Well, I made it through another week. It was a big one!
Tuesday we had clinicals and, since I had my OR trip last week, it was my first week this semester with a patient. I'm at the same hospital as last semester but on a new floor, and it was my first taste of how different each hospital floor can really be. I'd become accustomed to the floor we were on last semester and this one was a lot quieter, I'd say - but we'll see if I feel the same way after a few more weeks.
Of course I can't talk about my client, but I can say that I gave my first injection! It was a subcutaneous heparin injection. My instructor was there supervising, of course, and started quizzing me. "Do you aspirate a subq injection?" "No." "Do you massage after giving a subq injection?" "No." At this point the client joined in: "why not?" He didn't say this in a challenging way; rather, I'm pretty sure he knew the answer and just wanted to be part of the quizzing process. I was a bit flustered and answered something like "because it's a subq injection" (which, let's be fair, is of course how I memorized it for the test), but my prof came back with "come on, why wouldn't you massage a heparin injection?" at which point I had gathered my wits a bit and was able to reply "because it's a blood thinner and you could damage the tissue." Prof and client both satisfied, I gave the injection. It was a success! He even said it didn't hurt. And I don't think he would have said that just to make me feel good (although you never know).
Once everything was taken care of and we left the room to document, I actually did a bit of a bounce. I gave my first injection! It was really exciting for me. I was so apprehensive to begin with, just because it seemed so serious - sticking a needle in someone is not a small matter - but I did it and it was ok and he was fine and everything worked out. I feel like it's areal milestone of some sort. Hurrah!
We also had our first exam this week. I was quite apprehensive (new professor, new exam style!) but it turns out I got a 49/50, so I'm pretty happy. Hoo-rah! And that is after my cell phone/alarm clock turned off overnight before the exam and I woke up 5 minutes before I had planned to leave the house. (That is NOT a good way to start an exam morning. Let me tell you what. The level of adrenaline I had rushing through my body was intense. It was, however, a good review of the stages of stress that were on the exam.)
Thursday, February 10, 2011
Tuesday, February 1, 2011
Second Semester - Week Three (the OR visit!)
We've completed our third week of nursing school! On a Tuesday night, you might ask? That's a bit quick on the draw. Well, see, we have this thing in Chicago right now called a "blizzard" so school was canceled from today at 2PM all through tomorrow. I'll still have microbiology on Thursday, but that's not nursing class, so I consider it a true statement.
The snow is not without it's drama - oh believe you me, it is not. I have Tuesday morning clinicals and I was on tenterhooks, hoping with all my might it wouldn't be canceled. I realize it sounds slightly overzealous to be that eager for clinicals, but that's because today was my day to observe an OR procedure. Due to the OR schedule not everyone in our group would be able to observe one, and I managed to draw a lucky piece of paper. The idea that I'd lose out on my one chance due to weather was so appalling that it actually kept me up the night before. Luckily the roads were clear until well after our clinicals were over, so we were all set to go.
The procedure for OR observation is that we meet the person from the OR in the lobby at 7:30, and they bring us to the rooms. (Technically the first thing is that they tell you to make sure you eat breakfast - it helps keep people from feeling sick, apparently.) I was observing as well as another student from a different instructor's group, so we met in the lobby and stood around awkwardly for a while waiting for our contact. Once she arrived we hit our first roadblock - lots of surgeries had been canceled due to the impending blizzard, so she wasn't sure what kind of surgery we'd be able to see.
We got to the OR area and our contact brought us to our locker rooms and instructed us to change into our disposable clean outfits, grab a head covering (called a bonnet, not a "hair mask" which is what I came up with before I learned the proper term), and meet her on the other side of the locker room. I got dressed and as they only had mediums, I had to tuck my shirt in and tie my pants incredibly tightly. I am not size medium, as you can see.
Once we were suitably dressed (shoe covers were provided on the other side, as it were), we proceeded to the OR room. We put on our masks and went in. The client was already anesthetized and they were prepping him. This included putting foam all around him for stability, taping the foam all up, putting his legs in boots that were actually SCDs (to prevent deep vein thrombosis), putting blankets and a specific actual warming machine on him, and then covering all parts of him except the part being operated on. Really nothing is visible at all, and clearly that is safest for the patient but it was strange to watch happen. Like a magician and a disappearing act. It was fascinating (and I might use that word a lot, here) to watch the transition - the team worked together so well, and knew exactly what they were doing, all these procedures and processes that seemed arcane and confusing to me. Everyone had a role and was busy so I definitely didn't want to interrupt to ask questions at this point, although we did have chances to later.
