In the Operating Room Without a Clinical Instructor

 (Click Image to Enlarge) I wouldn’t be able to take my licensure examination without the complete list of my cases in Delivery and Operating Room. That’s why our whole group hates our last Clinical Instructor. It seems that she doesn’t realize how much important the number of cases are for us. She’s too lazy. She didn’t want to go to the hospital just because Malacanang suspended the classes last week so our group was not able to take any cases. Unlike the other group’s CI who even calls and wakes up her students at  2AM to handle a case. Last semester, our schedule for OR was 6AM-2PM but she just have us signed the attendance then waved us goodbye as early as 6:30 AM. We didn’t get any case.

The night before the last day of our duty in the Operating Room, she just instructed us to meet her at school. Luckily my cellphone is broken, and i didn’t read her text, so I went straight to the hospital that morning and saw that there would be a cesarean at 8AM. Thank goodness I was able to borrow a phone and inserted my sim and then I was able to read her text in my number.

When we’re at the school, she insisted that there  “is no cases anyway so we’ll just have an examination.” Therefore I contested her saying that I stopped by the hospital earlier and there is a scheduled cesarean. She called the always present and really diligent other group’s  Clinical Instructor and asked her if she can look at us while we handle the case, while she, our very own CI, lolls sitting comfortably giving an examination.

Hanzel, Loren and I went to the hospital and met the other CI.

It is really evident in her side comments and sarcasms that she just took us because she cannot refuse our CI’s request, given the choice, she would have done something else. She was actually planning to call her own group to handle the operation. But nevertheless, she’s still as nice as when I last had her as my CI when I handled a laparoscopic surgery as a circulating nurse and a cesarean as a scrub nurse. This time I’ did the cord care of the newborn, while Hanzel played the Circulating nurse and Loren the scrub.

It was Loren’s first time to be the scrub nurse and was very agitated. She asked us what to do, what to expect and the names of each instruments. She already knew all of these of course but she just want to be sure.

When the doctors and the two real circulating nurses came in the OR, I thought that they’d start the operation immediately so I told Loren to scrub her hands. Out of her excitement, she overdid her scrubbing. She soaked not just her hands but also her scrub suit. The circulating nurses, our temporary CI and the doctors were laughing at her. One even remarked, “Aba, nilabhan mo pati yung scrub suit mo ha.”(You even laundered your Scrub suit.). Man, how we laughed at her.

   

  

Loren scrubbed the second time only in our temporary CI’s instruction. Somehow she’s very reluctant to my and Hanzel’s suggestions.

This cesarean was a lot gorier than the one I handled last May. Somehow I felt a little bit uneasy as the Surgeon asked Loren why she’s handling the case without her real CI, especially when she commits mistake, which is inevitable.

Placenta

The process anyway was a lot faster than the one I handled last summer. In no time I was already cleaning the newborn inside the nursery. I have never done this before so I always ask the Doctor and the Nurse for some reassurance, heck I can’t even put the diaper correctly. This is my first Cord Care case afterall, the first time I cleaned a newborn. I know all the theories already but I was less than an amateur in the “real world.” I felt so dumb. I felt worse when the doctor started asking about my CI. I felt so blind without the guidance of a supposedly intelligent mentor. I wanted to melt on the spot.

  

 

Cesarean

 

  

Suctioning of Fluids (amniotic fluid, blood, and other mucosy stuff)

We were instructed to have our lunch after the case at 10AM. We were to return for a Minor OR case (Cesarean is a Major OR case). We decided that Loren should handle the case as well. Her case record is waaaay too pitiful. Hanzel decided to stay in the locker room while I decided to observe.

 

The case now was removal of bedsores. Bedsore (pressure ulcer or decubitus) is a sign of a very poor nursing care, especially in bedridden patients, just like our patient that time; an old man, 84 years old, immobile and arthritic. Bedsores are ulceration of the skin due to prolonged pressure in a body part.

He’s skin on his extremities and back are all shedding. It was all dry and flaky. It easily sloughs off the moment you touch and rub it at the minimum pressure. The guy indeed received the least of the least quality of Nursing Care at home. It is clear that the old man was neglected at home. The anaesthesiologist exclaimed to her colleagues that they should not let that happen to her, she asks for a Euthanasia. The surgeon agreed and told us that he doesn’t want to be intubated and if ever that time comes, he just have to say goodbye.

I was just going to observe, but the surgeon asked me if I can be a human side rail, the man is in right side lying positing. I supported the guy’s shoulder and limbs. I was face to face to the surgeon and the real assisting nurse. Loren was at the foot part minding the instrument, my CI was at my right, the Anaesthesiologist was on my left, the patient’s head part, explaining everything to me (she’s nice)

Imagine a raw meat. Burn its skin. Notice how the outer layer turns black while the rest of the meat stays fresh. This was how the patches of bedsores in our patient’s butt look like. The Surgeon peeled off the necrotic skin cells. The incision exudes blood, bright red but much thicker than usual, and though I was wearing a surgical mask, I still vividly smelled the putrid scent of the decaying meat together with the pustulence.

Time went by until the surgeon decided to cover the site with dressing. Somehow I felt warmer. Drops of sweats started flowing from my scalp, underarms, and chest. My eyes drooped involuntarily. My tummy turned upside down. I wanted to vomit. I know I was going to faint. Was it the smell? Was it the blood? No way, I ve been in more disgusting situations (like when a 7-year old girl vomited on my face), I cannot possibly faint. I felt hungry though I just had my lunch 30 minutes ago. I stopped thinking and told the nurse, “Maam, nasusuka po ako.” (Maam, I feel nauseated.).

Everyone in the room turned their heads to me and laughed. They told me to sit on the foot stool in the corner. I was sweating profusely. I went outside to wash. The electric fan and the water were soothing. I nearly fainted because of the heat in the OR, especially because the lights were all directed to me and the patient.

The Anaesthesiologist later on explained that they turned off the Air Condition because “Newborns and old people have impaired thermoregulation.” Meaning, they have difficulty maintaining a constant body temperature.

Phew… that was close.