Theatre from the outside looking in Part 3

Please refer to my disclaimer before reading any of my Nurse Boo categorised posts

Pre-op – I think a little piece of my heart will always remain there….

It was my first placement, the first ‘hospital people’ I came into contact with. It was a series of firsts that so quickly just became part of my ‘normal’ It’s genuinely a place I can think of and always smile. A lot of that has to do with the characters I met there – both in staff and in patients. It’s generally a nice place to be where people are not seriously unwell and their biggest problem that day tends to be nerves as they are going under the knife in a few hours. Minus one major incident, there was no drama during my time there. You could say you are limited on what you can learn there but following my long placement I can confirm that is not true. Being mostly ‘firsts’ these experiences and discoveries will definitely stay with me forever.

I had two mentors in Pre-op as my main mentor only worked 3 days a week so I need a second for the 2 extra days I worked. Two hugely contrasting characters, very different ways of teaching, very different ways of nursing, giving me two for the price of one on perspectives. Not a bad thing as I see it, but shaping myself with the qualities of both and being able to see the benefits of one person’s action over another in identical situations aided my learning.

My main mentor *Gabriella was a sweet and very pretty lady, perfect bobbed hair and natural make up and a warm and soft Irish accent. She seemed a little shocked when I was plonked down in front of her, I later found out that I was her first ever student, I guess in turn that only strengthened our bond – being each other’s firsts! (As well as the dark chocolate and freshly brewed coffee we frequently shared in the store cupboard.) Gabbi very quickly showed me the ropes, she had a good way with patients but despite her quiet and discreet demeaner and her small stance, I quickly saw how in control she was. She didn’t take crap from anyone and didn’t suffer fools lightly. She knew when someone was going to be a troublesome patient, and I’m glad to have had the chance to learn the ‘Gabbi way’ when it comes to intuition.

So Gabriella is a nurse in theatre admissions, it’s her job to admit patients for their surgery. Now, theatre admissions is a place that starts off complete chaos and they day gets easier and more straight forward as it goes on. You literally start the day being chucked head first into the deep end and end the day in the jacuzzi, that’s just the rhythm of TAU (Theatre admissions unit) I’m not quite sure how I’d fix it, nor am I in a position to be saying how things should be run, but given the opportunity I’d change a lot in the way the system runs in TAU. This is an NHS hospital, and NHS or no NHS they have a certain amount of surgeries scheduled to be performed on any given day and there are a range of specialities in that mix. Now the thing about surgery for a patient is that is such a personal and all-consuming thing. The angst of going ‘under the knife’, the worry about your problem being fixed or even not being fixed, the desperation for a better quality of life or just for the pain to go away. Then there’s the fear that something will go wrong, the feeling of being completely out of control and of course the fear that you will be put to sleep and never wake up? Everyone has thought it… Having surgery is a very personal and intimate thing. As a surgical patient you are extremely vulnerable, even if it’s something as small having a tooth pulled. I’ve seen grown women in TAU in shaking tears over having a tooth extracted! Therefore, when you turn up to the unit of the day of your surgery at 7am you are completely consumed and within yourself when it comes to your own thoughts and fears. So when you come through the doors and see that there are 20-30 others all coming to be admitted at the same time I think it’s a shocking reality check for many. You haven’t been thinking about anyone else, and you assume that as your letter says be there at 7am that there should be just enough time to ask questions, get checked in and changed and then off you pop down to theatre to get on with it – this thing that you have been waiting for maybe the last 3 months for, and that’s just on the NHS list, what about the suffering you have endured prior to getting referred?

And that is precisely where most people get a horrible shock coming into hospital. 7am they are sat downstairs, one of the nurses briefs them collectively on what will happen over the morning and at 7:30am they are called upstairs to the unit. This can only be described as slightly stampede like, you see we naturally all operate on the idea that first come first serve is how life works…. It doesn’t in TAU. It may seem like you have walked into utter chaos with a sea of hands waving letters and nurses pointing and ordering people around the space and searching for names on the list that correspond with those on the shaken letters. But you would be wrong to assume that this really is chaos because actually it’s all very streamlined an organised. Each surgeon has a list – there may be some deviation from the order of this list once the surgeon has seen the patients of taken into consideration some of their specific needs. Each of those lists has an allocated nurse or HCA, and each person on that list has to go through the same process of explanation, questioning and poking and prodding. Whether you are having a tooth or a breast removed, the process of admission is much the same. You can be seen first by the nurse at 7:45am but still be last on the list for surgery and not go down to theatre until 4pm. This seems to be a hard concept to grasp for most patients, and to be fair to them I can kind of understand it, but it creates a great sense of animosity within what is already a stress heightened environment.

Patients hand in their letters, their names are ticked as arrived on the list and the nurse uses that as her guide to call patients to start admitting them. Things move quickly at this time in the morning, and whilst the nurses are trying to admit these patients the various surgeons and anaesthetists are also circling trying to get their part in this process done so they can get into the theatre, scrub up and get on with the days surgeries. Each patient must be seen by both of them – the surgeon goes through the surgery, answers any questions, goes through the risk and witnesses you sign the consent form based on what he has told you and this binds the two of you. The anaesthetist is looking at any problems you may have with breathing or any of the medication they may need to give you in theatre and determines your safety for the procedure.

