What Being on the Table Taught Me About Treating on the Table

  1. Nearly two years ago, I underwent an aortic valve replacement for aortic stenosis (congenital deterioration). Through that experience, I got to see the 'other side' and as a result, have become a more compassionate caregiver in CT surgery.

    What Being on the Table Taught Me About Treating on the Table

    My story as a Congenital Heart Defect (CHD) Warrior starts long before I ever considered nursing in the cardiothoracic operating room to be 'my calling'. I was 5 when my pediatrician noticed an irregularity during a routine physical and referred me to a cardiologist as a precautionary measure. The resulting echo revealed a murmur and subsequently, aortic stenosis. I was asymptomatic at the time and I was closely followed by a cardiologist into my young adult life.

    Flash forward to when I began full-time scrubbing on our high-risk cardiothoracic surgery team and I noticed that I would become unusually fatigued and short-of-breath during marathon cases. After seeing my cardiologist and talking about the symptoms, it was clear that action needed to be taken.

    Ironically, I did not seek treatment at the institution I worked at - there's a privacy to personal health that I want to keep personal. I trust my coworkers immensely, but would never want to burden them with knowing a friend and colleague was on their table. Leading up to my open-heart surgery for an AVR, it was natural to think about every doomsday scenario that we, as surgical professionals, have seen happen. It may be weird to say this, but in some ways, 'ignorance is bliss'. But throughout this process, I learned some very valuable tips from the 'other' perspective:

    Customizing the conversation is everything: As a CVOR nurse, I wanted to know everything - who would be on the team, how many years of experience those team members had, what the hospital's mortality rates were for all CVOR procedures, etc. Your average patient is not going to know this, but I think it's super important to tailor the dialogue and in some cases, probe the patient if they would like to know certain things. Many patients are so lost that they don't even know where to start with questions.

    Care must be provided to the whole family: Open heart surgery may be performed on one person, but the whole family lives it. And I think there needs to be more focus on the family aspect - particularly with regards to post-op care, expectations of complications, etc. I think this is where OR nurses can really thrive - bridging the medicine with the relationship.

    Providing assurance without a guarantee: No surgical team can or should ever guarantee a successful outcome, especially in open-heart surgery. That being said, the 'cold' nature of CVOR practitioners is often very real. I, more than anybody, understand that a level of objectivity is helpful in such a high-stakes environment. But, I also think assurance that the team's experience and skill-level is putting the patient in 'good hands' goes a long way for both patient and family.

    The sound of silence: When I was wheeled into the O.R., my senses which were earlier very tired and anxious, were heightened to a level that can't be described. I remember every detail as I was moved to 'the table'. I remember hearing the side conversations, the clanking of all of the instruments, the 'count' being performed by the scrub nurse, and even the 'snapping' of the gloves as team members suited up. It made me even more nervous, but then something miraculous happened. The circulator quietly came up to me and asked if she'd like to hold my hand as I drifted off. I took her up on that offer and instantly, the silence and coldness turned my world into warmth and compassion. It was the first and last time I felt more like a person and less like a 'case'.


    My surgery went without issue and today, I enjoy a very normal life that enables me to do all the things (including scrubbing with some of the most talented cardiothoracic surgical teams) that I like to do. However, the experience of being on that table, has made me more self-aware of patient care.

    You may be the last voice or the last hand: Unfortunately, high-risk cardiothoracic surgery comes with...high-risk. There are a number of our patients who never make it off of that table. Knowing that you may be the last voice they hear or the last hand they touch encompasses a gravity that is often uncomfortable to grasp. But, it is very real. "Humanizing" the experience for the patient makes a world of difference whether that patient works in cardiothoracic surgery or is a blue collar steel worker. Surgery is the great equalizer - it puts the rich and the poor in the same position of vulnerability, and I think that is often overlooked.

    Your everyday is somebody else's everything: I am part of a team that cracks sternums every day and therefore, it's easy to get in the mindset of 'routine' and 'just another day'. But for that person on the table, it is the most vulnerable time ever for them and their families. There's no secret formula for addressing this, but self-awareness of the gravity that another day's work for you is 'the most dreaded day' for your patient and their family is so important.