Also during the setup, I noticed some tubing (I think for suction but I'm not positive) coiled on the floor and was concerned that it might be a trip hazard. As someone coming from a computer and technology background, those are the sorts of things I'm primed to notice - and lots of time I'm the only one who does. In this case, though, almost as soon as I noticed, the anesthetist put a towel over them, flattening them out and making it safe. That impressed me.
Once the client was ready, the robot was pushed into place. The procedure we were viewing was a robotic prostatectomy, so the first thing was making the incisions for the robot arms, camera, lights, etc. Based on what I've been told I assume this is when most people feel faint or sick, and I had been curious to know if I'd have that sort of reaction, but I didn't. We'd been given instructions on what to do if we felt like we were going to faint (go stand against the far wall so if you do, you fall safely and no one has to break sterility), but I know I never felt close and I don't think the other student did either.
Once the robot was ready, one of the surgeons went to the controls (which looked like a big virtual-reality console as imagined 20 years ago) and the other surgeon stood with the client. The scrub nurse was assisting as requested and needed, maintaining sterility, but she also did a fantastic job of answering our questions and making sure we could see the monitors. We had two different circulating nurses at different times, and they also did a great job of answering our questions as well. I didn't get to talk to the anesthetist, unfortunately. But just watching how the team worked together was great.
Watching the surgeons and scrub nurse in action was so interesting. Sterile fields are something we see on TV and in movies, with surgeons being gowned and gloved and people walking around with their hands above their waists, but it's just a bit more real to see it in person. I was quite interested and impressed by how it seemed so natural to all of them. The nurse was quite good at manipulating the environment without using her hands (she was a pro at moving the stool with her feet). I was also quite interested to see how they all had sterile ways of doing other things - there was a towel she could use to move a monitor, for instance, and they had handles to attach to the lights so that the sterile people could still move them. Certain pieces of machinery (for instance the carbon dioxide machine) had plastic over the front of it, so the surgeons and scrub nurse were the ones manipulating that, but things like the sterile water for irrigation and the suction tubing didn't, so the circulating nurse was responsible for that. I wondered if they set up practice rooms for new scrub nurses and for new medical students, so you can practice sterile procedure and someone, I don't know, presses a buzzer whenever you do something that would contaminate you.
The client was having his pelvic lymph nodes removed as well as his prostate, so the surgeons removed the lymph nodes first. Lymph nodes are kind of sticky, it seemed like. Watching the robot journey through the body was amazing. It was like the Magic Schoolbus, but with more robot arms and blood. We hadn't really had a briefing on what all the robotic instruments did, but I was able to figure it out. There was one just for grabbing, one for more dexterous grabbing (which was also later used for suturing - suturing! with tiny robot hands!), one that cauterized, one that irrigated, one for suction, and scissors (which, I learned later, also cauterized). The combined effect of the irrigation and the cauterization? Made it look like there was weather in the body - it looked like mist, or fog, blowing around in the body cavity. Brilliant. I also learned that they inflate the body cavity with carbon dioxide, to give more working room. The surgeons would request different levels of inflation at various points, based on what was happening at the time. Which was also really interesting to me.
One thing I found out is that the robotic prostatectomy is much safer than the open prostatectomy - not only for the normal reasons of lesser chance of infection and quicker recovery time, but because the nerves controlling sexual function and urinary function are attached to the prostate area. During open prostatectomies these are often severed, even though the surgeons do their best not to, just due to the greater size of the instruments and less level of available detail. The robotic procedure, on the other hand, actually peels the nerves away from the prostate, which gives a much greater chance for leaving the nerves intact. A thoroughly convincing benefit, I'm sure everyone will agree.
The procedure took about 3 hours and it was amazing how much was accomplished with minimal disruption to the body. I think the weirdest part was seeing the actual removed items come out - they put the items in a little bag, which closes, and then gets pulled out. I asked if anyone ever asked to keep anything that's removed but I was told that the specimens get sent to pathology for testing. When the prostate was removed, we actually got to put gloves on and hold it and see if we could feel the cancer. (I don't really know what prostates are supposed to feel like, so the answer was no, I couldn't tell where the cancer was.)