There is no order in which you see these people and this part of the day can only be described as what I imagine feeding time at the zoo to be like. The food here are the patients notes, and sometimes the patients themselves. The surgeons and anaesthetists are the big cats – they are the prowling lions, the circling cheetahs and have the pouncing ability of a jaguar. Everybody needs the patient notes to do their part of the job, once the lion has got the ones you want you don’t stand a chance! Once the lions have decided their order of prey – they will expect the first patient to be admitted, fully dressed and ready to be taken into theatre. So, you getting those notes back and that patient ready and where they need to be really does put you in a life threatening position.

Now as I said earlier, this is an extremely personal experience, the patient who enters your cubicle to be admitted is a mixed bag of feelings and emotions and probably slightly overwhelmed by the events of the morning. Bare in mind these people are ALL also hungry and thirsty as they are all nil by mouth. So there is the emotion of ‘Hanger’ to also contend with. What I found most hard about working in TAU was the lack of time you get to spend with you patients during this time. Especially if they are the first on the list and your focus is getting them ready and in the right place and less about comforting and reassuring them should they need that from you. Time constraints mean it’s hard to get all the information you need from them, all the boxes ticked and all the observations done and also really have time to explain to them what’s going to happen and to allow them the space to be vulnerable.

Despite feeling like I didn’t get to give enough of it, I really feel like having been through surgery myself prepared me so well for my time in TAU and makes me a better TAU nurse. I may not always have the time to show it but I do have the understanding and the compassion and I really do know what it’s like to walk in their shoes (and compression stockings) more than they will ever know. I therefore work my best around the time constraints and in between fighting with the lions, to give them the reassurance they need.

So it’s clear that my own personal surgical experiences give me an edge as a TAU nurse and allow me to relate to complete strangers. But they also perhaps put me at a disadvantage at times, in leaning me sometimes too far in the thought direction of the patient and straying me away from being a nurse doing an important job…..

On day 2 of my placement, a man was coming in for hernia surgery. He’d clearly long ago run out of patience with this hernia and his wife accompanied him to the hospital. They were clearly a very close and ‘concerned’ family. His daughter rang his phone several times when we were in the cubicle and his wife smiled at me and said, ‘our daughter – she’s just so worried about her dad’ – Gabbi and I of course did our best to reassure. As the newbie on the block my initial thoughts were – this is such a lovely close-knit family and they all look out for and support each other. Gabbi, the experienced nurse sees them as threats – they are going to need extra care, extra reassurance and the more of them involved the longer this process is going to take. This is a delicate meeting between patient and nurse only! He was extremely eager and pushy to be first on the list – I took this as his anxiety and worry and was surprised when Gabbi completely dismissed him as just someone who was throwing his weight around. My immediate instinct was she’s wrong – this poor guy is so anxious and we are just dismissing him and I know exactly how he feels poor man. This is day 2 on TAU, day 2 as a student nurse, day 2 in a hospital but one thing I do know is Gabbi is wrong.

In fact, on day 2, I was wrong.

On day 2 Gabbi taught me the very important lesson of finding the perfect balance of being ‘human’ and being ‘tough’.

Despite this man’s anxiety or whatever the reason behind his behaviour, he became the patient that no one wanted to help and tried the patience of all the nurses by being rude, abrupt and demanding. Huffing and puffing and standing in the middle of the corridor talking to anyone who would listen about how hard done by he was for having to wait. Staring glaringly at anyone who caught his eye as if to say, why aren’t you doing something for me? why aren’t you getting me in quicker? What this man, and many others don’t understand is that – nurses are very low on the list of how these things are controlled and maneuvered. The control is first in the hands of the lions – and the schedulers who booked the time slots and the theatre itself. We get just as frustrated with those forces ahead of us as you do. But so much affects your place on the list, even down to positioning of the theatre. If you are on a list with a ‘general surgeon’ you could be on list with another hernia, removal of a cyst, a cholecystectomy and a laparoscopy. If the theatre has to be set up with the bed facing south for the hernias and north for the other procedures the natural order of proceedings will mean that the two hernias are done first then the theatre breaks, the theatre is rearranged and the other 3 procedures are then performed. This makes sense, right? But it’s not something anyone ever thinks of when they come in – they just think WHY am I not first, why are you ignoring me, why did Doris who came after me go for her op first? This day is hard enough for me!!  

The irritation I developed for this man and his behaviours was heightened by the fact that I had made a bad judgement on him and situation and my inexperience reared its head. But it’s something that TAU, and Gabbi taught me. The instinct you develop as a nurse is something that comes to you over time, with experience and with encounters with many different people from all walks of life. Second guessing becomes second nature and it was only day 2……..

To be continued…….

Image credit – Stefan Schweihofer


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