Inside the OR: On Amputations, Colossal Pimples and Bullet Trajectory 0 comments

There will always be stories that will follow us. From something we've read, watched on the news, gossiped from that overly chatty friend or witnessed with our own eyes. The thing about being an operating room nurse is that the events we witness everyday, and is considered as norm (even downright boring as I stare into my 6th Caesarian Section in an 8-hour graveyard shift) are the ones most people cringe and gasp upon. 

But then, at times, stories will come swinging through the semi-sterile double doors that even the most experienced of us will remember.

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A 20-something year old just lost his leg the day I was complaining about how I had no time to get a pedicure. A victim of a construction freak accident, his post-adolescent leg was permanently detached from his body. Now, we've seen countless of below-the-knee amputations and once we've gotten over the crude bone sawing, it was not a big deal. But the devastating and instantaneous effect of a single tragic event followed me the whole day from the moment I transferred out the patient to the ward and had to explain to the receiving nurse why a handful of relatives were crying over a BKA. The patient, himself, was in silent tears as he stared at the ceiling, waiting for his stretcher to be wheeled beside the ward bed, probably wondering the future that lays before him.

We've all been there. Thinking that something (or someone) will be with us until the end of our selfish existence, always available and conveniently at an arm's length away. Until they're not. And then the world feels like it has stopped turning as we stand, shell-shocked. I've pictured this in countless scenarios, but never one starring a body part. I guess we are all under the wrong impression that anything we are born with will stay with us to the grave.

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Burn patients. I would always cringe internally whenever I see and care for one. Not because I was repulsed by their appearance, with their scorched flaky skin that needs to be scrubbed off like a wood furniture in need of sandpaper, or the smell of burnt flesh, cloying in the air even after the procedure is done. I recoil on the inside because I could not fathom the pain, the prolonged discomfort and the life changing effects of deformity brought upon by seconds of misfortune.

Then I remember the time I looked in the mirror and saw a colossal pimple right at the center of my nose, red and angry at the world. Everyone at work noticed and made me feel like the most dermatologically ill-fated person in the country with stubborn pores rallying against me. Curse those blemish free goddesses with clear radiant skin and perfect bodies. Why can't I look like them? It turns out, luck was still on my side. Very much so.

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Running. When people inside the operating room are running, you know there are urgent matters need to be attended to. When people inside the operating room are running with a patient on a stretcher on tow, you know it's a matter of life and death.

We didn't even have time to properly set up a complete explore laparotomy / thoracotomy set when the patient came rushing in from the hospital corridor one minute after a hurried phone call from the emergency room. Middle adult male, gunshot wound through the chest. Someone continued CPR, another ran for the e-cart and ampules of Epinephrine. He was fluidly transferred to the OR table and surgery started immediately amidst the systematic chaos.

It only took less than half an hour before the surgeon proclaimed the inevitable and death certificates were arranged.

A father of children, a husband to a wife, a son to a mother. He was watching TV in their apartment's living room when hit by a stray bullet from a domestic fight near their home. Intraoperative findings revealed that the bullet tore through two of the chambers of his heart, obliterating any chances of survival.

I could hear his wife's agonized cry from outside of the operating room complex as I concentrated on the novel that was my nurse's notes. Too many thoughts poured through my mind. What a shock it must have been to find a loved one dying in the sanctuary of your own home. And what, in this world of unexplained phenomena, willed a stray bullet straight through a man's heart?

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It's a common quote: "I cried because I have no shoes, until I saw a man with no feet." We understand what it means, hell, we've read it on Facebook with matching depressing black and white photo of a pitiful looking man looking sullen. Some even clicked "Like".

And yet, do we really remember, as we whine about unreliable WiFi signal and complain about the bipolar weather? They say "Time is gold" and no one has ever really contested that fact, and yet, why are we throwing away valuable stones by the kilo by spending hours on Facebook and obsessing about how everyone's life is better than ours? Or sticking to mindless, purposeless routines because society tells us to do so, all the while forgetting to live our life, the life we truly want to live?

Because, whatever we are doing at this very moment, what makes us so sure that a bullet is not on its way?

