Tuesday, July 30, 2013

Sketching in the Operating Room Take-Aways: Don't Need Surgery

Currently, I am in a Surgical Orientation class, and unlike previous years we have gotten access to the OR right away.  It has been an eye-opening experience, much different than medical drama TV show portrayals.  Though, overall it has been a positive stage in my medical illustration education, it has been extremely shocking to me.  Not because of the bloodiness, I was surprised to find that I never felt one ounce of queasiness.  I think being neck deep in a cadaver for a semester cures you of that.  At least this person is alive and not smelly!  No, the shocking part has been how unmagical and average the whole process and people involved are.

BVIS students all scrubbed up!
When I think of the people that have cut open my body as well as family and friends, I imagine these people as semi-gods.  Focused, extremely intelligent, unable to make mistakes, non-emotional.  Let me tell you, these are not the people that I have met in the operating room.  The amount of normal, average drama going on when a 8 inch long, 5 inch deep gash is being cut into a patient blows my mind.  I have gone to three surgeries, I'm going to show a few sketches as well as stories from each.

1) Hip replacement

I was pretty intimidated going into my first surgery.  With only a short tour of explanation, I was feeling a little shaky in my scrubs, booties, and hair net.  All the surgeries I've seen were early in the morning, I get there around 7 am, because they are most likely to start on time.  This day, I was there for the morning "pep talk."  This pretty much consisted of a nurse yelling at everyone about losing things, breaking things, and doing things wrong.  Whoa, people seriously lose medical stuff?  And they apparently wind expensive robotic parts too tight and break them.  The vibe was very negative, I was glad I was not the one being operated on with all of the negative energy around.

Round grater instrument to make new hip socket.
By the time I got to the room with the surgery I was going to view, I assumed someone would ask me who I am when I entered.  No, apparently you can walk into an operating room, stand in a corner and no one really cares.  Then surgery prep is not a hurried process.  I stood around til 8:30 before the patient made an appearance, where she was thrown around like a piece of meat after she was put under anesthesia.  The group the doctors and nurses then proceeded to bad mouth her, not believing her story of falling down stairs and hurting her hip.  I felt very uncomfortable.

Once the surgery began, me on my tip toes on two stools to try to see over the surgeons, I could concentrate on drawing.  Because of the bloodiness aspect, all the surgeons were wearing what a fellow student referred to as "hazmat suits."  Basically they come in washed up with helmet looking things on and a giant hood/jacket with a clear face area is put over the helmet.  They are good at not getting blood in your eye and also blocking me from seeing anything.

After the first cut, "gentleness" in treatment is thrown out the window.  Shove your whole hand in, no problem.  It's a difficult, bloody process, made even more exciting since a student is doing it.  These students are basically me, full of academic knowledge, very nervous, and definitely not completely qualified to be doing this.  Though I know they must learn someone, I would rather it not be my body in the first place.  When hammering into the bone socket could lead to total bone shatter, I want someone doing it not for their first time.

In the end, my sketches were very rough.  It was much more about getting to know the process versus making anything of quality.  I slipped out during the closing process and went to decompress for a couple hours.  It was a tough introduction to how the medical process truly works.  I want to see a much more positive, healing approach taken.  More respect given to the patient.  But the bottom line is, the doctors and nurses are just there for another day of work.  They chat about what they did last weekend, they play Pandora stations on the computer during surgery, and they gossip and fight amongst themselves.  Not semi-gods, just average humans who happen to have the power to slice into other humans' bodies for medical purposes.

Cutting open the hip.
2) Prostatectomy

Number one take away: I'm glad I don't have a prostate.  This surgery, a nurse actually introduced me to the people in the OR.  I was much more comfortable and everyone was happier than in the hip replacement.  It didn't take long for the male patient to be rolled in.  It was 80% women in the room and I think that the patient was a bit embarrassed that we were all about to become acquainted with his penis, bladder, and prostate.  The atmosphere was light and the patient was joking around, I felt much better about his treatment.

When the surgery began, I was sharing space with two medical students to get a good view.  They were both very nice and pointed out different processes that were going on and why.  The surgeon wasn't as nice.  At least once a minute he would say, "This is the slowest nurse team I've ever had," in a way where it could maybe, possibly be a joke, but most likely he was just being an ass.  It was uncomfortable the first time he said it, the other 30 times were just weird.  Luckily, the nurses didn't let it bother them and everything went smoothly.  I got much better sketches, feeling more comfortable with the process as well as having a better view.

First incision to layer of fat.

Open area of surgery, shows retraction of skin and fat.

3) Total knee replacement

The last surgery I saw was part of a total knee replacement.  Because the knee is bent upwards for most of the surgery I had an amazing view, but it takes a long, long time to get things right.  The person who makes/sells (I'm not sure which) the equipment introduced himself to me before the surgery and was the most excited about what I was doing.  He had met other BVIS students before and liked them.  Unlike other BVIS students, I never got much interest in my sketches or why I was doing them.  That is fine with me because I didn't need any pressure to make works of art!

The process of a total knee replacement involves screwing in many pre-made metal guides that all precision cutting of the bone.  This was not a measure twice, cut once process, there was a lot of recutting done.  I don't think that's the normal situation, another surgeon had to scrub in mid-surgery to assist.  I don't think anyone was doing a bad job, it was actually the pursuit of giving the patient the best possible knee.  Every knee shape is different and they only have so many sizes of parts, things were lining up perfectly.

The room is kept cold during surgery, but this one was kept particularly freezing.  Once they were going in to cut the same place for the 5th time, I was shivering and not getting any new drawings done. I decided to leave and let the surgeons have their space.  My sketches had come a long way from the first surgery.  I am looking forward to taking Surgical Illustration next semester.  The class size will be smaller, so splitting up surgery time between 20 people will not be a problem.  Also, I will know what surgery I will be going into view.  This time, I didn't know until I got to the OR what I would see; it was just a fun surprise.

Slicing off part of femur bone using a metal guide.

Retraction of knee (above); Drilling into femur (below)

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