SurgeXperiences 213

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Welcome to SurgeXperiences 213.
We begin our journey as infants, and who better to help busy mothers care for their newborns than a Maternity Nanny as described here on nursery jobs blog. As a maternity nanny, I am sure that you are trained to recognize pregnancy myths and legends, as are ultrasound technologists. But don't be fooled by this story recounted at Baby Lifestyles, it may become legendary but it is no urban legend.
There are many educational toys for children these days. Is your child showing an interest in medicine? Surgery? Well here are not one, but two games to help develop that interest, and all you need is a certain cell phone and a little cash.
As children grow, it seems they need a lot of sleep. Nap time seems to disappear as they enter grade school. Or does it? According to the popular website Slate, nap time seems to return with a graduate education but here's the downside. (While those pesky residents are napping, I'll steal their cases!)
Who better qualified to provide one with the ultimate nap than an anaesthesiologist? Perhaps a stingy one who doesn't like to share their drugs. An unfortunate, and hopefully uncommon occurrence among anaesthesia providers is discussed by our very own, Resident Anesthesiologist Guy, in One Strike You're Out.
Speaking of anaesthesia.....here is a post from a patient from the site, Disabled World. Describing his fears of general anaesthesia from induction to emergence in, My First Experience With Surgery, he offers some constructive criticism for health care providers to make the surgical experience more productive and less stressful for all involved.
Not all procedures require general anaesthesia. In, Live From Surgery Part 3, Robert recounts his third surgical visit for the treatment of varicose veins, complete with photos.
If you like photos of surgery, you're gonna' love the next four submissions from Oystein, a Norwegian medical videographer at The Sterile Eye. It's snowing at his blog but these videos will warm you up. Beware! Not for the faint at heart.....
1. Esophageal dilatation.
2. Gastroscopy.
3. Gastrectomy. (My personal favorite!)
4. Hepatic artery embolization.
Speaking of sites not for the faint of heart, our next story comes from Dr. Cris at Scalpel's Edge. Dr Cris shares her experience of being involved in an organ donation surgery and explains why that experience prompted her to become a registered organ donor.
If you are awaiting an organ transplant, you would hope for the very best surgeon to perform the procedure. Bongi relays to us why being The Best, or at least believing that of yourself as a surgeon, is important. Being the best surgeon also means that you would never perform unnecessary surgery on a patient and you realize that textbooks are meant to be a guide. Still, some aspiring surgeons seem to have never even read a textbook! In Bongi's third submission, Doctors For Africa, we see that standards for doctors vary geographically. At least she got one right, well sorta' . I bet she was thinking, Mama said there'd be days like this. Unfortunately, her mistakes involved people, not sewing machines and quilts.
Speaking of penises, 911 doc at MDOD recounts a story of A Surgeon with a Pair, yet the surgery may never have happened if 911 hadn't followed his instincts and ordered an abdominal CT.
Speaking of pairs......Vijay, aka the scan man, offers us a series on ultrasonography and scrotal swelling. This has gotta hurt no matter what age you are. I will present them here in what I hope is a logical order. Casebook 6-testicular torsion, casebook 7-acute orchitis, mind map-testicular torsion, and casebook 8-hydrocele, hematocele and pyocele.
And now, surgeons in the news.
Barack Obama's consideration for surgeon general.
A retired surgeon wins an Ironman competition.
And the Cleveland Clinic hosts the nations first face transplant.
I believe a face transplant is still considered plastic surgery and not transplant surgery, so here are some more plastics tidbits. The UK says the US is addicted to plastic surgery. It must be true because we even buy plastic surgery for the dead!
So we reach the end of our journey. Our prime behind us, we strive to grow gracefully into old age. Some of us just don't know when enough is enough. Would you let a 100 year old neurosurgeon operate on your brain? That is the age old question. Watch this video then you decide!
"Best of " lists seem to be popular at years end so I leave you with a few "Top 10 (50 and 100) lists."
Top 50 Eastern Medicine Blogs
Top 50 Medical Ethics Blogs
100 Helpful Resources for dealing with Crohn's Disease
and,
Top 10 Incredible Self Surgeries

Thank you for joining me in this edition of SurgeXperiences.
Wishing you all peaceful holidays,
MMT
SurgeXperiences is a blog carnival about surgical blogs, wherein surgical experiences are shared. It is open to all (surgeon, nurse, anesthesia, patient, radiologist, pathologist, etc) who have a surgical blog or article to submit. The next edition of SurgeXperiences (214) will be hosted by Dr. Bruce Campbell at "Reflections in a Head Mirror" on Jan 4, 2 weeks from now. Be sure to submit your post via this form.

The 12 days of Christmas

I was recently invited by Medblog Addict to participate in her latest creative endeavor, The 12 Days of Christmas (I will link you here with the first day if you promise to read the rest!). If you have never visited her blog, you are in for a treat. She is known for her Calendar Doc series and has branched out to include interviews of non-MD medical types, including EMT's, RN's and yes, even Surgical First Assistants, among others, to compliment her voyeuristic addictions. It's a hoot, it's great fun, and it's seasonally festive. Check it out!

Reply to September Email

I am so, so bad. This past September I received this question in my in-box.

"Which do you think is a better choice? Surgical Technology or LPN?

I know that some LPN's are restricted from the hospitals, but there are other areas they can work. In your honest opinion, would it be wiser to stay in surgical technology for the few months of general educations classes I have had, or LPN?

I have been researching & it seems as if surgical technologists are a little more limited . LPN's can scrub also. My school has LPN (15 mos) + add'l 18 mos to become an RN. Which route do you think is wiser. I can not get many other opinions. I just don't want to continue with surgical tech if later I may possibly want to go to nursing school.

What state are you in? What is the difference in pay for LPN & Surgical Technologist?

Thanks again..."