Top 12 Signs You Are An Operating Room (OR) Nurse 0 comments

12. You have dry hands and you fear imminent varicose veins eruption in the very near future.

11. You can sleep while standing up then snap awake at a sound of an instrument's name being called.

10. You already have glove and suture brand preferences. (Mine's Gammex 6 1/2 Powder Free for toxic cases. Catgut, most reliabe Chromic we've used!)

9. "Mayo" is not a condiment, as "Army Navy" is not a burger joint nor a specialized government unit.

8. The sequence"OS, OS, Knife, Kelly, Kelly, Army Navy, Mayo.." means something to you.

7. You like suctioning blood clots. It's fun. Seriously.

6. You have touched / poked with a gloved finger a patient's intestine at one time or another (with the surgeon's permission) just for the experience of it.

5. You have witnessed how the weirdest things get stuck in people's orifices. 

4. You know and have experienced the TRUE meaning of "an itch that can't be scratched".

3. You're used to seeing people naked and has seen private parts of all shapes, colors and sizes.

2. The phrases "tusok o patong?", "lunok laway" and "labas dila" don't sound awkward at all.

...and the top sign you are an operating room nurse:

1. You have seen both the pinnacle of human stupidity (with some of the weirdest clients you've catered to) and mortal ingenuity (from the health care providers you have worked with) with each case that has come your way. And, personally, that is one of the reasons that make this profession a cut above the rest.

The Things One Learns From Regularly Seeing Bodies Sliced Open 0 comments

I was supposed to write this deep and profound (redundancy intentional) blog series about my 1 1/2 year experience working inside the Operating Room. I planned it to be hard-hitting stuff, life-changing even, the kind of articles that would make you think about one's purpose in this world, how people tend to put much value on the wrongest of things and complain about the most insignificant details, but for some reason, I couldn't find my Paulo-Coelho-meets-Mitch-Albom voice and, after several sessions of trying, is still incapable to write my own version of Tuesdays with The Alchemist. 

Instead, what keeps popping out of my head is this sarcastic Gossip Girl style voice which likes name-dropping popular authors and makes fun of everything. So be it. I'll make use of you.

So, what did I manage to soak up after months inside a place where only few have gone inside of, half of them on the table, anesthetized, and the other half literally running around the place just to properly run the place?

Crocs are best friends. They may look fugly outside the sterile section of the OR but inside, they are your feet's closest buddy. From standing in one place for hours at a time to jogging around the facility for the whole 8 hour shift to doing the Tinikling just to get out of the way of spilling blood during bloody operations, you'd be glad to have a comfy rubber barrier protecting your feet from bodily fluids that are not yours nor from a person you're in an intimate relationship with.

Babies are not as fragile as you think. They are actually very nimble and resilient. After witnessing and assisting in hundreds of Caesarian Sections, I'm pretty much convinced I could throw one out the window and it will survive the fall. (Just a figure of speech, please don't report me to Bantay Bata.)

It's never as horrifying as macabre movies present it to be. Replace the gloomy, oil-stained walls with clean tiles and a set sterile instruments instead of chainsaws and pliers and it's pretty much the same thing, intestines and blood everywhere. The difference only lies in the anesthesia, and the fact that no one ever screams and loses their appetite after a major operation. In fact, it's all you can do to not forget to wash your hands before attacking that waiting meal in the pantry.

Nudity loses... whatever effect it has when you're surrounded by it everyday. Now I  can understand how people can go people-watching in nudist beaches and find nothing out of the ordinary. Now, seeing a pregnant mother's labia majora is just like staring at an elbow. Well, the inner part of a flexed elbow, maybe.

Surgeons are also humans. They have different personalities and techniques, they make mistakes and perform miracles, they sleep on meticulously scrubbed floors and wear crinkled scrub suits to work. They are not self-proclaimed Gods some people assume them to be nor crazy overachievers like the ones in Grey's Anatomy who have sex in the janitor's closet. Okay, I'm not sure about the latter because we do not have janitor's closets to begin with but you get the point.