Once the client was waking up we got to see the anesthetist in action. She asked the client to wiggle his toes, open his mouth, and then put an oxygen mask on him. His oxygen levels were a bit low so she kept having to ask him to take some deep breaths until it went back to normal, but that happened quickly so it really went quite smoothly. The client was understandably groggy and was quickly transferred onto a bed to bring him to the recovery room. I felt very lucky in that one of the nurses asked me to help with the transfer from OR table to bed! I helped! It was a great feeling, very triumphant.
After that we talked a little more with the nurses and surgeons, and made sure we had all the information we needed to write our reports for class. Everyone was great and I feel so incredibly lucky that I got to have this experience. I am now wondering if I want to be an OR nurse, and that's saying something. It was definitely one of the more interesting experiences of my life.
In other news, the blizzard is in full force outside and I actually heard some of the hospital staff talking about the preparations they were making, which is funny since I then read about the same preparations here. I am safe inside with my studying and actually have already finished some homework and studying, and while there is plenty more to be done I feel confident I'll be ready in time for our exam (which was scheduled for next Monday, but due to classes being canceled tomorrow, will now be on Wednesday). I should probably write my microbiology lab report first thing in the morning, though.
Goodnight, all. I'm going to fall asleep listening to the thundersnow. (Thundersnow! An operation! What a day!)
The snow is not without it's drama - oh believe you me, it is not. I have Tuesday morning clinicals and I was on tenterhooks, hoping with all my might it wouldn't be canceled. I realize it sounds slightly overzealous to be that eager for clinicals, but that's because today was my day to observe an OR procedure. Due to the OR schedule not everyone in our group would be able to observe one, and I managed to draw a lucky piece of paper. The idea that I'd lose out on my one chance due to weather was so appalling that it actually kept me up the night before. Luckily the roads were clear until well after our clinicals were over, so we were all set to go.
The procedure for OR observation is that we meet the person from the OR in the lobby at 7:30, and they bring us to the rooms. (Technically the first thing is that they tell you to make sure you eat breakfast - it helps keep people from feeling sick, apparently.) I was observing as well as another student from a different instructor's group, so we met in the lobby and stood around awkwardly for a while waiting for our contact. Once she arrived we hit our first roadblock - lots of surgeries had been canceled due to the impending blizzard, so she wasn't sure what kind of surgery we'd be able to see.
We got to the OR area and our contact brought us to our locker rooms and instructed us to change into our disposable clean outfits, grab a head covering (called a bonnet, not a "hair mask" which is what I came up with before I learned the proper term), and meet her on the other side of the locker room. I got dressed and as they only had mediums, I had to tuck my shirt in and tie my pants incredibly tightly. I am not size medium, as you can see.
Once we were suitably dressed (shoe covers were provided on the other side, as it were), we proceeded to the OR room. We put on our masks and went in. The client was already anesthetized and they were prepping him. This included putting foam all around him for stability, taping the foam all up, putting his legs in boots that were actually SCDs (to prevent deep vein thrombosis), putting blankets and a specific actual warming machine on him, and then covering all parts of him except the part being operated on. Really nothing is visible at all, and clearly that is safest for the patient but it was strange to watch happen. Like a magician and a disappearing act. It was fascinating (and I might use that word a lot, here) to watch the transition - the team worked together so well, and knew exactly what they were doing, all these procedures and processes that seemed arcane and confusing to me. Everyone had a role and was busy so I definitely didn't want to interrupt to ask questions at this point, although we did have chances to later.
Also during the setup, I noticed some tubing (I think for suction but I'm not positive) coiled on the floor and was concerned that it might be a trip hazard. As someone coming from a computer and technology background, those are the sorts of things I'm primed to notice - and lots of time I'm the only one who does. In this case, though, almost as soon as I noticed, the anesthetist put a towel over them, flattening them out and making it safe. That impressed me.
Once the client was ready, the robot was pushed into place. The procedure we were viewing was a robotic prostatectomy, so the first thing was making the incisions for the robot arms, camera, lights, etc. Based on what I've been told I assume this is when most people feel faint or sick, and I had been curious to know if I'd have that sort of reaction, but I didn't. We'd been given instructions on what to do if we felt like we were going to faint (go stand against the far wall so if you do, you fall safely and no one has to break sterility), but I know I never felt close and I don't think the other student did either.
