Friday, November 2, 2007

Talk in the OR

I'm going to try to give you a glimpse of what we talk about in the operating room. Let me make it clear that if you take me to a party I am the "wall flower" type. Something happens in the operating room and I engage in conversation much more so than elsewhere. I love talking to the crew (male or female). So let me give you a brief introduction:

Yesterday I had 4.5 hours of surgery (two surgeries) to do in the operating room. We won't go into what type. My crew at the outpatient surgery center included four other women, ages 42 yrs to 58 years. One has two children, 1 yr and 3 yr. One has a daughter in nursing school. One has middle school and high school children and is involve in a divorce. One has grown children and a couple of grandchildren. Me, I have my dog, nieces & nephews, and neighbor's children.

The first patient sets the stage for our early conversation. As she is falling asleep, she comments "You're playing my song. How cool!" The radio was very low, but she heard Jimmy Buffett singing MargariteVille.

So after "tucking" her in we move on to my niece and sister winning the trip from said radio station to New Zealand to see Elton John in concert. From there to music we enjoy. Singers who could sing anything and we would love it. The ones with voices that just soothe. For me Dean Martin, another agrees. For another it is Willie Nelson.

We move on to Halloween. Did anyone have many or any trick-or-treaters? None of us did. The one with small children tells us about their costumes--bumble bee (1 yr old) and "mean army man" (her 3 yr son's description of himself). She describes their outing, shows pictures on her cell phone. I tell them of my two trick-or-treaters. I only ever have two--my neighbors children (girl 6 and boy 10). She was Elvira. He was a ghoul with these wonderful fake hands with loong fingers! I mention how my neighbors allow me to make goodies (popcorn balls, candied applies, brownies--different each year) for their children. We comment on how different Halloween is from our youth.

We catch up on mutual friends. A CRNA we all know recently had a BCCA removed from her upper lip. She is big on her looks (and she is very pretty) so was depressed while healing but is in better spirits now. I ask if they knew that MG's father-in-law had pancreatic cancer in addition to his esophageal cancer. It is a second primary cancer. We talk about the family fighting that is already beginning about his estate. MG has told me that some of the siblings and their wives are rumbling about the dad's business he "gave" to MG and her husband. The truth is that MG and husband bought it from the dad. The CRNA in the room mentions that her husband's grandmother recently passed. No family squabbles there, but they have had to be careful going through the house. Apparently the grandmother, having grown up during the Depression, had a habit of putting money away in odd places (books, the odd jar, etc).

School sports get some time. The mother with teenage children comments on how serious some parents take the games. She dislikes the intensity of this and is "anti" sports. I and another couple of the women, while not condoning the parents behavior, defend sports. We had gotten a lot from playing --learned how to work as a team, to show up for games and practice, etc. This somehow leads to talking about the apparent increase in number of teachers these days who seem to get involved with their students. We all agree that for us, the female teachers that engage in the this behavior are worse than the men. We try to analyze ourselves and decide it is because we think those women should be more nourishing and so we hold them to a higher standard. (yes, we are sexist).

Food gets a great deal of time. Which restaurant is the surgery center (no internal cafeteria) ordering take-out from today? Did you remember to put your request in? Have you tried their spinach-blueberry salad? Comments are made on places we have eaten lately, good dishes we had, restaurants that we forgot about and need to revisit. One comments about a recipe she found in the local newspaper a while back--Elvis Presley Pound Cake. Tells us how good it is. Promises to make one for us and bring us the recipe. Talk about Thanksgiving food. How do you do your turkey? One has a large deep fryer and tells about deep frying turkeys, offers to do one for another of the girls. Offer accepted. Cornbread dressing or no--its split.

Comments are made about the hostage situation that happened the day before in the small town of Bee Branch, Arkansas. A man had taken his ex-wife and 4 yo daughter hostage with a knife. The situation had lasted 14 hours. He had held the knife to his DAUGHTER's neck to get his ex-wife's attention. We are all outraged and saddened. We think he must be crazy. We decide we would rather think that he is mental unhealthy rather than just mean. This leads to a discussion of the poor infrastructure of our state's (and nation's) mental healthcare.

We go back to mutual friends. Anyone seen or heard from MR since she left? Is she still liking her work over at the VA? Sure miss her. What about JS? Sent her a birthday card with phone number and e-mail, but haven't heard from her. (well, I guess I could pick up the phone and call) Someone has heard that P is unhappy. Someone comments that sometimes it's not the place, but the person.