Well, I have finally gotten around to answering. I apologize profusely for the delay and hope my opinion isn't arriving after the fact. Not that I believe my opinion should have a major influence. What is right for me may not be right for others. I can only inform you from my limited experience and knowledge of nursing.
I think the first question you might want to ask yourself is, do I enjoy interacting with people on a very personal level? For myself, I am a sociophobe, well o.k. not quite, but I am much more comfortable caring for someone that is asleep, or at least sedated, than I am caring for someone who is awake, alert, and oriented. Another question may be, do I want to stay in the O.R. and scrub all the time, or would I like to someday work in a doctors office, pain clinic, public health clinic, clinical trial, research facility, emergency room, etc., etc., etc. ? You are correct in your observation that techs are limited. While there are some opportunities to assist as a tech in a doctors clinic with some minor office procedures (vein disease treatments come to mind), surgical technologists are pretty much confined to the surgical setting. You may work at major trauma center where you are required to take call and work occasional holidays and weekends, or a small ambulatory surgery center with weekends off, holidays off, and you never have to be on call ( how boring is that?).
Wages for techs will vary with hospitals and duties. Trauma techs will make more than those who do not scrub trauma. Some hospitals offer techs monetary incentive, say an additional 10%, to be team leaders in the various specialties, such as ortho, neuro, etc. If you take call, you can expect to make anywhere between two (hopefully that has increased) to six dollars an hour just to carry the pager, and then bank time and half if you are called in. Many surgeons are willing to pay nicely for a private scrub. By knowing a surgeons routine and having everything needed for every case, every time, private scrubs can save a surgeon a lot of time and frustration. Given all of these factors, the salary range can be anywhere from $13.00 an hour starting, to as much as $30.00 an hour (so I've been told, but not seen) as a private scrub.
You are also correct in stating that an LPN can scrub. At least as far as I know. I used to work with one who did scrub. I don't know the exact going rate for LPN's but my guess is going to be ballpark range from $20.00 new grad to $30/35.00 an hour top out? Anybody? Wages will probably be higher on both coasts (ie. NYC or SF), in major cities, and through a nurses union perhaps. Again the question is how much do you want to scrub? Is that all you want to do? If you are an LPN, it has been my experience in the O.R. that nurses will be circulating, running the front desk, maybe even helping in pre and post-op when staff is short handed, and usually NOT scrubbing. In effect, nurses will be employed as nurses and not techs. There are some areas and hospitals that are of a mind to use only scrub nurses. However, as you have seen, technologists are generally cheaper.
Let me say this, I have not researched the different scopes of practice for LPN, APN, NP, or RN. I would say that if you are going to go to nursing school, get your RN. Do it all at once and you shouldn't regret it. Take it from me, it is a lot harder to go back and finish something after you've left school than it is to just "get 'er done!" and if you really want to be a nurse, I think RN is probably the way to go.
I don't know what your ST curriculum is, but if you are unsure about scrubbing, maybe you can stay in the program until you begin clinicals. I have mentored my share of students and clinical cases seem to be the make or break point for many. The notion of being in the O.R. may seem very romantic and thrilling until you smell poop from the inside out, or get a strangers blood tattooed across your eye protection or worse yet, soaked through your scrub pants. It is often nothing like they imagined. For others, it is exactly as they imagined and they can't get enough. You may never truly know unless you try it. If clinicals are definitive enough it will make your decision very clear. If you choose RN, hopefully the didactic portion of your tech program will transfer, A & P, microbiology, gen. ed. credits etc. Personally, for me, I have no inclination to become a nurse. I love being in the sterile field and I never want to leave the operating room. As an assist, I am doing exactly what I was meant to do.
If any one else has anything to add, please feel free. I can only speak from my own experience and I am not up on nursing privileges or restrictions and I am too lazy to research it!
Alright, I did look here and see that I was pretty generous with the LPN wage . According to this LPN ranges from $17-21.00 based on a fourty hour work week. I think you can make that as a Surgical Technologist. Seems an RN averages about 58% more in salary. Yeah, I say go for the RN if you don't love scrubbing.

SurgeXperiences

Visit SurgeXperiences 212 hosted by The Sandman at Quietus Leo.
I will be hosting the next edition of SurgeXperiences on December 21st. Deadline for submissions is midnight on Friday, December 19th. Be sure to submit your post via this form.
It has been quite a while since I've done this so I may be a bit rusty, bear with me. I have been lurking regularly enough to know that some hosts like to sport a theme. I am not that clever nor organized so I will not be asking for themed posts. So, post as you are!

Shout Out

Dr. Ramona Bates has combined two of the many things she is excellent at, quilting and compassion, and has created a wonderful quilt which is being auctioned on line to benefit a wonderful charity, The Childhood Brain Tumor Foundation. Please visit Ramona's blog, Suture for a Living to learn more about how you may bid on the quilt or simply make a donation to the Foundation.

Odd, wierd, crazy?

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I have a bit of trouble with dyslexia, at least I think that is what it is. I don't have trouble reading or writing or learning, per se, but on many occasions I will read something a thousand times as one thing and then, all of a sudden, one day, something makes me look at the same printed word just a little bit differently and it takes on a new meaning altogether. Some words will appear as total jibberish and I must concentrate intensely to unscramble it in my brain. This is a big problem with medical terminology. I know what the word means, I can spell it, I can write it, (well except for the letters b, d and p- I always have to pause and think about which way the loop faces on the stem) and more often than not, I can pronounce it correctly with in the confines of my synapses, but when forced to speak it out loud, it will not roll out of my memory and into my mouth correctly. Often times I will resort to a lay term instead, hiding safely behind a simpler pronunciation. I realize that this doesn't exactly project intelligence when conversing with other health care professionals. Lately I have taken to prefacing my sentence with..."I'm not going to pronounce this correctly, but..." when I want to use a grown-up word. Most people on the other end are more than happy to jump in and show off the fact that it is easy for them to say. The saddest part is that hearing someone else pronounce a word doesn't necessarily help me pronounce it. I seem to speak a bit dyslexic also.

I have a worse time with numbers. Once I remember a number, I usually don't forget it (duh) but recite four digits to me and if asked to recall them later, I will invariably transpose one or more of them. Thirteen-fifty-eight (1358), becomes fifteen-thirty-eight (1538), etc.
I also have an interesting thing that happens with colors. Not all colors or even random colors, but specifically red and green. No, I am not color blind. Apparently I am color dyslexic too. If I see a red vehicle and I am asked to recall what color that vehicle was, I will be POSITIVE that it was green. The reverse is true for recalling a green vehicle as red. This isn't specific to vehicles, it could be the color of a sweater or a sticky note or almost anything. Fortunately it doesn't happen with items that known to be a specific color such as grass or blood or traffic lights.

I could write a whole chapter on my food rituals, but I'll spare you. Besides, I don't think it has anything to do with the topic of this post. There was this one incident though that is interesting, well at least to me, this whole post is probably so NOT interesting to the rest of you, but indulge me. So, I had made two pieces of toast with almond butter and blueberry preserves. As is often the case, I was eating it while I paced around the kitchen (don't ask). I had both pieces of toast on a napkin in my hand while wandering around the room entranced in deep thought of some sort. I would take a bite, chew and pace, switch pieces, take a bite, chew and pace. Switch pieces, take a bite, chew and pace. Did I mention I have food rituals? The idea is to eat all of the crust of both pieces first so that your final two savory bites are the heavily laden, softest center of the toast. Somewhere in mid-chew, I looked down at the toast in my hand and the toast in the napkin. I laid both pieces down on the table for a better comparison.
Toast twins! Even though I was not paying attention and was alternating between the two pieces, I had managed to take bites from the exact same locations in the exact same sequence. I know, amazing only to me. It would be more interesting if ...say! Isn't that an image of the Virgin Mary in the piece on the right?!

Just a Matter of Time

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Well, it finally happened. It was just a matter of time before it happened. But it was a Thursday afternoon, a scheduled case. It's not like it was a sultry trauma rendezvous in the middle of the night! Just a simple, standard double incisional hernia repair with mesh. Booked for an hour and a half, but I knew from experience it would take longer. So why did I optimistically fudge the time when *FTS called to have me come meet him at 1530? I knew I would be later but I told him it should be about 1630 before I would be done. "Not a problem." he says. "Just come over when you're done and see where I'm at."