Once the robot was ready, one of the surgeons went to the controls (which looked like a big virtual-reality console as imagined 20 years ago) and the other surgeon stood with the client. The scrub nurse was assisting as requested and needed, maintaining sterility, but she also did a fantastic job of answering our questions and making sure we could see the monitors. We had two different circulating nurses at different times, and they also did a great job of answering our questions as well. I didn't get to talk to the anesthetist, unfortunately. But just watching how the team worked together was great.
Watching the surgeons and scrub nurse in action was so interesting. Sterile fields are something we see on TV and in movies, with surgeons being gowned and gloved and people walking around with their hands above their waists, but it's just a bit more real to see it in person. I was quite interested and impressed by how it seemed so natural to all of them. The nurse was quite good at manipulating the environment without using her hands (she was a pro at moving the stool with her feet). I was also quite interested to see how they all had sterile ways of doing other things - there was a towel she could use to move a monitor, for instance, and they had handles to attach to the lights so that the sterile people could still move them. Certain pieces of machinery (for instance the carbon dioxide machine) had plastic over the front of it, so the surgeons and scrub nurse were the ones manipulating that, but things like the sterile water for irrigation and the suction tubing didn't, so the circulating nurse was responsible for that. I wondered if they set up practice rooms for new scrub nurses and for new medical students, so you can practice sterile procedure and someone, I don't know, presses a buzzer whenever you do something that would contaminate you.
The client was having his pelvic lymph nodes removed as well as his prostate, so the surgeons removed the lymph nodes first. Lymph nodes are kind of sticky, it seemed like. Watching the robot journey through the body was amazing. It was like the Magic Schoolbus, but with more robot arms and blood. We hadn't really had a briefing on what all the robotic instruments did, but I was able to figure it out. There was one just for grabbing, one for more dexterous grabbing (which was also later used for suturing - suturing! with tiny robot hands!), one that cauterized, one that irrigated, one for suction, and scissors (which, I learned later, also cauterized). The combined effect of the irrigation and the cauterization? Made it look like there was weather in the body - it looked like mist, or fog, blowing around in the body cavity. Brilliant. I also learned that they inflate the body cavity with carbon dioxide, to give more working room. The surgeons would request different levels of inflation at various points, based on what was happening at the time. Which was also really interesting to me.
One thing I found out is that the robotic prostatectomy is much safer than the open prostatectomy - not only for the normal reasons of lesser chance of infection and quicker recovery time, but because the nerves controlling sexual function and urinary function are attached to the prostate area. During open prostatectomies these are often severed, even though the surgeons do their best not to, just due to the greater size of the instruments and less level of available detail. The robotic procedure, on the other hand, actually peels the nerves away from the prostate, which gives a much greater chance for leaving the nerves intact. A thoroughly convincing benefit, I'm sure everyone will agree.
The procedure took about 3 hours and it was amazing how much was accomplished with minimal disruption to the body. I think the weirdest part was seeing the actual removed items come out - they put the items in a little bag, which closes, and then gets pulled out. I asked if anyone ever asked to keep anything that's removed but I was told that the specimens get sent to pathology for testing. When the prostate was removed, we actually got to put gloves on and hold it and see if we could feel the cancer. (I don't really know what prostates are supposed to feel like, so the answer was no, I couldn't tell where the cancer was.)
Once the client was waking up we got to see the anesthetist in action. She asked the client to wiggle his toes, open his mouth, and then put an oxygen mask on him. His oxygen levels were a bit low so she kept having to ask him to take some deep breaths until it went back to normal, but that happened quickly so it really went quite smoothly. The client was understandably groggy and was quickly transferred onto a bed to bring him to the recovery room. I felt very lucky in that one of the nurses asked me to help with the transfer from OR table to bed! I helped! It was a great feeling, very triumphant.
After that we talked a little more with the nurses and surgeons, and made sure we had all the information we needed to write our reports for class. Everyone was great and I feel so incredibly lucky that I got to have this experience. I am now wondering if I want to be an OR nurse, and that's saying something. It was definitely one of the more interesting experiences of my life.
In other news, the blizzard is in full force outside and I actually heard some of the hospital staff talking about the preparations they were making, which is funny since I then read about the same preparations here. I am safe inside with my studying and actually have already finished some homework and studying, and while there is plenty more to be done I feel confident I'll be ready in time for our exam (which was scheduled for next Monday, but due to classes being canceled tomorrow, will now be on Wednesday). I should probably write my microbiology lab report first thing in the morning, though.
Goodnight, all. I'm going to fall asleep listening to the thundersnow. (Thundersnow! An operation! What a day!)
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