As I’ve written previously, I’ve
been working in the OR for a little over 2 years. It has been a wild
ride learning the ins and outs of surgical nursing. While the OR here
is similar to the one I worked in before, there are distinct
differences. Since this is my first time with Mercy Ships, I’ve been
learning how their operating rooms (or theatres as the Brits call it)…
well… operate.
I was understandably nervous on the first day of surgery. Not many people know what happens
behind our doors so I thought I would share what my typical day is like.
I’ll think you’ll discover, as I have, that it is anything but
typical.
My day begins pretty early. After
doing some morning exercise (either running or the exercise class in the
International Lounge), a shower, and daily devotions, I head to the
Dining Room on Deck 4 for breakfast around 0700. On Mondays, the whole
ship has a meeting at 0730. We celebrate new arrivals and say farewell
to those departing. All meetings have the potential to be boring, but
we can’t help but be entertained when each one is themed. This last
Monday was Star Wars Monday and guess who wore the appropriate cap for
the occasion!
No matter what day it is, we have a team brief at 0800 in our
assigned operating room. We meet together (nurses, surgeons, and
anesthetists), introduce ourselves, and discuss each of our patients for
the day– what their specific needs are, supplies and equipment we’ll
need, how their case might be challenging. Back home, we didn’t have
team briefs and now I’m a firm believer in them. It has decreased the
potential for miscommunication between team members and it is a casual
reminder that each of our patients is a person with hopes and fears.
Before you think, “Well, duh!”, I can’t tell you how easy it can be to
forget that there is a human being under those sterile drapes. I love
that we start the day talking about them and then praying for them as a
team!
Tuesdays have become my favorite day in the OR for one reason– weekly
devotions. After our team briefs, everyone who works in the OR (from
those who wield a scalpel to those who sterilize the instruments) gather
and worship together. After we sing, one of our team members shares a
devotional– something that has been on their heart recently. This last
week, Sue, the team leader for Max Fax shared how she conversationally
prays with the Lord and how God sees us. I’m going to share in a future
blog all that God has been teaching me. He is speaking and I’m finally
listening!
From there, the nurses in the room split into 3 different roles:
Circulator, Scrub Nurse, and 2nd Circulator/Assist. My routine for the
day depends on what role I choose.
Circulator:
When anesthesia says that their machines are ready, they give me the
green light to bring my patient to the room. The Africa Mercy has hired
Day Crew who help with everything from cleaning to mechanical repairs
to translating. In the OR, we have been blessed with four Day Crew
members who assist with translating and turnover (cleaning) of our
rooms. All of them served during Madagascar #1 and shared that their
experience on board changed their lives for the better.
The OR Day Crew is the best!! (From Left to Right: Yvette, Me, Elisa, Odon)
The majority of our patients speak primarily Malagasy. They may
speak French, but that isn’t always a guarantee. I speak neither
language so that’s why I couldn’t do my job without our fantastic
translators. They help us communicate our care when we can’t.
The circulator and a translator goes to the Ward on the other side of
the ship and locate our patient. We conduct a pre-procedural
questionnaire confirming their identity and surgery. Once all the i’s
are dotted and t’s crossed, I ask the patient if they’d like us to pray
for them and if so, would they like the translator or myself to pray.
Surprisingly, most of the time they choose the nurse to pray for them.
They don’t care if they can understand what is prayed– they just want
prayer from someone who cares.
The operating theatre hallway
We walk the patient to one of our 5 operating rooms and have them lay
on the bed. Almost all of our patients have never had surgery before.
This is a scary experience for them. Back home I would have reassured
them with my words, but I’ve had to develop my reassuring touch instead.
Once again, our translators are vital to our patients’ safety and
comfort.
The circulating nurse assists anesthesia with sedating and intubating
(putting a breathing tube in) the patient. When the patient is asleep,
we position and prep (paint solution on the surgical site) the patient
for their procedure. When the surgeons are gowned and gloved, we
perform a time out confirming the patient and procedure again. Another
distinct departure is that some of the surgeons pray for the patient and
the team before making incision.
During the procedure, the circulator charts, opens sterile supplies
for the scrub nurse, and ensures all the equipment functions properly.