You never know what you got until it's gone. Sometimes, the simplest things are the most important ones. And ironically, these are the things we most often take for granted. Like, feet, for example. I mean, I like my feet, I take them to spas and pedicures every month. But I, you, and most people, don't go around saying "God, I feel so blessed to have these feet." because they've always been there, attached to your legs.  And then the next thing you know, you're witnessing someone get theirs sawed off because of a disease or a freak accident and the unthinkable possibilities that have never entered your mind seemed all too real and plausible. And trust me, it will make you stop ingesting sugar by the kilo. 

Nurse's Notes: 1 1/2 Years Shift 9 comments

OPERATING ROOM NOTES

(August 2011 - December 2012 Shift)

> In from bum life / office work via ward with fat pads stubbornly intact on hips, belly and on subcutaneous layers covering self

> With mental, physical and parental consent to work for 8 hours a day, 5 days a week, in the most random General Reliever shiftings possible

> Transferred into Post Anesthesia Care Unit, transferred out patients

> Scrubbed and gowned aseptically

> Hooked to ongoing operations with OS and instrument count repeatedly done with complete remarks

> Operations ended, post-op care to patients rendered  instruments repeatedly washed and packed.

> Ingested 386 units of 3-in-1 coffee 350 ml type Kopiko Brown Sugar, sipping well

> Above coffees consumed followed by 1,257 cases of Caesarian Section

> Kept alive and usefull to society

> Encouraged foot and leg exercises by circulating ongoing operations

> Referred to Dimsum with orders made, paid and eaten

> Referred back to self for further evaluation and management of further plans in life

> Emotional needs perfectly attended

> Endorsed to bum life/office work with stable happiness, with memories attached at heart :)

2012 in a Paragraph 5 comments

Because endings are beginnings and beginnings are both thrilling and exciting, like when you start the year with an optimistic view of the weeks and months to come because you are now employed, well okay, not technically because the "salary" is called an "allowance", nonetheless there is money to receive from someone other than your parents, but better than financial stability in a definite time frame from a one-year contract to work in a sterile area where you are unbelievably grateful to be in, there's the Whole New World of Romantic Possibilities and ending a long term relationship may very well be the best decision you did that past year and everything seems bright and fluffy and brimming with saccharine sweet potential, but it just so happen that things do not turn out the way you expect them to and the weeks and months thereafter are spent in a blur of monotonous routines where there is this inexplicable feeling of uneasiness and forced detachment from the world from not having to load your phone for a month because nobody cares and you know you sound like those whiny schoolgirls who can't go to the bathroom by themselves but that's just the way it is, but then, even though the clouds refuse to part for months, you get used to the shadows and the gloomy weather and see that playing in the rain is actually kind of fun if you're with the right people and then the days are great again and the emptiness is filled with chaotic schedules, operating room antics, hilarious friends and just life in general where you say to the world, with conviction, that goddamit you were born alone from your mother's womb and you can surely exist in peace and ecstasy all by yourself and then it feels like nothing was ever missing because this is just the way it should be, but then just when you least expect it, like a cold gust of wind, with rising orchestral background music, something happens, and your world is plunged into a whirlwind of coded phone book entries, late night rendezvous, tachycardia and butterflies hovering inside and around your digestive tract that you start to wonder if this is all real because it certainly feels like a scene from some movie or novel you've seen or read before or it may very well be just from your own imagination because you've thought about this numerous times but never actually believed it could actually happen in real non-fairy tale existence but then it IS real and here you go again back to the start and the possibilities are both exhilarating and downright terrifying and nothing is yet certain so you tiptoe around the facts and the paranoia and the daydream skits but then after a while, it's still there, more tangible than ever, and you think, we may have something here and you start to realize the reason and the purpose of all the things that have happened before, and you look up to the sky and say, "Hey, nice writing there," and then you're ready for the next chapter...

Inside the Operating Room: The Sterile R.N. 4 comments

They stand at the end of the line, near the foot of the bed, away from the action. While everyone is looking one way, a lone entity looks at another, fussing over a table littered with blood streaked instruments. They are the quiet ones often pushed at the end of the field while a handful of assists grapple with retractors and bang each other's heads for a good view of the action. 

