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Jul. 15, 2010

OR Anthropology

by Dana Greenfield

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Hi, Mom. Hi, ether. On my first clinical rotation, I did step into a whole new world. And while I’m back to real life, I definitely brought a little part of the wards back with me. But I also left a little part of my former self there, too. For better or worse, these past few months have been some of the most intense (and the most rewarding) of my life. I wish I could write one blog entry that could capture how much I’ve learned or what I saw, but that would be impossible. Instead, I’d like to share a few reflections on, and a peek into, the very privileged world of hospital medicine.

Mom, you were totally spot on. My reports to you on the telephone weren’t just the mad ravings of a sleep-deprived med student. I really did love surgery. I loved being in the hospital taking care of patients, getting all their “numbers”, (re)presenting them on rounds, learning how to change their dressings (not a trivial task), and assessing their wounds, drains, staples, and sutures. I felt empowered with new skills; I was useful to my patients and team. I was even more intoxicated by the OR, its predictable rituals (draping, scrubbing, time-out, instrument counts, etc.), accoutrements, sounds, smells, colors, and people. I took every opportunity I could to steal away from the floor service to “scrub in”.

I’m surprised at how far I’ve come from my first OR exposure just 1.5 years ago as a “pre-clinical” med student—when I found everything there so alien—to now, viewing the OR as a sanctuary. But on my last day as a surgical clerk, I was reminded of the OR as the unnatural and otherworldly place it too often is.

It was our last week on the general/trauma surgery service and most of us had “checked-out” retreating to our books to study for the upcoming exam that completed our rotation. Taking a break from my studies, I ran into one of the trauma nurse practitioners (integral members of our massive team). She stopped me in the hall: “Hey, why aren’t you in the OR!?” A major car crash with three victims arrived in the ER just an hour or so before. The wife had already died; the husband hung on by a thread while my attending surgeons and chief resident were trying to save his life. They had come to visit San Francisco. Tourists and their taxi driver.

I had seen my fair share of traumas, but it had been a relatively quiet 2 months and nothing quite so devastating had come through our doors. I ran to the OR, grabbed a mask, a cap, and entered OR room #1 for the first time. OR #1 is reserved for major emergencies and remains empty waiting for them to arise. I joined a throng of nurses, technicians, anesthesiologists, surgeons, and students. It was no longer a safe and predictable place. The OR felt alien to me again. 20-30 blood-soaked sponges lined up in the corner, empty blood product bags scattered on the floor, and nurses and technicians were running about. The head trauma surgeon was in rubber boots, elbows deep in the abdomen, and anesthesiologists were monitoring his vitals closely and actively infusing life-sustaining fluids and drugs into his middle-aged body.

The draping was haphazard; meticulous control of the field was sacrificed for the sake of a few seconds of time in this life-threatening situation. Still, the various tools, towels, sheets, monitors, poles, and people that surrounded him obscured his form and face. All I could see was every effort used to keep him alive, rather than the person beneath it all. Normally, this disassociation (dehumanization, even) is what allows us to cut into and “wound” the body of another person. But this time, I struggled with that. I knew he was dying on the table and I wanted to see him as fully human, not as a part of this techno-medical mess.

My stay was brief. They were “closing him up” and hoping to stave off the bleeding and maintain his blood pressure. I left not because I was not useful, but because I was overwhelmed by what I saw. The controlled, orderly, and ritualistic OR where I had spent the past 2 months, and in which I had become so comfortable, so at home, was instantly transformed into something entirely unsettling and frightening.

Later that night on the local news I heard that the man did not make it. The next day, we discussed him in our morbidity and mortality conference and I understood why. He had fatal injuries. The chance that any OR could control the bleeding was very small. Was all that effort, the 4 hours of surgery, and the 20 liters of blood products we gave all for naught? Or was it just another ritual of the OR, of the hospital, of our medical system? We use every life sustaining effort we can because we hope that even the smallest chance will make our efforts heroic.

One of my greatest fears going into medicine and particularly surgery was that I would only see patients in the unnatural environment of the hospital—living in hospital gowns, scrubs and beds, reduced to malfunctioning body systems and lab data. I would lose sight of their humanity. I think no matter how hard we try as students or residents, this transformation of people into mechanical bodies is inevitable, if not necessary. But this last day in the OR, observing one of my first deaths despite resuscitative efforts, jarred me back to a time when I was more innocent of hospital medicine. It re-impressed me with the humanity and gravity of this work, and humbled me to it as well.

This, my first rotation in surgery, will feel different than every other one to follow. There’s no turning back now. I have chosen a path where I will constantly straddle two worlds and now hopefully I can do so while maintaining my humanity, and especially that of my patients.

I am incredibly grateful for having the opportunity to be invited into the lives of so many extraordinary people—patients as well as “the team” of surgeons, nurses, and others. Most of all, I now understand a bit of what my parents went through; how hard they worked to become who they are. I also see that they both provided us with exceptional (perhaps rare) examples of extremely dedicated and caring physicians. I’m grateful for that, too.

Will I fulfill my mom’s fantasy and travel the path to become the first ever mother-daughter ENT team? Stay tuned!

About Dana Greenfield

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