    You can remain objective while still being vested: A cardiothoracic surgeon once told me, 'there is so much going on in my mind to stop a heart, fix it, and get it restarted, that I don't have the capacity nor the inclination to learn about that patient - I need to be tunnel-vision from first consult to discharge.' There are times when I've felt like this, especially with younger adults - I didn't want to get to know them and learn about their hopes and dreams as a person. It's a natural defense mechanism after seeing patients pass before your very eyes. But, after going through it myself, I do think that treating your patient like a person and not like a case, actually makes me more vested in all areas of their care. There are limitations, but those limitations should never take away the fact that the person under your drapes needs compassionate care from their team, which means talking to them like people, putting things into layman's terms, ensuring they are comfortable and understand what is going to happen, and being there for them as it happens.


    Cardiothoracic surgery is a high-stakes environment that is unlike any other specialty - after scrubbing multiple services, the heart rooms are the ones that stand out as being so different. They are much more structured, require larger teams who often only specialize in hearts, and very rarely give practitioners second chances when mistakes happen. But, the environment for the team can be enhanced to soften the patient experience. I am so grateful for those who took care of me and saw to it that I not only got through it, but felt like the team was getting through it with me and for me.
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    About ctsurgeryscrubrn Pro

    I am a cardiothoracic scrub nurse, a CHD warrior, a yogi, a friend, and an advocate. I believe in dreams whether you're 25 or 85 - a dream is what made my nursing story a thought; a belief in that story is what made my dream a reality.

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    12 Comments

  3. by   traumaRUs
    Thanks for a great article about your personal experience - glad you are feeling well.
  4. by   Leader25
    Having gone through several surgeries myself[not as critical as yours] I can attest to the noise level in room and side conversations and whispers when something is not right.I does make you more anxious.Thank goodness for anesthesia.
  5. by   Kitiger
    Thank you. You made many good points, This is a very helpful article.

    Although I understand your reluctance to use the same hospital where you were employed, I chose to use my own hospital. When friends and coworkers first say me on the gurney, their first reaction was dismay. ("Oh no! What happened?") I quickly reassured them. But I was comforted, knowing they were nearby.

    I had a very minor surgery, but with general anesthesia. I knew when they were about to put me under when the room abruptly became silent. The anesthesiologist started speaking quietly to me, and my arm got cold (IV full open). Point of no return. I reached up to scratch my nose, and the room exploded around me with bright lights and NOISE! I was in recovery.

    I asked for my glasses, as it had been prearranged that my glasses would be in the recovery room waiting for me. They told me that I had been awake and talking for 2 hours already. Huh? I just now woke up!

    Can we say, disoriented?
  6. by   brownbook
    Love your post. I just have to ask, was the circulator wearing gloves when she held your hand?
  7. by   ctsurgeryscrubrn
    She was wearing gloves, but I could still feel the warmth of her hand and that made a huge difference.
  8. by   ctsurgeryscrubrn
    I understand your perspective, but I was thinking about the complexity of this surgery. If I was scrubbed-in on a coworker's case, I know it would have made me feel an extra layer of pressure - for some, that makes them give their absolute best, but for others, it can provide distraction.
  9. by   ctsurgeryscrubrn
    Quote from Kitiger
    Thank you. You made many good points, This is a very helpful article.

    Although I understand your reluctance to use the same hospital where you were employed, I chose to use my own hospital. When friends and coworkers first say me on the gurney, their first reaction was dismay. ("Oh no! What happened?") I quickly reassured them. But I was comforted, knowing they were nearby.

    I had a very minor surgery, but with general anesthesia. I knew when they were about to put me under when the room abruptly became silent. The anesthesiologist started speaking quietly to me, and my arm got cold (IV full open). Point of no return. I reached up to scratch my nose, and the room exploded around me with bright lights and NOISE! I was in recovery.

    I asked for my glasses, as it had been prearranged that my glasses would be in the recovery room waiting for me. They told me that I had been awake and talking for 2 hours already. Huh? I just now woke up!