We finally made incision at 1445'ish on our hernia patient. I calculated in my mind that we would not be done before 1700 but I hoped for the best. The clock was on the wall behind me, and while time usually has no bounds for me in the OR, this day I could feel each passing moment. The (other trauma) surgeon even asked me, "What time is he starting his case?"
"Supposed to start at 1530, but you know what that means, start time will probably be closer to 1600." Even as I said it, I didn't feel it to be true. Somehow I was sure they would start on time at the other hospital.
"You'll be done by five, don't you think?" I asked. To which he enthusiastically shook his head yes.
First hernia (at an old ostomy site) reduced, cleaned up, meshed and closed, we moved on to the second, a smaller peri-umbilical, mid-line, incisional hernia. I resisted the urge to look over my right shoulder at the clock. As is often the case, the area of defect was larger than anticipated. Well, I anticipated it, but that's more akin to Murphy's law than medicine.
After placing the mesh, tacking it down in four "corners" and sewing one side of it in, we switched places and moved to the opposite sides of the patient. Although I already had resigned myself to missing the sigmoid resection with my FTS (he was on ER call this day, not trauma), I couldn't resist a peek at the clock. Almost 1700. As was expected, we would finish close to 1730.

As soon as the wound was closed, I broke scrub and called the other hospital. I asked to be put through to the room my FTS was working in. The phone was, as usual, on auto-answer so when I identified myself and asked if he was still working, the room could hear the conversation. While the nurse was trying to explain to me that he was closing, I could hear him in the background. "Tell her she's fired! She missed my case and I'll never, ever work with her again."
This is a running joke with us because he knows that I can't say no, and when, or if I do miss a case or call day, I get anxious fearing that he (or they) will stop asking me to assist. Of course I know that this is not true, especially with him. Still he knows I always have that sliver of doubt so he likes to tease me.
"Tell him not to say that! He knows I'll believe him!" I yell through the phone with a smile.
"Nope, it's too late, she's fired. Well, right after this open appy I have to do next. She can help with that if she wants. Then she's fired."
I tell the nurse I'll be over shortly.

After I arrive and change into scrubs I seek him out in the ER. "I came to beg for my job back!" I tell him.
He almost seems hurt when he asks what took so long on the hernia case and tells me he really could have used my help. I didn't have an answer for him except that the defect was larger than expected. Even as I spoke the words, it felt like a weak excuse. He turned to the chart he had in front of him and I told him I would wait upstairs. Before I turned to go I told him, "It was just a matter of time before I got caught cheating on one trauma surgeon with another!"

*favorite trauma surgeon

Slowly coming back to life.

photo from freephotos.com
I have had an extended vacation it seems from blogging. I've barely been lurking. I do actually feel sort of rested and ready to work my way back into posting. A few things have happened since my last entry.
I did, in fact, take my first assist certification test. I took it over three weeks ago and I still don't have my test score back. I have been told that they had the preliminary results and "I should be
pleased.." I am assuming that it means that at least I passed. I was
told that I would have my certification card in the mail by the end of last week, but that hasn't happened yet either. So here I sit, still waiting.
I bought a BlackBerry. My Razor was dying a prolonged, painful death as the result of one too many falls to the O.R. floor. It was fond of blacking out for no apparent reason and periodically begging me to check it's SIM card. I think it was trying to tell me that it's heart was giving out. I took the hint. I don't have a clue regarding the full extent of BlackBerry capabilities yet, but what I have discovered so far, I like.
I have assisted on 46 cases since my last blog entry.
I missed the last two SurgeXperiences, edition 209 and 210. I was supposed to host 211 but many, many thanks to "M" for stepping up. I was starting to panic because it is due to be published on November 23 and I will be spending November 22 in house and on call for trauma. (Have I mentioned how deadlines make me anxious?) It could always be a mellow night of call but it is Saturday night and the weather has been super mild for this time of year. In fact, I am on call for trauma 6 nights this week. The seventh night is ortho call. I don't know how students and residents can keep up so well with blogging and their careers/studies. I think I am horrible at time management. I know I am great at procrastination. I think that is why I like surgery so much, as an assist, I don't have to plan it, it plans itself and I just show up. I don't decide what time to allot to it and there are no excuses to put it off, they call, I go. Muddling through my billing paperwork is another story.
I have become a 1099 employee (a bit like contract labor) for a large local orthopaedic group. I actually started about two months ago. Sounds like a big deal but I only really work with three of the orthopods there. They were surgeons I already worked with and now it is just a different pay and billing arrangement.
I did a quick peek at what search phrases brought visitors to my blog, and I have discovered that there are some men out there worried about their hand size. "depressed size of hands", "what is a small hand for a man" and "man with small hands" all showed up as keyword searches leading to my post. I hope the size of my hands hasn't pushed anyone over the edge.

I'll be back....

My apologies to my two (!) faithful followers, my assorted lurkers, and those whose email I promised to answer in the form of a new post. I have exactly six days left to "cram" for my first assist certification test, and for the last month or so, I have been procrastinating on other events in my life. You know, like paying bills, exercising, cleaning house, creating posts, etc.
All I have left to do is review anatomy by drawing structures I am unsure of, reviewing the 200-300 index flash cards I have created, and retaking the practice test one last time. I've had a pretty lax call schedule of late but I have been crazy busy with scheduled cases. This coming week is just the opposite, six call days but a light surgery schedule. Barnes and Nobles has reserved a seat for me to study in.
I love taking tests, I just hate being unprepared!

Customer Loyalty Program

Quite a while ago, I posted about my Trauma Hopes and Dreams . Almost a full year later, and nothing has come about as far as a position with Trauma Services. There is constant discussion among them as to how to change the way things are currently done , but no solution has been reached. There was talk of reducing the trauma shift from 24 hrs to 12, but that just means twice as many call days. The latest suggestion was to hire someone to handle the critical care of patients in the ICU. This made sense to me until one of the docs explained it as if the trauma surgeons would be the ones taking critical care call. ? I'm sure I don't understand any of it. All I know is that my FTS recently threatened to give up trauma next spring if something didn't change. Say it ain't so!! I practically pleaded with him not to give it up for purely selfish reasons which, of course he understood, but it seemed his mind was made up.

