A year at U of R

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Sunday, October 08, 2006

fallopian tubes

I was in the labor and delivery unit again, and business was slow. When I overheard talk of a tubal ligation (female sterilization procedure) that was going to be performed, I decided to see if I could get involved. I'm always hesitant to bother the nurses, since they are very busy, and I feel like I'm in the way. But I plucked up some courage, and asked a nurse standing nearby if there was going to be a tubal.

The man sitting next to me overheard, and answered yes. It turned out he was the anesthesiologist. He said it was up to the physician performing the procedure to decide if I could observe, and he'd help me ask.

The physician in charge of the procedure, it turned out, was none other than the chief of staff for the whole department. He was already going to be teaching a resident how to do the procedure, and when asked if a nursing student could stand in, his immediate response was yes.

The procedure was beginning in a few minutes. I rushed to put on a paper hat and mask. I introduced myself to the patient as we walked to the operating room. I tried to stand in a corner, out of the way as they prepared the anesthesia, but the anesthesiologist motioned me over.

"I need you to talk to her, and make sure she's stable sitting up," he said.

I was thrilled to be of any use at all. I stood in front of the patient, and tried to make some encouraging comments as they started the epidural anesthesia. When the epidural was done, I retreated back to the corner. The physician in charge then walked in.

"Do you know anatomy?" he asked me brusquely.

"I hope so!" I said, surprised that he even noticed or addressed me.

"What's attached to the uterus?" he asked.

"Well, the round ligament attaches the ovaries to the uterus," I said.

"Right!" he said. "And it doesn't do much good to cut them!" I think he expected me to give the obvious answer of fallopian tubes. Did he think I didn't know what a tubal ligation was?

The procedure began, and the physician was soon immersed in assisting the resident, who he was teaching the procedure to. He went at a leisurely pace, and was patient with every step. I drew a little closer from my corner as they cut the incision, and used the small hole in the abdomen to try to visualize the fallopian tubes. They then drew the fallopian tube entirely out of the abdomen, to identify the medial portion. As the physician instructed the resident, he continually glanced at me, meeting my eyes to make sure I was following the procedure. When the tube was severed, he asked me directly if I could see the actual tube itself. "Come over," he said. So I stepped right up, and he showed me the severed tube, so small it looked like a swizel stick in a cocktail. I quickly asked him a question about the fascia attached to the tube, and he showed me the broad ligament. Then the procedure went on.

"How long after the procedure before the patient feels pain?" he quizzed the resident.

The resident looked confused. "Twelve hours?" she guessed.

"Right!" he said. "Now why twelve hours? Why not right away?" he asked.

The nurse, resident, and scrub tech all looked perplexed. No one knew the answer.

"Come on! Anyone! Why isn't the onset of pain immediate? Think about the blood," said the physician, clearly enjoying the teaching.

Still, everyone was silent. I didn't want to speak out. I was just the nursing student, the least experienced person in the room. But the silence was too tempting.

"For $1200, I'll guess that it's the iron degrading from the blood!" I guessed.

"Yes!" he said. "The blood becomes more acidic as it degrades."

The nurse turned to me, and through her mask, gave me a smile, and a punch on the shoulder. The doctor went on with the procedure, and after over an hour of pulling at fallopian tubes, it was finished. I had learned how to do a tubal ligation, although I can't say it's something you'd ever want to try at home.

As I left the O.R., and pulled off my mask, I called the doctors name, and said "Thank you." I don't know if the Chief of Staff realized that a few questions over fallopian tubes had just made my day.