21 Apr THEATRE
When I was in college, I thought theatre was complicated, it scared me even. Too much was going on, the patients with various surgical needs, the procedures, overwhelmingly many instruments, different types of surgeons and their preferences, anesthetists with their dangerous drugs. Then there were theatre nurses, brilliant, organized, so focused, and they seemed to go with the whole theatre flow. The nurses prepared all the cases by arranging the instruments for each case and trust me, the instruments are many with different complicated names, wrap them in a tray with green towels and sterilize them in CSSD. Next they would prepare the theatre rooms, clean them, arrange all the equipment needed and ensure all the supplies required are available like sutures, gloves, sterile gowns etc. The scrub nurse then starts preparing themselves, wash their hands with the international handwashing technique, wear the gowns and gloves in a very keen manner so as not to break the sterility. Scrub nurse then arranges the instruments on the trolley according to how the surgeon will use them step by step. He/she knows what the surgeon will use first and what’s next because the scrub nurse knows the whole procedure very well.
The circulating nurse is busy prepping the theatre with all the equipment’s such as the diathermy(the hot knife), the suction, the lights above the theatre bed, the steris if the patient will need to be positioned, tourniquet in case of major surgeries like orthopedics, set up the image intensifier(II), set up the tower incase it is a laparoscopic case. The patient is then wheeled to theatre, another nurse assists the anesthetist to sedate the patient. It can either be general, spinal, sedation or local anesthesia. The anesthetist assistant(AA) prepares the medication that will be used according to the preferred mode of anesthesia by the patient. General anesthesia requires major muscle relaxants like tracurium, induction agents like propofol, and other supportive drugs. Endotracheal tubes to be used, laryngoscopes, masks, bacterial filters, catheter mounts, and gases are then set up and while the patient is induced, the anesthetist and the AA, monitor the patient through the procedure. Spinal anesthesia requires muscle relaxants and inducing agents such as marcaine, fentanyl only this time, they are injected into the CSF at the lumbar spine with a spinal needle. It’s not scary, I hope no one is getting the jitters.
Cutting time is when the surgeon makes the incision and starts to operate, the whole team works collaboratively so that the cutting time starts as scheduled, they work together to ensure the procedure goes smoothly, they all work together for a good outcome for the patient. Once the procedure is done, the patient is transferred to the recovery unit, where the Post Anesthesia Care Unit( PACU) Nurse monitors and nurses the patient until the anesthesia wears off and the patient is fully awake. Pacu nurses hand over the patient to the ward when they are happy with the patient’s vitals, GCS, and the state of the surgical site.
First time I scrubbed was in my internship, it was a gynae case. I remember the surgeon was a woman, there was blood, I won’t lie it was flowing, and we had stood for a while. I was holding two tenaculum forceps, one in each hand, all of a sudden, it was hot, I could feel the heat move all the way rom my feet up to the last nerve in my brain, I started feeling woozy, I felt dizzy, the whole theatre was a blur, and in circles, I felt light, I felt strong arms hold me and then black!. When I woke up, a handsome doctor was standing next to me. There were always handsome doctors around most who were on their medical internship as well, we met with them in every department that they did their rounds. He told me that I had fainted during the procedure and he gave me pointers on what to do next time I scrubbed in; I should not stand still at one point for long, I should keep making small movements, mostly I can try moving my toes frequently to allow circulation. You would think that people will sympathize with you when you faint, okay they did but there were repercussions, the surgeon was not happy, immediately I felt I was becoming weak, I should have said, and another nurse would have scrubbed in, it could have been risky if I jeopardized the procedure because I was the one assisting the surgeon, I was apologetic. By the time I was done with my two weeks rotation in theatre, I had scrubbed in or several cases successfully without any fainting spells, especially cesarean section(C/S), and I understood the flow of theatre a bit.
Theatre now has its flaws, but it has been the most exhilarating experience in my life; professionally and socially too. The first days since my request to be allocated in theatre were tough, I was officially a perioperative nurse and I had to take the work seriously. Learning the theatre instruments and equipment by their various terms was the toughest, I am still learning some of them five months down the line. The first case I scrubbed in after a long time out of theatre was a cesarean section, the surgeon literally called me ‘a theatre virgin’, I was not fast enough in handing him over the instruments so he could tell I was new. He encouraged me though, told me that I was doing incredibly well for a newbie, my colleagues and other doctors were also very encouraging, they said they saw a lot of potential in me and that is all that I needed to motivate me. Apart from feeling so cool being able to participate in many major cases, I have also made really cool friends ; my colleagues are awesome, friendly, wild and so adventurous. My male colleagues are excellent at their job, they are naughty and they take each opportunity they get to tease, flirt and make us laugh and they always have our backs in the heavy lifting in the unit. For us ladies, we have taken the saying ‘life is for the living’ literally; we dwell in adventure and fun. At work we do awesome and excellence nothing less and off duty, we take it upon ourselves to enjoy ourselves. Every month we ensure to have an outing whether it’s a restaurant, a resort, or just somewhere with an exciting activity, being in Mombasa we have lots of them, especially involving marine life.
Personally I detect a more mature, more confident woman within me, it’s quite liberating watching yourself grow into a person you love. All I can say, progressing to perioperative nursing was a good move, it has really boosted my character; if it’s not theatre then, I am just astounding, and am bragging!