They are the silent ones with roving eyes and reeling minds, mentally counting sponges and having that mini heart attack whenever one is nowhere to be found. They are consistently the first on the scene to set up the suite and the last one to go after the patient has been transferred to the recovery room. Then even after that, there are the myriad of instruments to be washed, dried and packed for sterilization. 

While surgeons battle their inflamed appendices, myomas, gallbladders, cysts and a variety of infected tissues, scrub nurses are in combat with a different kind of villains. Each and every one has his/her own share of "Kelly. KELLY!!!" scenario, unavailable sutures, deaf moments, missing sponges and unfamiliar instrument names of unknown origin and appearance. 

Truth is, no patient nor relative is going to thank a scrub nurse for a successful operation. In fact, they are rarely seen by those they serve. Hidden behind masks, the drowsiness of anesthetized patients, and commonly in the shadows of the operating theater lights and the egos of more important people, one could easily underestimate the utmost significance of that unassuming person scrubbed in at the end of the table, waiting to serve.

To assist selflessly as the heroes work their magic in battling the forces of internal anomalies is a trademark of all dedicated scrub nurses. Never mind the grumbling stomach, clogged nose, full bladders, aching feet and, by god, the varicose veins. Never mind the burn out of assisting in a 6-hour operation, doing post-op care to the patient and yet still have 2 trolleys full of used instruments to wash, dry and pack.

Because then, where would surgeons be without their scrub nurses? Where would Aladin be without his Genie? Bruce Wayne without his ever loyal Alfred? Frodo without Sam? Harry Potter without Ron and Hermione? Nemo without Dory? Edward Cullen without his hypoallergenic foundation and body glitter?

A successful major operation is achieved not by individual brilliance nor state of the art equipment. It is by teamwork that lives are saved and souls are once again tethered to this mortal coil. Heroes may swing and punch and flex their bulging muscles, but it is the keepers of the weapons, among others, who help them succeed in their sacred endeavor.

The clanging of swords in a mid-century war clashing for freedom or territory rings the same bell as the resounding clink of scattered steel instruments in a mayo table in battling stubborn bleeders and messed up anatomy. We are all fighting the same war, saving the same lives. And the scrub nurse plays a crucial role in the struggle, even without the spotlight. 

Inside the Operating Room: An Introduction 2 comments

Blood. There is blood everywhere. On the floor, pooling in basins, dripping from sponges and coating once glimmering stainless steel instruments. Smoke lazily floats up the room as the smell of burning flesh lingers in the air, cloying, at times suffocating. A monitor is beeping incessantly at one corner of the room, wires and cables extending from its body like a robotic creature happily entangling its prey. 

The room is filled with aliens. Or maybe not, but they sure look like extraterrestrial beings. Or maybe those specialists who cater to ones. All suited up, capped and masked, with rubberized hands. They talk with invisible mouths, their eyes being the only windows to their souls. Assuming each of them has one.

And in the middle, a body. Lying down, immobile and strapped up. A tube protruding from its mouth, and its intestine poking out from its torso. A plastic suction tube held by one of those rubber hands slurps out excess fluid as a variety of metal clamps stick out from the abdominal hole like some grotesque part of a Saw torture chamber.

Buzz. Smoke. Clamp. Tie. Suture.

Stitch, stitch, stitch.

The scene may seem like an empty mechanical show of technical procedures, but behind every needle bite is a disease and behind every disease is a person, and behind every person is a story. 

These are the stories that I would never have witnessed anywhere else. 

This familiar shiny hallway and these tiled rooms have witnessed much of people's weaknesses, but also humanity's unwavering strength, more than any other places in the world. To be a spectator a midst all the action, suspense, drama and comedy have undoubtedly shaped me more than I can explain and have made me view things in a different lense. Things may not appear brighter nor more colorful, but they do extract sense and importance in this world governed by misplaced priorities and the pursuit of temporary bliss.

Future related posts in this series will tell stories not my own, but of life's complexities that only presents itself in the most trying of times. No paper-pushing routine job, even the highest paid ones, could mirror this front-seat view on the unadulterated, barefaced truths of our existence. And this is why I wouldn't exchange this experience for the glitz of a more glamorous job.

So, who am I?

I am an OR Nurse. And I have stories to tell.