Surgical Team Quotes

Throw one more thing, Jimmy, and I’ll shove my three-inch heel so far up your ass you’ll need a surgical team to extract it.

It wasn't the paramedics or the surgical team that saved my life. It was Ray and Stella Quinn.

What does it take to unwind the unwanted? It takes twelve surgeons, in teams of two, rotating in and out as their medical specialty is needed. It takes nine surgical assistants and four nurses. It takes three hours.

McKusick's belief in this paradigm-the focus on disability rather than abnormalcy-was actualized in the treatment of patients in his clinic. Patients with dwarfism, for instance, were treated by an interdisciplinary team of genetic counselors, neurologists, orthopedic surgeons, nurses, and psychiatrists trained to focus on specific disabilities of persons with short stature. Surgical interventions were reserved to correct specific deformities as they arose. The goal was not to restore "normalcy"-but vitality, joy, and function. McKusic had rediscovered the founding principles of modern genetics in the realm of human pathology. In humans as in wild flies, genetic variations abounded. Here too genetic variants, environments, and gene-environment interactions ultimately collaborated to cause phenotypes-except in this case, the "phenotype" in question was disease. Here too some genes had partial penetrance and widely variable expressivity. One gene could cause many diseases, and one disease could be caused by many genes. And here too "fitness" could not be judged in absolutes. Rather the lack of fitness-illness [italicized, sic] in colloquial terms- was defined by the relative mismatch between an organism and environment.

Code Blue! We’re losing him!” The EMTs hustled the gurney containing Erik Dawson’s broken body into the operating room where the surgical team waited. The nursing staff literally ripped his clothes off as they worked to stabilize him. “What do we have here?” the lead surgeon asked. His assistant didn’t bother to look up as she answered, “Auto accident. An eighteen- wheeler smashed his car into a guardrail.” The lead surgeon whistled through his teeth. “It’s a miracle he’s still breathing. Let’s keep him that way.” As the surgical team moved into action with skill born of practice, Erik drifted on the fringes of consciousness. Erik’s thoughts raced. What? Where? Anesthesia put him under, but as the doctors began their work and his parents prayed fervently in the waiting room, Erik spasmed and stopped breathing. Family Matters, from Home Again

The Nazis were tedious in their self-righteousness and triumphalism. They were like a winning soccer team at the after-match party, getting drunker and more boring and refusing to go home. He was sick of them. Some people might say that the USSR was similar, with its secret police, its rigid orthodoxy, and its puritan attitudes to such pleasures as abstract painting and fashion. They were wrong. Communism was a work in progress, with mistakes being made on the road to a fair society. The NKVD with its torture chambers was an aberration, a cancer in the body of Communism. One day it would be surgically removed. But probably not in wartime.

Society would have much to gain from decriminalization. On the immediate practical level, we would feel safer in our homes and on our streets and much less concerned about the danger of our cars being burgled. In cities like Vancouver such crimes are often committed for the sake of obtaining drug money. More significantly perhaps, by exorcising this menacing devil of our own creation, we would automatically give up a lot of unnecessary fear. We could all breathe more freely. Many addicts could work at productive jobs if the imperative of seeking illegal drugs did not keep them constantly on the street. It’s interesting to learn that before the War on Drugs mentality took hold in the early twentieth century, a prominent individual such as Dr. William Stewart Halsted, a pioneer of modern surgical practice, was an opiate addict for over forty years. During those decades he did stellar and innovative work at Johns Hopkins University, where he was one of the four founding physicians. He was the first, for example, to insist that members of his surgical team wear rubber gloves — a major advance in eradicating post-operative infections. Throughout his career, however, he never got by with less than 180 milligrams of morphine a day. “On this,” said his colleague, the world-renowned Canadian physician Sir William Osler, “he could do his work comfortably and maintain his excellent vigor.” As noted at the Common Sense for Drug Policy website: Halsted’s story is revealing not only because it shows that with a morphine addiction the proper maintenance dose can be productive. It also illustrates the incredible power of the drug in question. Here was a man with almost unlimited resources — moral, physical, financial, medical — who tried everything he could think of and he was hooked until the day he died. Today we would send a man like that to prison. Instead he became the father of modern surgery.

And he’s still fighting the infection. But he’s kept the leg. His surgical team is absolutely top-notch—I’m impressed.

