wo abortions, a scan for possibly malignant tissue, removals of an
ovarian
cyst and uterine polyps, a delivery by Caesarean section - each
operation is
unique and arouses different feelings among staff and patients. A day
in the
gynecological operating room at Hadassah.
A day in the life of operating room No. 12 for gynecology patients at
Hadassah University Hospital, Ein Karem, Jerusalem, is not easy. The
anxiety
of one patient, scheduled for the relatively simple removal of a polyp,
contrasted sharply with the serenity of another patient, whose uterus
had
been examined for a suspected malignancy. The tears of relief streaming
from
the eyes of a woman who had just given birth by Caesarean section were
supplanted by the tears of silent pain that flowed from the eyes of a
patient who had just undergone a long-overdue abortion.
The human warmth that the anesthesiologist radiated and his soothing
hands
welcoming the patients immediately prior to their operations gave way
to
professional jargon and advanced technology the moment the surgery
began.
The day of a scheduled operation is a difficult one for all concerned:
tor
the surgeons, the operating room nurses, the anesthesiologist, the
cleaning
crew and, first and foremost, the patients themselves. Everyone is very
tense, everyone wants the operation to be successful, all the members
of the
surgical team have been on their feet since early morning and are
working at
peak concentration and intensity. They all have a specific function and
must
all leave their personal problems and concerns outside the doors of the
operating room (OR), from the moment the worried, anxious patient is
brought
in and until she is brought out, sleepy and smiling (because of the
narcotic
administered to her) to the recovery room.
Operating Room 12's anesthesiologist, Prof. Yoel Donchin, tried to
brighten
up the spirits of the patients, the staff and the visitor-for-a-day.
However, in the end, after eight consecutive operations, the only
smiles
that could be seen were on the faces of the patients who had been
operated
on, and they would continue smiling only until the effect of the drugs
had
worn off.
The day begins
The anesthesiologist's day begins a few minutes before seven in the
morning.
Donchin parks his car and runs into the hospital, quickly donning his
green
surgical uniform and his cap and sterile mask. The list of the day's
scheduled operations are posted on one of the operating room's walls.
Donchin checks the gas machine as well as the stock of narcotic drugs,
pain-killers, syringes and the respirator that he will have at his
disposal
that day. He reads the patients' medical charts and, at 7:30 A.M., the
first
patient is brought in.
"Hello! How are you today? Pleased to see me?" Donchin fires out this
greeting and rests a large palm on the woman's cheek, gently caressing
it
and then delivering the following declaration: "I'll be giving you a
very
slight blow to your wrist, a tiny injection. You will fall asleep and
then
you won't be able to be angry with me."
This is the same routine he describes and uses with all his patients,
who
accept the sentence he hands down to them. The injection is followed by
the
"Pina Colada" - that is the nickname given to the highly effective and
pleasant whitish-colored anesthetic with the slightly sticky texture.
"Good
night!" Donchin roars immediately after administering the injection.
The
patient is not even asked to count backward from 10, because, in most
cases,
she is already asleep before she can even say "nine."
That day, Donchin threatened his patients eight consecutive times with
a
slight blow to the wrist, an injection and a deep sleep. He roared
"Good
night!" eight times and woke his patients eight times with a "Good
morning,"
and with the question, "Wasn't it sublime, and would you like me to
order
you some breakfast?"
The operations performed that day included a therapeutic abortion -
dilation
and curettage (D&C); the removal of an ovarian cyst via laparoscopy;
the
abortion of a 19-week-old pregnancy through artificial stimulation of
contractions; a hysteroscopy (examination of the uterus by means of a
fiber
optic device) to check out a suspected tumor, followed by removal of
the
suspected tissue; a Caesarean section (the infant girl was healthy, her
father is a Betar Jerusalem soccer team fan); a combined operation for
removal of two polyps from the uterine cavity by means of an endoscope
and
for the removal of an infected wound from the vagina; another
hysteroscopy;
and the removal of two uterine polyps.
The CDs played that day were by Yehudit Ravitz, Esther Ofarim, Shlomo
Artzi,
and Simon and Garfunkel (that CD was played twice - at the visitor's
request). Ravitz's rendition of "Slichot" ("Forgiveness") was
loop-played
five consecutive times (at the anesthesiologist's request), until the
nurses
threatened to sever the CD-player's electrical cord. Number of calls
received and returned on the mobile phones of the OR staff: 11. Number
of
visitors who entered and left the OR (excluding its visitor-for-a-day):
3.
Number of breaks that the anesthesiologist took to drink a cup of
coffee, to
freshen up or to stretch his weary limbs: 0.
Surfing in the OR
The OR circa 2004 is no longer the quasi-sanctum sanctorum it once was,
explains Prof. Donchin, in response to the surprise aroused by a
surgeon who
conducted a cell-phone conversation during an operation (using an
earphone)
on more than one occasion; by an anesthesiologist who entered the OR
just to
show his colleagues the new digital camera he had received two days
earlier
and then took a few pictures; and by the open laptop placed at the
disposal
of anyone who wanted to read e-mails or surf the Web. And, of course,
by the
deeply intellectual conversation that was conducted over the question:
"Esther Ofarim or Yehudit Ravitz - who grates your nerves more?" Those
present voted for Ofarim. Judging by visits to neighboring ORs (Nos-.
