Nurse! Bring me an Otis Elevator!

Tuesday morning at one of the local outpatient surgery centers, I hurry over to the elevator to go to the third floor O.R., and the door is almost closed. I make it in time to activate the mechanism that slides the door back open. As I enter the elevator, I notice a woman standing in the back, and the Smith and Nephew endoscopy rep, here for my next case, is revealed behind the elevator door as it opens. I look up at him-I am six feet tall and he towers over me-and say "Oh, hi!" As he begins to reply, I see that the doors have stopped closing at about 3/4ths of the way. The elevator starts to ascend an inch or two, seems to realize that the doors are still open, and gently bounces back down to floor level.
Now, I am not fond of elevators in any manner. If they do any little thing that is jerky or it sways, or goes too fast, or stops too sudden, or is in any way what I consider abnormal, I either pucker up and finish the ride if I'm already committed, being sure to take the stairs for the return trip, or I bail out in a panic. This time I had opportunity to bail and I took it.
"Oh CRAP! I'm not taking this elevator! I'm taking the stairs! See you up there." I said to the rep as I bail out.
At the top of the third floor landing I'm confronted with an electronic key pad that you have to punch a code into to open the door. I don't have the code. No problem, I pull out my cell and dial the surgery center to tell them to please come open the door. My cell phone wails in my ear informing me that there is no service at the third floor landing. As I contemplate just how I'm going to get in without going back down the stairs and getting on an elevator, someone hears me knock and lets me in.
I thought nothing more of it as the case progressed. The rep and the scrub tech were chatting back and forth and something reminded me to ask, " What is the code for the keypad?"
The scrub joked with me that he wasn't sure if he was allowed to give it to me. I asked what I was supposed to do if I didn't want to take the elevator? The rep then said, "Yeah, after you got off the little girl said, Mommy, are we going to be alright?"
"What! Little girl? I never saw a little girl!?"
"Yeah, she asked her mom, why did that girl get off? Is something wrong? Are we going to be alright?"
I was so embarrassed!
The rep said, "I told her we would be fine."
Somehow I could see how a little girl would be comforted by this giant, soft spoken, strong man. But I got ribbed for trying to scare the children going to the second floor pediatric clinic!

d'oh !

I have been trying to come up with some beliefs about anatomy, physiology, and surgery that I held before I knew any better.

Here's what I have so far.....

If the bowel is eviscerated (small bowel) all of those slippery loops MUST go back into the abdomen and lay EXACTLY as they had before they came out.

If your appendix bursts, you will die within the hour.

Here are some things I recently discovered....

The reason they tell you in high school health class not to pop pimples in the danger zone, or "triangle of death" the triangle from either side of your upper lip to an apex at the bridge of your nose, is because the nasty stuff inside the pimple might travel backwards eventually reaching your sinuses, instead of shooting across the room. Sinuses are the front door to your brain.

It took me five years to suddenly realize what was meant by a loop ostomy.

Hungry P.A.s are scaring me

A few of the local surgical groups have PAs that help them in clinic and then assist in surgery. Up until now, they have been little threat to my livelihood of first assisting. Most PAs work with one or maybe two different surgeons and so, the rest of the group still needs me, or someone like me. Then I got all wrapped up in Ortho. Don't get me wrong, I love my Ortho docs. I work with three of them consistently, all of them from the same group, but suddenly they all, well two of them anyway, want to use a PA. They don't have one. That doesn't stop them. They "borrow" a PA from their partners. I know the docs hate rounds (here they have to round at up to four (five?) different hospitals), and those pesky phone calls from the floor, or from the patients wanting prescription refills on the weekend, so, one hungry PA to the rescue. This PA will shadow their call, do their rounds, field those phone calls and alas, assist them in surgery. Granted it is only when the surgeon is on call, but that used to be my gig. Call cases were my extra cash. Extra cash if the patient was insured anyway. My motto has always been, "Quantity, not quality." Not to be confused with my other motto, "Buy high, sell low." I figure that if I scoop every case available, I'll have about a 70% chance that I'll get paid. Now I feel the need to solicit some more general surgeons. At least not being on call will give me more time to sit at home and wonder what I'm missing while I'm wishing I were working. Some are just waiting for this PA to burn out. I am one of them. The irony of the situation is that one of my orthopods using the PA is the same orthopod that convinced me that I shouldn't spend my money on PA school if what I wanted to do was assist.