As I mentioned in my post last year, my FTS has come to depend on me. The bond has strengthened throughout the year. He's thankful when I am there for trauma because he says, "You calm me down." He jokes with me that I cannot desert him when he is on call. I plan my "life" (as if I really have one!) around his call schedule. There are two other trauma surgeons who have remained loyal to me (my group of five down to three) but on rare occasions, I have been known to tell those two that I am not available.
A few weeks ago I jokingly, or not so jokingly, told FTS that they should just give me a trauma pager and I would stay in-house when he is on call. Subconsciously I guess I was hoping that if I could make his call nights just a little but easier, maybe he wouldn't give them up. He really liked that idea. I really like the idea. In fact, I'm excited to implement the plan but he is gone for two weeks. It will be near the end of the month before it happens. Of course, while he is gone, I can see how it goes with the other two surgeons. Schedule permitting, I can stay in-house on week nights. Friday and Saturday nights will be easiest, and in fact may be all I need to commit to because those are historically the busiest trauma nights. With winter coming on soon, being in-house is a lot safer than me trying to get to the hospital in a hurry from home. Yeah, the more I think about it, the more I like it!
Friday, while assisting FTS on a right hemi-colectomy (he also uses me when he is on ER call and for scheduled cases during the week), he mentioned that due to some new financial obligations, he would NOT be giving up trauma call anytime soon. I made him repeat it twice. I'd like to think it had something to do with me, but I know better. No matter, I am just psyched that he will be remaining on the call schedule!
All three of these trauma surgeons still promote me to the chief. I know they are trying to find a way to compensate me when assisting on indigent and sum dood trauma patients. And while I may never have a paid position with Trauma Services, I know that I will always have a job with at least one of the trauma surgeons.

Take a look at these hands.

These aren't so manly, are they?

I wear a size eight glove. Only a few of the male surgeons I work with wear gloves as large as mine, and I'm not aware of any other females who do. Often times, when I finish scrubbing first and enter the room before the surgeon, the scrub tech will try to give me the smaller pair of gloves, assuming that a female must wear the smaller size. This stereotypical division of size according to gender also occurs in restaurants. If I am out with a male friend and we both order the same item, whether it be steak or dessert, the larger portion will always be given to the man. This recently happened with a dessert and when I pointed out to the server that my friends portion was bigger than mine, she suggested I trade him. Since the plate had already been set down in front of him, my food compulsions (oh yeah, they go way beyond simply not allowing certain foods to touch each other!) would not allow this.
A good friend of mine recently began calling me "Man Hands." Anytime we give each other a ration of shit he says "O.K. M.H." While I was out of the room, one of the surgeons finally asked him what M.H. stood for. My friend informed him that it meant Man Hands and suggested the surgeon call me that also. Well, as you can imagine, size eight hands don't belong to a demure, petite, fawn-like Barbie. I'm a full six-foot-zero and while I'm not heavy, I'm big enough to take care of myself. When he told the surgeon to call me Man Hands, the surgeon replied, " I guess it's O.K. to call her that, as long as she doesn't mind!"
The funny side of the nickname is that famous Seinfeld episode, Bizarro Jerry where Jerry dates the woman with Man Hands.



The practical side of the nickname is the fact that large hands are often a blessing in surgery. In ortho I assisted on a proximal humerus fracture just last week and I was able to hold two hohmanns under tension by spanning the wound with my left hand, thumb on the right hohmann, pinkie and ring finger on the left hohmann, while providing suction with my right hand. In a difficult trauma splenectomy earlier this month on an overweight male with guts that insisted on getting in the surgeons visual field, I was able to use my left hand backhanded to sweep guts out of the way while temporarily holding the tail of a suture placed on a stubborn bleeder between my left thumb and forefinger. Meanwhile, my right hand was occupied with maintaining traction on a large rich. I think the surgeon (my F.T.S.*) even made a comment about my hand span(?) though I don't remember it now.
There are occasions where size eights are a hindrance. In vascular surgery where 6-0 and 7-0 suture is often used and one must follow suture (maintain slight tension on the suture as the surgeon sews) with just the right amount of tension so as not to tear through the vessel, I feel like the proverbial bull in the china shop. When trying to provide traction on tissues deep in a narrow male pelvic cavity, my size eights are sometimes in the way of the surgeons field of view. If anyone has been wondering if I like the nickname or not, I do. All in all, I think my Man Hands are pretty handy.

*Favorite Trauma Surgeon

Path to SFA 6 Ortho rules!

five here
Training in the "real O.R." was much more stressful, but the cool factor was significantly elevated. In the beginning, you do a lot of work on opening supplies for the case, setting up the back table and mayo stand, and then observe as the primary scrub passes instruments. It is sort of like grunt work with no glory but a valuable lesson none the less. You may be surprised at how easy it can be to contaminate the field if you aren't careful. Do it once or twice and have to explain to the surgeon why you have delayed the case, and explain to the OR manager why you have wasted supplies and you become more vigilant.
Scrubbed in as the observer during those early cases, I would use an empty glove wrapper and a sterile marking pen and take notes of the procedure in sequence. After the case, I would transfer my notes to a sheet of paper and use it for reference the next time the same procedure came along.
After observing as second scrub for about a week, you begin to first scrub and your preceptor gets to sit back and observe. With the pressure of knowing that I would have to take call in about four months I became anxious to scrub everything. The crew was more than happy to oblige me. If there was only one line that day, I scrubbed it all. If anything got added on during a slow day, I scrubbed it.
The influx of information was often overwhelming and I thought that I would never be able to retain it all. Ortho cases, particularly total joints, have a high volume of instruments. You may have as many as six instrument trays in addition to your basic setup. In fact, you need to use two back tables to accommodate them all. Being slightly (yes, just slightly) obsessive compulsive, the clutter from total joints was frustrating for me. It was also hard to retain the sequence of surgical steps and instruments during the case. I would take whatever notes I had been able to gather and tape them to the wall behind my back table so I could "cheat" during the case. It was too difficult to turn away from the procedure long enough to squint at my notes trying to find my place again in the sequence. I longed for a better way since I didn't have a better memory.
Then my hero came along. The girl from central sterile processing, that I had spent a week with back in the beginning, had discovered that if you use a permanent marking pen on a 4x6 index card, put it in a peel pack and run it through the autoclave, it comes out sterile and still readable. Hallelujah! I soon had a collection big enough to require it's own space in the supply cabinet. Total knees went from my most frustrating case (I am a perfectionist), to the most satisfying and fun. And, bonus! The orthopaedic surgeon was the most fun to scrub for.
The general surgeon was very high strung, and the Gyn doc was a bit of an ass, but in a clever sort of way. More on that later.
prelude here
one here
two here
three
SFA four here

What I learned Today

Today I learned that when the trauma surgeon recounts his last trauma call shift and says, "Trauma was dead last night." He doesn't mean that it was slow.

The "Arte Y Pico" My First Award!

Oh my gosh! My first blog award! Thank you Oystein of The Sterile Eye for choosing me to be honored with this award. And thank you for your compliment,

The blog of the Surgical First Assistant that calls herself makeminetrauma. To her “surgery junkie” is a compliment. Her love for anything surgical shines through in all of her posts. I envy her hands-on access to the human anatomy, and I love her blog.

Now I pass the award on to five other blogs. The rules are as follows:

1.You have to pick five blogs that you consider deserve this award in terms of creativity, design, interesting material, and general contributions to the blogger community, no matter what language.

2. Each award has to have the name of the author and also a link to his or her blog to be visited by everyone.

3. Each winner has to show the award and give the name and link to the blog that has given him or her the award itself.

4. Each winner and each giver of the prize has to show the link of “Arte y pico” blog, so everyone will know the origin of this award.

