the OR. I stared at the newly born neonate in disbelief. My thoughts were gathered after receiving a pat on my shoulder. I wasn't frightened with the pat but rather the coldness of the hand touching my nape. It was my clinical instructor. That was the nastiest operation made by a licensed physician.
The neonate was in perfect condition after an hour of extra-uterine life. Finally, we took off our patient's leg and ready for closure. Right after the surgery, we cleaned all the instruments, mopped the floor and made our documentation. I remained silent for 2 hours of the entire shift. We took our dinner then I started to share what I saw earlier. My colleagues made a lot of assumptions about what I saw. Some said that the physicians might be upset or resentful for the 14 year old girl. Another colleague on her mid 30s said that she deserved that for being a slut, an ungrateful daughter to her parents. I never said a word during their argument. No matter what were the circumstances she's into, she deserved to be treated with dignity in her surgery. I always want to become a doctor but I don't want to be like them. Even right at this very moment, I can hear her screaming in excruciating pain. We've seen such scenarios like in House, M.D. but a patient has their rights. Nursing and medicine is humanity. We should maintain that notion for our profession is noble for its cause.
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