The importance of a group seeing one another may sound trivial, but it can be deadly serious. Until recently when medical teams gathered to operate on a patient, studies showed that they often did not know one another's names before starting. A 2001 John's Hopkins study showed that when members introduced themselves and shared concerns ahead of time, the likelihood of complications and deaths fell by 35%. Surgeons, like many of us felt they shouldn't waste time with the formalities of seeing and being seen, for something as important as saving lives, yet it was these silly formalities that directly affected the outcomes of surgeries. It was when [the surgical team] practiced good gathering principles that they felt more comfortable speaking up during surgery and offering solutions.

It left me and the whole surgical team traumatized.

There wasn’t much more to it. But getting teams to stop and use the checklist—to make it their habit—was clearly tricky. A couple of check boxes weren’t going to do much all by themselves. So the surgical director gave some lectures to the nurses, anesthesiologists, and surgeons explaining what this checklist thing was all about. He also did something curious: he designed a little metal tent stenciled with the phrase Cleared for Takeoff and arranged for it to be placed in the surgical instrument kits. The metal tent was six inches long, just long enough to cover a scalpel, and the nurses were asked to set it over the scalpel when laying out the instruments before a case. This served as a reminder to run the checklist before making the incision. Just as important, it also made clear that the surgeon could not start the operation until the nurse gave the okay and removed the tent, a subtle cultural shift. Even a modest checklist had the effect of distributing power. The surgical director measured the effect on care. After three months, 89 percent of appendicitis patients got the right antibiotic at the right time. After ten months, 100 percent did. The checklist had become habitual—and it had also become clear that team members could hold up an operation until the necessary steps were completed.

I’m Jay Powers, the circulating nurse”; “I’m Zhi Xiong, the anesthesiologist”—that sort of thing. It felt kind of hokey to me, and I wondered how much difference this step could really make. But it turned out to have been carefully devised. There have been psychology studies in various fields backing up what should have been self-evident—people who don’t know one another’s names don’t work together nearly as well as those who do. And Brian Sexton, the Johns Hopkins psychologist, had done studies showing the same in operating rooms. In one, he and his research team buttonholed surgical staff members outside their operating rooms and asked them two questions: how would they rate the level of communications during the operation they had just finished and what were the names of the other staff members on the team? The researchers learned that about half the time the staff did not know one another’s names. When they did, however, the communications ratings jumped significantly. The investigators at Johns Hopkins and elsewhere had also observed that when nurses were given a chance to say their names and mention concerns at the beginning of a case, they were more likely to note problems and offer solutions. The researchers called it an “activation phenomenon.” Giving people a chance to say something at the start seemed to activate their sense of participation and responsibility and their willingness to speak up. These were limited studies and hardly definitive. But the initial results were enticing. Nothing had ever been shown to improve the ability of surgeons to broadly reduce harm to patients aside from experience and specialized training. Yet here, in three separate cities, teams had tried out these unusual checklists, and each had found a positive effect. At Johns Hopkins, researchers specifically measured their checklist’s effect on teamwork. Eleven surgeons had agreed to try it in their cases—seven general surgeons, two plastic surgeons, and two neurosurgeons. After three months, the number of team members in their operations reporting that they “functioned as a well-coordinated team” leapt from 68 percent to 92 percent. At the Kaiser hospitals in Southern California, researchers had tested their checklist for six months in thirty-five hundred operations. During that time, they found that their staff’s average rating of the teamwork climate improved from “good” to “outstanding.” Employee satisfaction rose 19 percent. The rate of OR nurse turnover—the proportion leaving their jobs each year—dropped from 23 percent to 7 percent. And the checklist appeared to have caught numerous near errors. In

Almost every term the surgical teams used was unfamiliar. We all supposedly spoke English, but I was often unsure what they were talking about.

THIS PART OF THE HOSPITAL SEEMS LIKE FOREIGN COUNTRY to me. There is no sense of the battlefield here, no surgical teams in gore-stained scrubs trading witty remarks about missing body parts, no steely-eyed administrators with their clipboards, no herds of old drunks in wheelchairs, and above all, no flocks of wide-eyed sheep huddled together in fear at what might come out of the double steel doors.