5. To show these rules.

Buckeye Surgeon. His posts are well written and always interesting with some great case presentations. He is very representative of the human side of medicine and his compassion for his patients is obvious.

Mother Jones, R.N. at Nurse Ratched's Place . I love her writing style and the nostalgic pictures she finds. Her captions and interpretations of the pictures are as entertaining as the posts themselves. She has a very clever sense of humor.

Bongi author of Other Things Amanzi. He is my hero of the blogosphere. His posts are an insight into another world that most of us will never experience. From the "sink or swim" style of surgical training to the roadblocks of dealing with the Government, his dedication to his country and his patients is unwavering. He truly loves his craft.

Addicted to Medblogs. Here is a loyal medblog addict. She is very creative. From her monthly (pretty close to monthly, as time allows) series Calander Doc, to all of the goofy cool stuff she finds to incorporate into her posts.

Someonetc at Orthopaedic Residency. He cleverly incorporates everyday challenges and situations as a mirror into the challenges of training ortho residents as their attending . He is constantly striving for more creative, motivating and successful methods of teaching.

Path to SFA five. Training begins

SFA four here
After placing ads and interviewing candidates, of which, if I remember correctly, there were only a few, none qualified as certified or experienced. Surgical techs were still a scarce commodity at the time. The fact that the town was so small and basically in the middle of nowhere was also to my advantage. With no local employee base to draw from and relocation an issue for anyone else, it was announced just two weeks after the search began, that I would start my on the job training as their new surgical technologist. I had made it at last! My patience and perseverance (harassment ?) finally paid off.

My training began by spending the first week in central sterile processing. This is where the instruments are brought after they are disinfected with enzymes that remove gross contamination.The sets are brought here to be reassembled and placed in their containers or peel packs or wrapped in blue wrap and autoclaved for sterilization. Central sterile is a great place to begin learning the names of the instruments, a vital bit of knowledge for a surg tech. You also learn proper sterilization techniques and how to identify something that has not passed sterilization parameters. There are checks and triple checks performed to insure sterility of instruments.
Before you can begin doing the fun stuff, you must first know the proper way to scrub, gown and glove, and learn sterile technique. With the help of a timer, scrubbing was easy enough. Gowning yourself if fairly simple, but learning how to closed glove yourself takes a little more practice. You must keep your hands safely within the end of the sleeve of the gown and not extend beyond the cuff. Then you pick up a folded sticky glove with your mittened hands and lay it on one gowned wrist, usually right hand first, upside down and backwards with thumb to thumb. The long cuff of the glove is folded over about halfway. With certain brands of gloves, the cuff is often quite sticky and hard to separate. With your other mittened hand you peel the folded cuff of the sticky glove forward around your fingers while holding the other cuff end of the glove with the enclosed hand you are currently gloving. Then, as you wrap the glove around, you are able to slide your hand forward through the gown sleeve and it should end up enclosed in the glove. Sounds easy enough! The good news is that after you perfect this move, you get to smirk under your mask at residents, PAs, med students and even some assistant surgeons who have no clue how to glove themselves.
Sterile technique is something tangible that can be taught. Sterile conscience is a little bit different. Part of sterile conscience involves recognizing a break in the sterile field, reporting it, and taking steps to reestablish sterile field. It is about being the patients advocate. As a tech, one very important part of my job is to protect the sterile field. It also became my pet peeve. If anyone non-sterile gets too close to my sterile field, I let them know. And they don't forget.

When it was finally time to start learning procedures, the girls who were precepting me decided that I should begin my training in the Procedure Core. The worst duty one could have was in the Procedure Core, which was their title for the Endoscopy Suite, aka GI Lab, aka any other title that makes what goes on there seem more glamorous. Well, let me tell ya' there is nothing glam about EGD's and colonoscopy's . Especially if it is your own. For the first week , they stood right there with me, instructing me on the proper way to handle a polyp specimen, how to give proper sigmoid pressure to help the surgeon maneuver the colonoscope through this redundant section of colon, care and cleaning of the endoscopes, etc., etc. By the third week, they would sit just outside the room at the nurse's station, within a shout's reach should I need help. Week four, I was on my own. Not a problem, I felt pretty confidant. However, I began to wonder just when I was going to be allowed in the OR to learn "real" procedures. Two more weeks had passed and I realized that they were very content just to leave me up there because that meant less poop and drool for them. I had to throw a little hissy to finally let them know I was on to them!
prelude here
one here
two here
three

Hey, I finally wrote a post for "My First Time" What? You mean there was a deadline?!

Last weeks' SurgeXperiences theme, hosted by Jeffrey MD, (excellent job, Jeffrey!) was "My First Time". As usual, I missed the deadline, partly because deadlines make me anxious, but mostly because I could not think of a single "first" that I thought was memorable enough to blog about.

Having been away on vacation for 9 days, I have been refueling my obsession and passion for the OR by reading "Top Knife" The Art and Craft of Trauma Surgery, by Dr.s Asher Hirshberg and Kenneth Mattox, actually/finally studying for my Sept. First Assist certification test, spent a few hours one afternoon hanging out in the ER near the ambulance bay and the trauma rooms while under the guise of waiting for one of the Orthopods I work with to come and examine a patient, (Discovered an ER doc I wouldn't mind knowing better!) and catching up on "Hopkins". If you have not seen "Hopkins" it is about the Johns Hopkins hospital in Baltimore. It isn't fiction, the stories and patients are real. They focus on both the ER and OR but it seems to me that they favor the OR which is awesome for me. I missed the network airing of the series(?) but all episodes in full can be found on the ABC website.
Every episode that I watch causes me to swell with pride and tear up. How can anyone not love a surgeon!? Heart transplants, brain tumors, dissecting aortas from arch to abdomen! My adrenaline starts pumping and I get all jacked up for the OR! I sit here at home, on call, and will the phone to ring with a surgeon on the other end.

My point is.....while watching the opening credits on "Hopkins" one surgeon reaches across the operating table at the end of a case and shakes the hand of his assistant. And then, suddenly I realized what "My First Time" should be about.