10 and
13), the situation is not much different in the hospital's other
operating
rooms. Indeed, Hadassah was particulary open when it permitted this
highly
unusual visit, without setting limitations on the reporting or ground
rules.
The patients are brought in. Lying on their hospital bed, they are
nervous,
frightened and hungry. An important part of the anesthesiologist's
work, as
Donchin sees it, is "to calm them down before the drugs do." An
important
part of the nurses' work is to make them feel comfortable: They replace
head-coverings on the heads of patients after the operation is over and
remove the patients' legs from the gynecological leg supports before
the
patients open their eyes. When the nurses were slow to perform these
functions, because they were busy dealing with the equipment on the
tray,
Donchin lost his temper: "The patients come first. After you help them,
you
can arrange the instruments and samples."
Between the different operations, the "silent partners" entered the OR:
This
is the name given to the members of the cleaning team who clear away
all the
bleeding, sad evidence of what took place previously in the OR, as well
as
to the nurses responsible for renewing supplies. The surgeon, the
anesthesiologist and the head nurse sum up the information for the
medical
chart, then the anesthesiologist wheels the patient to the recovery
room,
where he verifies that she has awakened, is hungry and has forgiven
him. If
necessary, he prescribes her a painkiller and, even if not necessary,
he
offers to order her some breakfast - even if it is already 2:30 in the
afternoon.
After the third operation, all the members of the OR team are already
roaring, a la Donchin, "Good morning!" to the patients when they
awaken. A
happy chorus. And that is how things go until the end of the day. But
the
word "happy" is certainly not the word you would use to describe the
atmosphere in Operating Room 12. Fatigue can be seen on the faces of
everyone present.
"One day we had a visit from a group of students from the Technion
[Israel
Technological Institute in Haifa] who wanted to observe the work of an
OR
team," recounts Donchin. "In the pictures they took of themselves
before the
shift began, they looked fresh with smiles on their faces. In the
pictures
they took after the shift was over, they looked very tired and very
drained."
‘Sheer perfection'
Each operation is unique. In each operation, different feelings are
aroused
among the OR team and in the patient. In each operation, the procedure
and
atmosphere are unique. In each operation, the anesthesiologist prepares
a
different cocktail and uses different respiratory aids. And each
operation
has a different result - emotionally and practically speaking. The two
abortions created a gloomy atmosphere in the room. The first was a D&C
performed in the wake of incestuous sexual relations. The second was
the
abortion of a deformed fetus, performed on a drug addict in the 19th
week of
pregnancy. Donchin caresses the cheeks of these two patients a little
more
gently than he does the others' - both before and after the operation.
He asks the woman who is about to undergo the removal of a uterine cyst
whether she wants to be operated on "with or without anesthetic"; the
woman
who is about to have a hysteroscopy - the screening of the uterine
cavity by
means of optic instrumentation - because of a suspected tumor requests,
"Please don't start before I have fallen asleep"; and the father who
has
been given his newborn infant daughter and holds her in his arms,
following
the Caesarean section, says to the mother, "Perfection, sheer
perfection."
This time, the chorus said "Mazal tov!" instead of "Good morning."
Waiting for results from the pathology laboratory, as to whether the
suspected tissue was malignant or not, was making everyone nervous. For
a
moment, the entire OR seemed to be in suspended animation. Once the
news was
received that the tissue was benign, movement in the OR went back to
normal,
as if it had never frozen; the concentration and gentleness demanded of
the
surgeon removing the infected tissue from the sixth patient's vagina
were
immense, and the exhaustion that spread through the OR could be
strongly
felt. The images projected on giant screens of the uterus and uterine
tubes
of the patients undergoing laparoscopic surgery were truly impressive.
The pictures on the screens looked like something from a National
Geographic
film, and the room was darkened, as if it were a movie theater. The
smiles
of the ultra- Orthodox Jewish woman, a mother of six, before the
removal of
an ovarian cyst, were infectious, as were the tears of mute pain
flowing
from the eyes of the young woman from whose uterus two polyps had been
removed and who had awoken in pain. The recovery room was slowly
filling up,
and more and more half-awake, half-asleep patients were being sent
there
from the various ORs. The corridors were slowly filling with visitors
and
relatives.
My eyes were slowly adjusting to the darkness of the operating room
while
optical instruments and endoscopes were in use. My mouth and nose were
slowly adjusting to the sterile mask I had found uncomfortable in the
morning and which, toward the end of the day, I no longer noticed. I
could
slowly feel a continuing desire to leave that place and to be
elsewhere,
where people do not wear green surgical gowns, do not don masks and
gloves
and do not speak in a coded language. And that is the way things went
until
we left - the anesthesiologist and the visitor-for-a-day - "tired but
happy"
as we proceeded back to the parking lot.
Prof. Donchin. Human warmth.
(Alex Levac )
ENVIADO POR: Dr.Alejandro Wajner
Febrero 20, 2004.
E-mail: [email protected]
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