THIS PART OF THE HOSPITAL SEEMS LIKE FOREIGN COUNTRY to me. There is no sense of the battlefield here, no surgical teams in gore-stained scrubs trading witty remarks about missing body parts, no steely-eyed administrators with their clipboards, no herds of old drunks in wheelchairs, and above all, no flocks of wide-eyed sheep huddled together in fear at what might come out of the double steel doors. There is no stench of blood, antiseptic, and terror; the smells here are kinder, homier. Even the colors are different: softer, more pastel, without the drab, battleship utilitarianism of the walls in other parts of the building. There are, in fact, none of the sights and sounds and dreadful smells I have come to associate with hospitals, none at all. There is only the crowd of moon-eyed men standing at the big window, and to my infinite surprise, I am one of them. We stand together, happily pressed up to the glass and cheerfully making space for any newcomer. White, black, brown; Latin, African-American, Asian-American, Creole—it doesn’t matter. We are all brothers. No one sneers or frowns; no one seems to care about getting an accidental nudge in the ribs now and again, and no one, wonder of all, seems to harbor any violent thoughts about any of the others. Not even me. Instead, we all cluster at the glass, looking at the miraculous commonplace in the next room. Are these human beings? Can this really be the Miami I have always lived in? Or has some strange physics experiment in an underground supercollider sent us all to live in Bizarro World, where everyone is kind and tolerant and happy all the time? Where

The farmer pulled up to the mews at the back of the hospital. The first inkling Longmore had that it was going to be a long night was when Thompson, the head porter, called him. 'Mr Longmore, is that pig in a Land Rover in the mews anything to do with you?' 'Yes, it is.' 'Well, it has just got out and turned left along Wimpole Street.' Reluctant to make its own valuable contribution to medical progress, the pig had escaped. It is surprising how fast a pig can run, especially when its life is at stake. Still dressed in their operating theatre gowns, caps, masks and boots, the entire surgical team gave chase. The pig ran as fast as its little legs could carry it, but was no match for London's finest heart surgeons, who eventually caught it halfway up the road.

Legal You will learn that there are restrictions placed upon you in some areas. These restrictions are for your own protection. You will be prohibited from administering medications, recording sponge counts, or carrying out direct physician’s orders regarding treatment of a patient out of your scope of practice. As soon as you overstep your limitations and boundaries and perform any of these actions, you are placing yourself in legal jeopardy. Whether functioning under the supervision of a surgeon or a registered nurse, a CST is always part of the surgical team and you must carry out your responsibilities within the scope of your practice. Never try to do a task that does not fall within that realm. All counts are significant and have important legal ramifications. When performing a count, it is crucial to ensure that the count is correct for the patient’s well-being. When you are scrubbed, you count sponges while the registered nurse observes and records the count. At any given time during a surgical procedure, the CST may request a sponge, and possibly a sharps count to take place. If you are assisting the circulating nurse in a nonsterile role, you may assist with the counts as long as the nurse verifies it. In this scenario, the nurse is legally acting as the surgeon’s agent. It is the responsibility of the registered nurse to obtain the required medications for a case. The CST draws the drugs into syringes and mixes drugs when scrubbed; during this process, the proper sequence of medication verification and labeling must occur. In any phase of your responsibilities, there are possible grounds for legal breaches. Shortcuts may cause a patient to suffer tragic complications, even loss of life. Negligence must be avoided. Both as an employed CST and as a student, you carry the responsibility to do no harm. If you should become discouraged in your role or begin to feel this responsibility is overwhelming, it could simply mean that you need a change; it isn’t always the other team players or the place of employment that are at

Teamwork may just be hard in certain lines of work. Under conditions of extreme complexity, we inevitably rely on a division of tasks and expertise—in the operating room, for example, there is the surgeon, the surgical assistant, the scrub nurse, the circulating nurse, the anesthesiologist, and so on. They can each be technical masters at what they do. That’s what we train them to be, and that alone can take years. But the evidence suggests we need them to see their job not just as performing their isolated set of tasks well but also as helping the group get the best possible results. This requires finding a way to ensure that the group lets nothing fall between the cracks and also adapts as a team to whatever problems might arise.