We talk about nursing school. The daughter in school is being talked into a PhD in nursing by her instructors. I ask why one would want a PhD in nursing? What does she want to do--teach? The mother says her daughter is really good with patients, loves geriatrics. I ask if she'll be able to do patient care with a PhD or will she be told "You're over qualified."? I suggest (and I know I may be wrong here) that she might want to look into nurse practioner or physician assistant degree. I give her a name of a nurse practioner I know who I think would be willing to talk to her daughter.

We get off on cleavage and heels. I comment that I think that little "jiggle" at the top of the breast is lovely and difficult to get with implants. (If you don't know what I mean, take at look at Jennifer Love-Hewitt in the Hanes bra commercial) The woman with the 17 yr daughter comments that she thinks (for 17 yr) her daughter wants to wear her neckline too low [the old mother-daughter conflict]. We all comment on our own comfort level for neckline. I never undo more than one button on a button-down shirt. E says she goes for three. Wow! I just don't have the nerve. Heels get coverage. We all agree that they make our legs look better. We all agree that we can comfortably do 2-2.5 inch heels, but over 3 inches gets very uncomfortable to our feet. I relate to them the name for stilettos I learned from a Boston scrub nurse during my plastic surgery residency--"FMP's" One asks what that means--"F*ck Me Pumps" I reply. I tell them that I now (the prude that I am) have a hard time wearing heels that are very high without thinking about that. The things that get stuck in your head.

I try to tell them about blogs (though Dr Rob does a much better job). What is that? I tell them about a few of the ones I read--the Gyn from Manhattan (TBTAM), the radiologist from India, the scrub tech who loves trauma, the ER nurse, the general surgeon in Africa just to mention a few. The "loves trauma " makes us all review how we enjoyed it before our bodies complained so much the next day. The reference to Africa makes us remember the Pediatric cardio-thoracic surgeon we had here a few years ago who committed suicide on Christmas Day. It makes us sad, the loss, the failure of medicine to adequately treat his long history of depression.

So there is a glimpse of the conversation that we had yesterday. My husband often asks me what we talked about in the OR. I find it hard to retell. I'm not at all sure that you will get the true flavor. I enjoy being there. Somehow the mask, the place, loosens my tongue more than any drink can do. All this and the patient still gets our attention. When necessary, all talk ceases.

9 comments:

jmb said...

What an interesting post R. We all know from TV that non-related conversation does go on, but here we see some not scripted by someone paid to write it and maybe not really having a clue.
regards
jmb

The Happy Hospitalist said...

I remember years ago in undergrad, I had an ACL repaired with an epidural; I was fully awake

The words that still stick in my mind in the middle of surgery with AC/DC blasting the the back ground, was my surgeon saying:

If I won the lottery tomorrow, I would quit.

I see nothing has changed in 15 years, only worse with the current reimbursment models out there.

Bongi said...

i must say, theater (or) talk is almost never about the work at hand, unless of course all hell has broken loose.

nice post.

make mine trauma said...

What a great idea for a post! Nice capture of how the conversations evolve and morph.
With some of those topics it would have been interesting to have a man in the room! He would have added a whole new perspective to the "jiggle" and the "FMP's"

Thank you so much for the mention.

rlbates said...

Thanks to all of you.

Happy-when my patients are awake we try to include them in the conversation. It helps distract them from the noises (suctions, cautery, etc) and the smells (cautery burning tissue).

Bongi--how true, unless there is a student of some kind (medical, nursing, etc) who asks questions.

Make Mine--yes, the conversations are often different when the crew is a mixture of men and women. Adds another flavor.

Femail doc said...

This post makes me think about how I feel about flight attendants chattering about this that and the other during flights. Very reassured--if they're not worried, then no need for me to be.

I'd like to think that the atmosphere in any OR in which I was under the knife was light and comfortable, "oh well just another day when we've knocked someone's lights out, taken control of their breathing, and now we're digging around in their innards. So what's on the menu today and how's your grandkid?" Truly, I find it reassuring!

Thanks RLB!

Jeffrey said...

excellent post.
how abt pimping medical students? ;)

Sid Schwab said...

A good representation of how it is. I also like doing locals, and talking with the patient. Sometimes describing what I'm doing ( at least warning when things will happen; but mainly about whatever the patient feels like discussing...)

ckel1 said...

Sounds like a rerun of MASH 4007