I used to scrub exclusively on the swing shift for the gynecology oncologist whenever he had a line. His operations were not typical gynecology procedures. While he did some simple hysterectomies and oopherectomies, they were for cancer or suspicious tumors. His big cases were modified posterior pelvic exenterations, often with node sampling, and on occasion, urinary diversions and ileal conduits if the exenteration was anterior as well. All of his cases are by referral only and so very often, the referring surgeon is there to assist. As I have mentioned before, the almost psychic rhythm between a surgeon and an assistant is magical. As a scrub, I often shared this same magic with this particular surgeon. You hand him the right instrument, at the right time, in the right manner without a word passing from either ones lips. This interpretation/anticipation becomes second nature, yet I always recognized the thrill of it.
So, on with the story. At the end of a particularly long case, the Gyn/Onc surgeon reaches across the OR table and shakes the hand of his assistant surgeon. "Wow, that was pretty cool." I think to myself. That was the first time I had ever seen anybody do that. I began to observe the actions of other surgeons and noticed that the hand shake doesn't come that often. It is reserved, it seems, for long or difficult cases, or long and difficult surgeries perhaps. A surgery where the primary surgeon is very thankful for an assistant.
As I made the transition from scrub to first assist, I never forgot about the rare handshake. I fumbled along through my provisional cases required by the hospital before I would be granted assist privileges. Just when I would think that I was getting the feel of things and feeling fairly confident, I would make a rookie mistake, or freeze when asked to hand tie a suture. I took a lot of ribbing and criticism from my main preceptor but I paid attention to everything he said. Active privileges granted at four hospitals and about 15 months under my belt later, I was assisting my F.T.S. (favorite trauma surgeon), on a somewhat difficult bowel resection. Extensive adhesions make dissection on somewhat distorted anatomy very tedious. The patient was also obese which means a lot of tissue that is tougher to retract (and keep it there) and a deep abdomen in which visualization isn't always easy. To top it off, the patient was male which translates to a narrow pelvis, making mobilization and resection of the sigmoid colon more challenging. I think I did all of the right things that day. I had finally found my rhythm. Providing traction and counter-traction was intuitive. Clamps were effortlessly being released with my non-dominant left hand. Suction was right where my F.T.S. needed it, when he needed it. Manual traction with a lap under my outstretched, slightly fanned out fingers protecting healthy bowel from electrocautery was unwavering until it was safe to move. And as we were finally closing, it felt good.
As I sometimes do, while mindlessly following the looped PDS suture as the surgeon closes the abdomen, I rehearse the procedure that has just been completed, looking for weak spots in my technique so that I may improve them next time. I am a bit in my own world as the dressings are called for, and I am brought back to reality as my Favorite Trauma Surgeon extends his hand across the table. To me! I look at his hand for an ever so brief second and it registers that he wants to shake my hand. Suddenly afraid that the moment will pass and he will withdraw the gesture, I slap my hand into his palm, perhaps a bit to eagerly, and accept the rare handshake that I have long awaited. As I blushed behind my mask and he broke scrub, I could barely contain the exhilaration of that first time handshake.

Filler and Fluff

Got distracted with this test.....hope the assassination victim doesn't pan out.

What Famous Leader Are You?
personality tests by similarminds.com

Home again.

Made it back in one piece. I drive everywhere. The highways were noticeably uncrowded this trip. It was me, truckers, giant expensive bus conversion RV's, a few u-haulers (the most dangerous species on the road), motorcycles and a spattering of mostly fuel saving cars with license plates from the state we were in or one state away. There are some advantages to the fuel prices.

I only had one OR related dream. I was on my way to the hospital. I wasn't sure what I was going there for, but I knew I was late. My cell rang and I answered it with, "I'm on my way!" It was the vascular surgeon that I was apparently on my way to assist. He ignored my salutation and proceeded to tell me all of the special equipment, thrombectomy catheters, shunts, grafts,etc. that he would need for this case. I was still driving, didn't recognize half of the stuff he was rattling off and had no way to write it down! I felt a little panicked but there wasn't much I could do but say OK and hope for the best.
Next scene I am in the OR and the patient is a male friend of mine. Not too bad except we seem to be doing a bilateral inguinal hernia repair, or so I think. I don't really want to see my friends "junk" so my dreaming psyche resolves that by having his testicles selectively draped into the field but I don't recognize them as such because they are neatly butterfly filleted! To top it off, he is awake, propped up on both elbows and conversing with me about ?? I don't remember.
Well, at least I didn't contaminate everything.

Vacation! Well sort of, away from my business of assisting for a week or so anyway. It actually stresses me out to be leaving. I'm packing about four Trauma/Surgery/Review books with me for some bedtime stories. About four days out, I'll be craving some O.R. action. On about the sixth day, I will be in actual physical withdrawals. Maybe another glass of wine on the back deck at sunset will help them go away.
I will probably dream of being scrubbed. That usually happens when I don't work for a while. I just hope it's not that horrible recurring dream where no matter what I do, I can't keep from contaminating the sterile field. That one really wears me out.
Call schedules won't come out until after I leave so at least I won't be squirming over who's trauma call I'm missing. There are several surgeons gone all or some of the same time frame that I am, so I probably won't be missing much. Still.....
When I get back, I'll work on finishing my long winded novel that "Path to SFA" has become. See y'all soon.

Meanwhile, back at the ranch...

My ortho docs are off passing their boards. The state of the economy has slowed my business. No, the surgical assisting business is NOT recession proof. Resistant perhaps, because traumas and emergencies still happen, but elective surgeries decrease and partners assist partners and my services become unnecessary. But the gods smiled upon me these past several days and I had the ultimate pleasure of working with my favorite trauma surgeon. Truth be told, he is my favorite surgeon, period. (Please don't tell my ortho docs!)
It started Sunday afternoon while he was on ER call, which means general surgical cases from the ER are referred to him. First case, a perfed (perforated) viscus at the jejunum. Fairly straightforward repair with a patch of omentum thrown over the top for added strength and healing power. He complimented me on having quiet hands. I was flattered.
Early Monday morning, 0500 early, another perfed viscus, this time of the duodenum. Another repair incorporating an omental, or graham patch. That same afternoon we had a previously scheduled case together, splenectomy. We were finished around 1700. It was an excellent case and I was honored that he had chosen me to assist. Somewhere in the middle of the case one of his partners who had been operating at the same hospital came in to announce that they were done and asked how it was going.
"Got some bleeding right now."
"Do you need a hand?"
I was concentrating on providing him with exposure but I was still aware of the conversation. I usually dread hearing that particular question because most often the surgeon will say, sure, if you want to. After all, they are peers, colleagues and there is a professional courtesy or protocol of sorts, and I sometimes feel like an accessory. Of course, I will always defer to another surgeon, especially a partner in the same group, but he has never traded me in.
He simply did not answer because he was concentrating and I was aware that his partner had left the room. When we were in recovery, he complimented me for being attentive during surgery and made a point about what a difference it makes when the assist actually cares about the surgery at hand. I knew that he was referring to not losing concentration when we had encountered bleeding. Coming from this surgeon, whom I respect so much, I was honored.
He was on trauma call Tuesday, and he asked me if I wanted to assist him on Wednesday. He had two cases, a lap chole and a small bowel resection. He forewarned me that he thought they were both Medicare patients (that means I don't get paid), but I jumped at the chance. After all, I had nothing better to do and I don't often have the opportunity to assist him so many days in one week.
The Trauma Gods brought us together again Tuesday afternoon. A fall from what and how high, I don't know, but it was enough to tear the patients mesentery, fill the abdomen with blood, and necrose a portion of the small bowel. The resection of the dead bowel would have taken less time had the patient had not been on long term steroids and blood thinners. That combination causes the tissue to become very friable and therefore more susceptible to bleeding and the bleeding more of a challenge to control. In fact, who's to say that the injury would have resulted from the fall at all, had those two factors been absent. With skill, gentle handling and the blessing of hemostatic agents, a very stable patient was delivered to ICU two hours later.
There were no more surgical traumas that night so we met again on Wednesday. Our lap chole was not so easy, a large, stone filled, edematous gallbladder and some variant anatomy made dissection tedious. Even after decompressing the gallbladder, pulling out some 45ml of dirty brown fluid resembling 30wt motor oil, it was still taut and difficult to grasp, but in the end, the gallbladder always loses.
Our final case of the week together was a small bowel obstruction. Often an obstruction is caused by an adhesion wrapping around the bowel narrowing the lumen and stopping flow. Or, the bowel may adhere to itself and cause such an acute angle that obstruction occurs. This patient had a combination of both. The bowel had adhered in the pelvis and had turned itself around so that it was twisted shut, sort of like the beginnings of a balloon animal. A short distance from that adhesion was another side to side adhesion that, despite blunt dissection attempts, refused to let go of itself. A small bit of bowel had to be resected and reanastomosed and before I knew it, my four days with my favorite surgeon were over.
There is a certain harmony between two people who work closely together for an extended period of time. As an assistant, you don't have to be told what to expect, what to do next, or what the surgeons next move will be, you already know and you act and react without thinking about it. In the operating room, it is a dance of sorts, and when you click, when you work well together, you begin to know each others moves by instinct. The choreography is perfect, flawless and smooth as silk. It is a high unlike any other.

