A year at U of R

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Sunday, January 28, 2007

Watching surgery

Watching surgeries is always fun. I feel guilty that I'm so fascinated with someone else's insides. I'm always interested seeing the layers of skin and viscera, and trying to identify different internal structures. Unlike the colored and labeled models we learned on, when I see the real thing, I can hardly tell a bladder from a bowel. Good thing I'm not the surgeon!

For one of the surgeries I observed, the anesthesiologist chose to use MAC anesthesia, or Monitored Anesthesia Care. The client was given the same drugs as are used for general anesthesia, to induce amnesia, sedation, and for pain relief. However they were given in tiny increments as needed during the procedure. By doing this, the patient was just over the boundary of sleep, but maintained respiration on their own. However the boundary between sleep and awake was rather slippery.

The client snored through most of the procedure, but every few minutes, the patient would rouse and open their eyes a little. Several times, the client woke up wincing, and clearly said, "Ouch, it hurts!" "Sorry, sorry," the surgeons said quickly, and the anesthesiologist gave another tiny bolus of fentanyl or propofol. In a few minutes, the client would resume snoring.

It was a little disturbing to me that while I could see the client's insides, and the client was awake and complaining that they could feel it too. I asked the anesthesiologist if it was normal for the patient to wake up. "The patient won't remember any of it," he assured me. "And they're not really in pain. They might just feel some pressure. If the client was really in pain, you'd know it. They would be yelling and jumping off the table."

I still had my doubts. We were taught that if someone winces and says they're in pain, you believe them. I asked him about each of the drugs, and when the client's memory would return. I think that the anesthesiologist was thrilled to have someone take an interest in his art. He explained each drug, and then confided, "If I was going to have anesthesia, I'd never have general. Epidural anesthesia has fewer risks, and you stay in control. I'd want to know what was going on!"

After the surgery, it took less than two minutes for the patient to wake up. The patient was still on the OR table, as the doctors quickly cleaned up and removed drapes. The client looked around, and said, "Is Judy there? I like her!" I walked into view, and smiled. What an honor! I had been with the client through the whole process, from the waiting room through the OR. I had spent a solid hour getting to know the patient and their family in the pre-op area, chatting about their jobs and the weather. The client trusted me.

"Did I say anything while I was asleep? I bet I snored," said the patient. For the first time ever as a student nurse, I lied.