A while back, after finishing one trauma case with my *FTS, a thoracic aortic aneurysm was coming in by helicopter. The vascular surgeon on call saw me there and asked if I wanted to help. I most certainly did want to help! Though after a moments thought, he assured me it wasn't necessary. Since the patient was of medicare age, surely I would not get paid for the assist. I assured him that I still wanted to help because I don't get the experience of thoracic aneurysms very often.
We had to work rapidly and while I mostly did well, vascular surgery is not my strong suit, the surgeon had to guide me in proper technique a time or two. After the graft had been successfully sewn in place, and any leaks identified and repaired, we closed quickly to get the patient off the table and to the ICU, ASAP.
I always stay with my patients after the drapes come off. I help to transfer them from the OR table to their bed, I like to remain available for anaesthsia should there be any complications, and I help the OR team transport the patient to PACU or the ICU. While waiting there in the OR, the surgeon thanked me for helping and pointed out that I had helped save the patients life. I exhaled a sort of a self-conscious puff of air. He looked at me and insisted that he was serious. Without my help, he told me, he couldn't have done the operation and I definitely helped save a life.
I knew that if I hadn't have been there, my FTS would have been in line to help (he was having a very busy busy trauma night that night and I later told him that I took the bullet for him), or one of the vascular surgeon's partners would have come in and assisted. Still, it felt really good to be acknowledged with helping save a life, and that was payment enough.

*Favorite Trauma Surgeon

I'm in love with trauma (surgeons)?

I'm in love with trauma surgeons. The most unattractive trauma surgeon is still pretty hot. In fact one of the trauma surgeons told me that the girls always go for the trauma docs. That's why he became one! All of the trauma docs are married but one, and he has a significant other.
You know who else is hot? Neurosurgeons. Not spine surgeons, but bona fide, frontal lobe to cauda equina, neurosurgeons. The ones who can pluck a tumor out of your gray matter and send you home with all your functions still intact. That is power. That is amazing. That is hot. But, I also find it a little bit boring. Too predictable perhaps? Look at me, I'm calling brain surgery predictable. I guess what I mean by that it that it is so controlled. So calculated and mapped out in advance.
What is this deeply embedded desire I have for trauma? Is it about the surgeons themselves? With a trauma surgery you have to be thinking three steps ahead of the procedure. If Action A leads to Consequence B do we have Equipment C in the room? You must realize and admit that if what you just tried to do to control bleeding didn't work, it probably won't work the second time you try it either. You'll have to try something different. That's where plans B, and sometimes C and D come into play. Two eyes and hands are focused on the patient, one ear is tuned into anaesthesia, and the other ear monitors what's going on between the scrub and the circulator. The surgeon has to know when the time is right to do damage control only and get out, or if he has the luxury of being able to do a definitive repair. It's often fast moving, fast thinking, and always requires technical skill. I find the whole process, from the trauma bay (bonus if we get to meet the helicopter on the roof!), to the operating room, to the ICU, very seductive and addictive.
So my conclusion is that it is not the physical attributes of the trauma surgeons themselves that I find so attractive, as much as it is the fact that they have welcomed me into their world, shared with me some of their skill and knowledge, and have appreciated my obsession without taking it personally.

Ski Season

Ahhh, ski season. The season of broken femurs and severe head injuries, sometimes on the same patient. Broken ankles, wrists, pelvic fractures, and broken spines from C2 all the way to the tip of your coccyx. Trees and rocks and cliffs are so unforgiving.
Horses get a bad rap for being DANGEROUS creatures. I've taken more spills off of a horse than I can count on two hands, I know, doesn't say much for my riding ability, but in my defense I've ridden everything from barely broke Mustangs to horses who were just plain clumsy, and I have never had a broken bone or a head injury. Thank goodness.
You may think I look forward to ski season being a surgery junkie and all, but I actually find it to be a rather sad time of year. It's sad when teenage snowboarders come in with a traumatic head injuries, or a 40 something year-old comes in as a quadriplegic and has to be maintained on a vent.
I guess every one's gotta have a hobby, and maybe I am extremely lucky so far, but I think I'll stick to horses and leave the snowy mountains to those of you who don't fear it.

SurgeXperiences 213

photo credit
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!