Path to SFA Chapter Four

photo credit
prelude here
one here
two here
three
My job as unit clerk was right up my alley. They had always been without one and there was a lot of organizing to be done. With my OCD tendencies, I became the organizer. I created new charge sheets. I organized bookshelves. I rearranged the desk. I retyped surgeon preference cards. I tracked scheduling. I became the keeper of the grease board. Oh yes, and I entered surgery charges.
The keeper of the board was serious business for me. "The Board" is usually a dry erase, magnetized white board. You can write directly on it, but most often there are magnetized strips about two and one half inches tall by two feet or so long, that you write the case information on and then stick the strips on the board. Case info might include the time, patients initials, the surgeon, the procedure, and if there is any room left over, special equipment requested for the procedure. Then the strips are arranged in descending order beneath the operating room number in which the procedure will take place. Since this was a small rural hospital with a minimum of services and surgeons, our strips were color coordinated to the service. Yellow for ortho, green for general, red for the g-y-n. The board was my baby. Without saying anything, everybody knew that they were not to write on my board! If someone attempted to write an add-on strip and I spotted it, I would erase it and rewrite it. If someone had some information they wanted to write on the board for everyone to read, they handed me the info and let me transcribe it. I couldn't have mismatched handwriting on my work of art.
While I didn't really have time to observe surgeries, I would have an occasion or two to peer through the door for a brief glimpse. Thing is, you can't see a lot through a window, just blue gowned bodies hovering over a blue draped patient. If the case happened to be laparoscopic or arthroscopic, you could see what was taking place on the video monitors. As a first time spectator, what was mundane for others was way too cool for me, even though I wasn't sure what I was looking at. I knew that at least for me, surgery was never going to be a spectator sport. I kept dreaming of the day that I would become a participant.
As time went on I began to feel as if I fit right in with the crew. I was invited to the OR meetings. Okay, it was to take notes of the meeting, but it was still an invitation and I felt like an insider, no longer an outsider begging for entry. And then, on one glorious day, the pale warmth of an early winter morning illuminating the room, the announcement came.
One of the surgical techs was reluctantly relocating due to a change of venue at her husbands' job. I held my breath. The OR manager assured the remaining techs that she would search for a certified tech or at least someone with experience to replace her. My heart sank. I exhaled. I literally wanted to cry. The consensus was that they really did not want to go through the process of training another tech. It would take six months before a trainee would be ready to take call and then that would be with back-up. That meant six months of extra call for everybody remaining. An experienced new hire could be taking call in as little as six weeks. The meeting adjourned and in between the hugs and tears for the departing surg tech, I cornered the manager and begged to be trained if her employee search failed to produce any qualified applicants. I hoped that time was on my side.

Path to SFA . Three

prelude here
one here
two here
I was so enthralled with the OR that I knew I had to find a way in. I spoke with the surgical techs and found that they had been in a fast track program where they basically had to take five classes, have a certain amount of clinical cases, and then they could test to become certified. I knew what the classes were at the time, but I have forgotten them. The rules were changing anyway, and it would be too late for me to begin. Besides, the program was designed for on the job trained techs who were already scrubbing and I was not. Three of the four techs scrubbing there had been OTJ trained. That sparked my hope.
I hounded the OR manager every week to ask her if there were any positions open. I practically insisted on being the next one hired. I noticed that her trips to the business office to discuss charge issues with me were diminishing. Circulating nurse were showing up in her place. One afternoon as I leaving work, I saw her on the sidewalk ahead of me. Anxious to inquire and remind her one more time that I really wanted to fill that future job opening, I shouted her name and trotted up behind her. I swear I saw her pace quicken, and her head bow a little lower as she tried desperately to avoid me. It was then that I realized that she must have thought that I was more of a stalker than a eager prospective employee.
In the week or two that followed, the OR manager I had worked so hard on to hire me, was leaving the hospital to take a position elsewhere. I was discouraged and a little shocked. What do I do now? Who will be the new manager? Will he or she be receptive to training new scrubs, or would they insist on hiring someone with experience? Would he or she also think I was a stalker? In the back of my mind I wondered if my "stalking" led her to the decision to relocate. In the end I decided I probably didn't have that much power.
As is often the case, a setback ultimately becomes an opportunity. The new OR manager was not a stranger, but rather one of the RN's from the OR. She already knew me and my obsession. While there were no scrub openings yet, she had been working on creating and gaining approval for a unit clerk for the surgery department. Almost one year exactly from my beginnings in the business office, I transfered to surgery as the new Health Unit Coordinator, or HUC for short. It wasn't scrubbing, but it was my big foot in the door and I was overjoyed!

