The Operating Room exists as a separate entity within the grander scheme of the hospital. I mean, like its own universe, really. It is indeed part of the greater culture of ANY Hospital, but the OR environment contains its own separate and peculiar atmosphere, linguistics, tools, habitat, and a unique care commodity – surgery, and the anesthesia and nursing necessary to get the job done.
In what other department in a hospital do people come to work in their street clothes and then change into pajamas? And talk to each other behind masks? Where else besides maybe the morgue is the temperature of the workplace just a tad above perfect for chilling a case of brewskies? And where besides the OR can the majority of the female workers cringe as they leave work for fear that someone may see their hat hair, a unique and freakishly sad-looking phenomenon that occurs after stuffing one’s hair into a small shower cap for eight consecutive hours (think pillow-crushed Cyndi Lauper-type morning hair on Betty Boop).
Operations can be scheduled days or weeks in advance, or emergently added onto the OR schedule if there is urgent need. This does not distinguish the Operating Room from other units in the hospital that encounter emergency situations, but it does add the OR services to the short list of personnel who live at high alert, even red alert, at all times.
Every OR has a mission control desk, also known as the Brain of the department. Every decision that is made passes through here. Usually equipped with a public address system and enough phones to make someone happy, The Desk will determine what, when, and who goes where, why, and how. It’s all about flow. A very confusing place.
The patients that pass through the OR department are visitors for the day, for varying lengths of time, and although some will be repeat offenders, most zoom out almost as quickly as they are launched into the OR universe.
Their first stop is the OR holding or admitting area, where the stretchers of patients line up assembly-line style. Yes, indeed, it can look a wee bit impersonal on the surface, but each patient is greeted, ID’d, interviewed, evaluated, reassured, and comforted, if need be. Several times. By representatives from the departments of surgery, anesthesia, and nursing. No patient should enter the OR suites until the myriad of checklists, standards, and consents have been processed.
The patient is then wheeled to the OR suite. Invoking the word “suite” is probably a misnomer, but it’s a throwback to early surgical terminology, and it sounds so much kinder and gentler than “the room where you get sliced.”
Surgery, anesthesia, and nursing must cohabitate in the OR arena. The surgeon is romantically considered the “captain of the ship” – but all three disciplines need to be in control of their practices, techniques, and actions. The OR scrub nurse, dressed in sterile gloves and gown, not only assists the physician with the performing of the operation, but is a critical second set of senses and sensibilities for the surgeon. The circulating nurse is not sterile, and can basically run all over the place ‘preventing and putting out fires’ so to speak, plus answer cell phones and pagers while making sure that the surgical team has everything they need and all instrument and sponge counts are correct. Good OR nurses are really like poetry in motion – they make it all happen.
The tools used by OR culture are cold and metallic, razor sharp, clamp-like, and can burn human flesh. They have funny names like army/navy, sweethearts, clamps, forceps, scissors, scalpels, hooks and retractors. Nothing warm and fuzzy. It’s icy and it’s precise. And it’s all sterile.
Anesthesia lives at the head of the bed, territorially-speaking, and doesn’t do much besides make sure that the patient is properly anesthetized and stays alive and unharmed. And if you think that’s an easy task, you must have slept through your education.
Not to be left unmentioned are the ancillary staff: the unsung heroes who clean each and every OR suite at case’s end (not always a pretty job); and the anesthesia technicians who keep everything well stocked and in working shape for the anesthesia providers.
The operating room universe can be a big place (ours has 14 operating suites and loads of personnel), but many people refer to their co-workers as “my OR family,” no matter what the size. In a world where its very existence cannot occur without cooperative effort and clear, concise interactions, the OR family all must learn to get along, and play nicely.
Such is life in the OR universe. What a long, strange trip it’s been!