When the surgery is finished, we pull the drapes down and help
anesthesia with waking up the patient and extubating (pulling out the
breathing tube). Do you know how confusing it can be when you wake up
in a hotel room away from home? Well, imagine what it is like for our
patients! Our translators help us calm our patients through some wild
wake-ups!
We transfer the patient to a stretcher (or trolley) and transport
them to the Post-Anesthesia Care Unit (PACU) down the hall. If they are
a baby, we get to carry them to PACU–yes, please and thank you!
Once report has been given to the PACU nurse, we return to the room
to help clean it in preparation for the next patient. We repeat this
process until all the scheduled cases for the day are complete.
Scrub Nurse:
After laying out my sterile gown and gloves, I go out to the hall to scrub my hands and arms up to the elbow.
The 5 minute scrub may seem tedious, but I’ve used the time to hum a
worship song or pray silently for our patients. There have been a few
days where I can hear the Malagasy Day Crew singing worship songs to the
patients on the Ward.
After gowning and gloving myself, I begin to set up my back table and
mayo stand. The last 2 weeks, I’ve been assigned to Max Fax. At first
I was afraid (in fact I was petrified) that I wouldn’t know the
instruments because I’ve never scrubbed these cases before. You may not
know this, but there are hundreds of instruments and they all have
specific uses and may have different names depending on the surgeon.
Although this is true here, I’ve been able to quickly learn which is
which.
While the circulator helps the patient on the bed, the second
circulator counts everything with me. (We don’t want anything left
behind in the patient.) As soon as the patient is positioned and
prepped, I begin to drape the patient so only the surgical field is
visible. We timeout, pray, and surgery begins. The surgeon asks for
something and I pass it to him. He uses it and hands it back. He asks
for something different and I pass it to him. It sounds simple, but
what the best scrub nurses learn is how to anticipate the surgeon’s
needs and hand him the right instrument before he even has time to ask
for it.
When the surgery is finishing, I count everything again with the
second circulator and start cleaning up. Once the patient is out of the
room and on their way to PACU, I take the instruments to
decontamination where they will be cleaned and sterilized. I repeat this
process until all the cases for the day are finished.
The thing to keep in mind is that once you are scrubbed in, you are
scrubbed for the rest of the surgery. If a case goes through lunch
time, I have the circulator set aside a food plate for me to eat later.
Second Circulator/Assist:
My first week here, I was in general surgery doing hernia repairs.
God was looking out for me because I am super comfortable in general
cases– they are the type of surgeries that new OR nurses start with.
However, it was my first time fulfilling the Assist role- helping the
surgeon retract (hold open the incision/cavity). Someday, I hope to
study to become a registered nurse first assist (RNFA) who helps the
surgeon with performing the surgery. This was my first small taste of
it.
The last few weeks, we’ve been blessed to have two surgeons in each
room so a nurse assist isn’t really needed. The second circulator,
however, assists everyone in the room. I act as the second set of
non-sterile, but clean hands. While the circulator is focused on the
patient, I can help the scrub nurse with drawing up medications and
counting.
Monday through Friday, our shift is from 0800-1700. If we are on
call and cases are going past 5pm, we need to eat dinner early and take
over for those not on call. When I’m on call, I carry a pager until
0800 the next morning. If any patient needs emergency surgery, I might
be called in to work. On the weekends, we are on call from 0800 to 0800
the next day (24 hours!) But it really isn’t bad– I haven’t been
called in yet.
At the end of the day, I make sure my room is set up for an emergency
case and the supplies for the cases tomorrow are bagged up and ready.
If I’m free at 5pm, I can have dinner and free time until bedtime.
Which reminds me, as I write this, it is way past mine! I better wrap
this up and get some zzzzzz’s for tomorrow.
Stop! Prayer Request Time!
- Healing (both physically and psychologically) for our patients. Many of our patients are here for face deforming tumors. They are learning to see themselves with a new face after surgery. Pray that they would have continued hope for their futures and to realize that there is a God who loves them no matter how they look.
- It’s a holiday weekend so most of the crew is going to be traveling in the city and throughout Madagascar- pray for safe travels and good health- no bed bugs, malaria, rabies, or sand fleas!
- God has been sharing some amazing insights with me– I hope to share some of them with you all soon. Pray that I will know and follow what He wants me to do in the future.
Photo Credit Katie Keegan – Hospital Crew in front of the AFM
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