Despite all this bad news, there is real-world evidence that groups do confront bullies as a group—and it works! A shining example is the “Code Pink” technique used by surgical nurses. These highly skilled professionals are often berated and belittled by pompous surgeons, both men and women. In some hospitals, whenever a bullying surgeon steps over the line into mistreatment, “Code Pink” is called by the targeted nurse. Immediately, supportive nurses form a circle around the physician. Together, they declare their unwillingness to assist that person with current and future patients, if an apology is not given with a promise to behave in a civil manner. The interdependent nature of surgery makes the surgeon powerless without the help of the team in the operating room. All work stops and the physician is accountable for her or his bullying. It is the physician who is responsible for the patient’s life. “Code Pink” is the group displaying its power to the bully, demanding cooperation instead of controlling games.

beside his brothers in a small, living room-style waiting room in their unused-until-today surgical ward. Hell, The Arsenal didn’t even have a medical team on site yet. Fortunately, Logan had come along and recruited a trusted surgeon to assist. Edge had dragged the spook doctor from a certain death, and he wasn’t about to bug out when she was down. He’d called in favors to make sure she got the best treatment possible. Logan’s surgeon friend, Maisey Winn, seemed competent enough for a bitchy piranha. She took one look at Dylan “helicoptering

The medal had been moved from her shirt to her hospital gown. It had seemed so important to her parents that I mentioned it in passing to the cardiac surgery resident as we sat writing chart notes in the nursing station on the evening before the surgery. He gave me a cynical smile. “Well, to each his own,” he said. “I put my faith in Dr. X,” he said, mentioning the name of the highly respected cardiac surgeon who would be heading Immy’s surgical team in the morning. “I doubt he needs much help from Lourdes.” I made a note to myself to be sure to take the medal off Immy’s gown before she went to surgery in the morning so it wouldn’t get lost in the OR or the recovery room. But I spent that morning in the emergency room, as part of

Immy spent the next day or two undergoing tests, and I saw her several more times. The medal had been moved from her shirt to her hospital gown. It had seemed so important to her parents that I mentioned it in passing to the cardiac surgery resident as we sat writing chart notes in the nursing station on the evening before the surgery. He gave me a cynical smile. “Well, to each his own,” he said. “I put my faith in Dr. X,” he said, mentioning the name of the highly respected cardiac surgeon who would be heading Immy’s surgical team in the morning. “I doubt he needs much help from Lourdes.” I made a note to myself to be sure to take the medal off Immy’s gown before she went to surgery in the morning so it wouldn’t get lost in the OR or the recovery room. But I spent that morning in the emergency room, as part of

Patients diagnosed with cancer and treated with our multisdisciplinary approaches are knocked down physically and emotionally, but they pick themselves up off the canvas and struggle on. They carry the reminders of the acute and chronic side effects from cytotoxic chemotheraly and radiation-induced skin and functional-organ changes. They endure the scars, complications and impairments imposed by the blades of surgical oncologists like me. Though sometimes they want to, they don't leave. They remain. They maintain. I respect the effort, the invincible spirit, and the patients, who don't give a damn about the odds or probabilities, they are going out swinging. We are tag-team partners in oncology, entering the ring to attack cancer with every move and method we know. Hell, I'll even throw a few chairs if it will help.

In her later e-mails to me, Nancy struggled to capture the existential reality of trauma. “I want to tell you what a flashback is like. It is as if time is folded or warped, so that the past and present merge, as if I were physically transported into the past. Symbols related to the original trauma, however benign in reality, are thoroughly contaminated and so become objects to be hated, feared, destroyed if possible, avoided if not. For example, an iron in any form—a toy, a clothes iron, a curling iron, came to be seen as an instrument of torture. Each encounter with a scrub suit left me disassociated, confused, physically ill and at times consciously angry. “My marriage is slowly falling apart—my husband came to represent the heartless laughing people [the surgical team] who hurt me. I exist in a dual state. A pervasive numbness covers me with a blanket; and yet the touch of a small child pulls me back to the world. For a moment, I am present and a part of life, not just an observer. “Interestingly, I function very well at work, and I am constantly given positive feedback. Life proceeds with its own sense of falsity. “There is a strangeness, bizarreness to this dual existence. I tire of it. Yet I cannot give up on life, and I cannot delude myself into believing that if I ignore the beast it will go away. I’ve thought many times that I had recalled all the events around the surgery, only to find a new one. “There are so many pieces of that 45 minutes of my life that remain unknown. My memories are still incomplete and fragmented, but I no longer think that I need to know everything in order to understand what happened. “When the fear subsides I realize I can handle it, but a part of me doubts that I can. The pull to the past is strong; it is the dark side of my life; and I must dwell there from time to time. The struggle may also be a way to know that I survive—a re-playing of the fight to survive—which apparently I won, but cannot own.