Path to SFA Two

prelude here
one here

It was so frustrating to get answers from the OR regarding their charge sheets, I suggested to my boss that it would sure be easier if I were in the OR when I was entering charges. If I had a question, someone might be able to answer it that day, not two or three days later, and that would ultimately keep pending claims current. I also suggested to her that if I knew just what exactly these UFOs, or Unidentified Foreign Objects, were that I was charging for, it would really help me to identify missed charges. A business office manager is all about capturing income and keeping AR current so it didn't take long before she had arranged a deal with the OR manager. I would go up there for two hours a day to input OR charges. But first, she actually suggested that I watch a surgery take place. She reasoned that if I saw the equipment and supplies being used, I would be better able to identify them and their applications. Besides, even outside of the OR, sitting at the desk, one can be engulfed in the sounds and smells going on behind the door. Even that amount of exposure is not for everyone. I don't believe she knew just how many worms were in that can she just opened.
I was elated at the chance to watch a surgery! The crew picked one out for me, a carpal tunnel release, had heard of it, not really sure what it entailed but it sounded non-exciting for sure. On this particular day there was to be another observer, an occupational therapy student. After the patient was prepped and draped, we were allowed to enter the OR. We were both given the routine instruction.....stay at least six feet away from anything blue, if you want to move somewhere else in the room, ask first, if you start to feel lightheaded or queasy, sit, or ask to sit down immediately, if you have to, sit on the floor and lean against the wall, don't be a hero, it's okay, it happens to a lot of people.
The surgeon made his incision and explained each step, showing off for his audience as some surgeons do, and all I wondered was, where is the blood? It is such a small incision, I can't see anything! Yeah, whatever, yada, yada, yada, is there another surgery I could watch later? Meanwhile, there was a commotion behind me. I turned to see the O.T. student being lowered to a chair. The nurse was standing next next to her asking her if she was sure she was okay? Did she need some water? Did she want to leave? I thought that she looked sorta' green and turned my attention back to the surgery. Yep, still no blood, still can't see, what a gyp!
Somewhere along the way the O.T. student had decided that she really did want to leave. I hadn't noticed until the surgeon asked, "What? Who left? The OT student?"
HA! What a wimp! It felt like a victory for me even though it was a very benign surgery even to my inexperienced standards. And from that day on, I was hooked.

photo credit

Path to SFA, Part one

I have always hated hospitals. My mother died in one about 24 years ago. I didn't like the smells, the perceived secrecy, even when it came to my own Mother's care. When I would ask her Dr. questions, he would all but snap at me, "Why don't you ask her!?" Guess he didn't realize that asking and answering wasn't something we did in our family. And no, HIPPA wasn't invented yet, besides, I was family. But I am getting off track.
As much as I had professed my hatred for hospitals, imagine my surprise when some 13 years later I found myself actually applying for a job in the business office of local hospital in the small wild west town I was then living in. I already had a great paying job as jobs went in that small town. I was making good money at a local auto dealership in the finance office. In fact, I was the F. and I. guy (gal). I was "promoted" from parts dept. where I had been very happy. Selling finance and insurance just felt sleazy. I was always honest with customers and never pressured them into decisions which is why selling is just not my forte'. If they say no, I say okay. It would become the end of my life long affiliation with mechanics and parts and dealerships.
I saw the ad in the local paper and applied. The hospital business office manager was new to this hospital and I found her a bit wacky. Full of nervous energy, somewhat attention deficit perhaps, but very personable and honest, she laughed at things that apparently only she found the humor in and I liked her immediately. My interview went well but I didn't think much of it. I really had absolutely no experience in all things business as it pertained to hospitals. The next day she called and asked me when I could start. I gave the dealership two weeks notice and so, in that fall of '98, began my hospital career.

Two of us were hired at the same time for the business office. On the first day we were shown to the data room which was inside the business office but it was a separate, rather large room that housed a couple of desks, computers, a long table with a monstrous printer fed by a box of folding perforated green computer paper, file cabinets, a modern copier/printer, and a good old fashioned AS400 operating system. Once we were there, the manager shut the door and we never saw her again that day. We both wondered what we were hired for. She had told us both that we would be doing data entry. We sat there most of the morning not sure what to do. We had been given no instruction. Eventually we organized and cleaned the long neglected space and found some filing to do, but mostly, we just sat in that room and conversed for almost three days before the manager actually showed us our tasks.
My office mate moved to her own desk amid the cubicles of the main office and became a Blue Cross B.S. (stands for bull shit but they hide behind blue shield) billing clerk. I remained in the data room which I now shared with the hospitals' I. T. guru. (We became and still remain great friends). I became responsible for charge master maintenance, printing daily reports, downloading Medicare claims, sending electronic claims, and doing the nightly billing backup run. Some where along the way they decided that it would be okay for me to reconcile the hospital bank statements every month. Oh the joys of a small town business!
My favorite job was entering patient charges. I would receive charge sheets from all the departments and enter them into the system which would ultimately become a patient bill. I had to be a bit of a detective and spot any missing charges. For instance, an inpatient on the floor who was post operative should have a MAR (Medication Administration Record) sheet, an OR patient who had a rotator cuff repair should have a charge for a shoulder immobilizer, and so forth. Since charges were still recorded by hand on a paper charge sheet by each individual dept and then sent down to my in-box, there was a lot of room for human error and forgetfulness. I became the charge police.
The OR became my fascination and obsession. Their charge sheets were the most complex and challenging considering the foreign language contained therein. Bair Hugger, what the heck is that? Corkscrew, really, a corkscrew? Cyro cuff? Bone plug? Insufflation tubing? Just what are they doing up there? I would have to make several phone calls to the OR several times a day to get answers to my many questions and often they would be so busy that it might be two days before anyone could get back to me. So much was my fascination with what went on in the OR, that I planted a seed in the high speed, somewhat disordered brain of my boss and sat back and watched it grow.

My path to Surgical First Assist, the long version. Prelude

I've been a big blog slacker lately. Can't blame it on house hunting anymore. Remember the house I found? Well I seem to have serious commitment issues......have I mentioned that before? After inspections I felt that there were too many do-it-yourself non-permitted revisions and add-ons that I didn't want to deal with. Truth be told though, I think it was the financial implications that subconsciously made me nauseous. Anyway, that deal is off and I've decided that now is not the time for me to buy, perhaps next spring. The economy is way to scary right now and I believe that housing will actually be even lower next year.

But enough of that. A while back someone posted a comment asking me the following, "....I went back a couple of posts .....and saw that you are not an RN, PA, MD or Scrub Tech. I was just wondering what route you took to become a first assist? "

Well, it has only taken me about six weeks to answer but here you go. I am a Surgical Technologist-Certified. That is the minimum you must be to go on to assisting. That is the short answer. Since I have long been contemplating blogging about my personal path to First Assist, what follows in 2 ?, 3 ?, parts, is the long answer.

Freud

Here's a thought, more of an observation really, that crossed my mind today as I was safety pinning the key of the locker I used today in the OR to my scrub shirt.

Since it is considered very bad sterile technique to scrub into surgery while wearing a ring (little bugs can safely harbor themselves in, around, and/or under a ring) married folk encounter a dilemma as to where to safely keep the ol' wedding band in a spot close to them where they won't forget it or lose it, as they go about the business of surgery.

Married men who scrub in the O.R. (and actually wear their rings on a daily basis) generally run one end of the drawstring tie at the waist of their scrub pants through the gleaming eternal symbol and then incorporate it into the the bow knot. Thus displaying said ring at at supra crotch level for safekeeping.

Women who scrub in the O.R. generally do one of the following things with their sparkly status symbols symbols of eternal love. Women either pin them to the front of their bra straps, pin them to a shirt breast pocket, or run a necklace that they are wearing through the center and wear it around their necks. Thus safekeeping said ring somewhere very near cleavage and of course, their hearts.

Coincidence or Freud?

photo credit