    Can we say, disoriented?
    Nearly a year ago, I scrubbed in on a friend's whipple where there was portal vein convergence. It was a very long case (12 hours), the dissection of the PV was very delicate and unfortunately, she began hemorrhaging and went into DIC. I'll never forget having to initiate the MTP and then the fury that went on for the next 45 min to try to get her off our table. It was extremely traumatic for everyone when we had to call TOD.
  10. by   Dikibo
    A good one I must say. The bottom line is psychotherapy which can be "administered" in various form and at any point of care. The form you received was that of touch, others need just smile. What reassuring touch.
  11. by   FurBabyMom
    Quote from ctsurgeryscrubrn
    I understand your perspective, but I was thinking about the complexity of this surgery. If I was scrubbed-in on a coworker's case, I know it would have made me feel an extra layer of pressure - for some, that makes them give their absolute best, but for others, it can provide distraction.
    I've cared for coworkers and/or their family members and other people "connected" to our system (employees/family members outside of periop). I've been in plenty of "request" or "VIP" (I hate that term - all of my patients are VIPs) cases. I can handle it, and perform well. But I prefer not to know before the day or case if that is my assignment (don't tell me two weeks or five days in advance, honestly I don't want to know the day before). Drop me into it before I get the chance to chew it over.
  12. by   FurBabyMom
    Quote from ctsurgeryscrubrn
    She was wearing gloves, but I could still feel the warmth of her hand and that made a huge difference.
    It's amazing that such a small little gesture can do so much for someone isn't it? It takes no time really, as I have to be around to help anesthesia with induction...and despite what some techs believe, I don't need to be focused on them unless the case is emegent (even then I can break a few rules for a real life threatening emergency). Most of our RNs who scrub don't ask to count during induction... (scratches head - I'm soooo confused by that).
  13. by   FurBabyMom
    Quote from ctsurgeryscrubrn
    Nearly a year ago, I scrubbed in on a friend's whipple where there was portal vein convergence. It was a very long case (12 hours), the dissection of the PV was very delicate and unfortunately, she began hemorrhaging and went into DIC. I'll never forget having to initiate the MTP and then the fury that went on for the next 45 min to try to get her off our table. It was extremely traumatic for everyone when we had to call TOD.
    I'm sorry for your experience! I don't have something quite like that. I was a floor nurse before being an OR nurse. I had patients die in both environments. The OR deaths struck me far more severely than the floor deaths (even floor codes we sent to ICU and they coded again and died). I think for me it's the juxtaposition of the chaos and then silence after time is called. Also - that the "lead" provider (in our facility) asks everyone for ideas/dissent before calling TOD.

    I think emergencies in the OR are so different than elsewhere...it's hard to describe. I work in a Level 1 trauma center...so we get it all. MTP is exhausting in and of itself, let alone trying to find/fix/stop the bleeding. We usually have an extra person (or two) in the room just to manage checking products and harassing the blood bank because FFP is always what is difficult to stay on target with... Even some of my non-death cases haunted me...it's just different than the floor.
  14. by   FurBabyMom
    Quote from Kitiger
    Thank you. You made many good points, This is a very helpful article.

    Although I understand your reluctance to use the same hospital where you were employed, I chose to use my own hospital. When friends and coworkers first say me on the gurney, their first reaction was dismay. ("Oh no! What happened?") I quickly reassured them. But I was comforted, knowing they were nearby.

    I had a very minor surgery, but with general anesthesia. I knew when they were about to put me under when the room abruptly became silent. The anesthesiologist started speaking quietly to me, and my arm got cold (IV full open). Point of no return. I reached up to scratch my nose, and the room exploded around me with bright lights and NOISE! I was in recovery.

    I asked for my glasses, as it had been prearranged that my glasses would be in the recovery room waiting for me. They told me that I had been awake and talking for 2 hours already. Huh? I just now woke up!

    Can we say, disoriented?
    Your perspective is interesting regarding your hospital of employment. I've been a patient at work, and depending on the procedure might have surgery at work if needed. If it's something on the service lines I've been working with, probably...because as much as I value privacy, I want to be able to pick the surgeon, based on what I know about how they handle themselves under pressure, how often they have unanticipated issues come up, their skill level in general. I don't have the luxury of assessing that if I am a patient outside of my hospital. I also want to be able to pick the anesthesiologist, and CRNA or resident. Most of our surgeons don't run concurrent rooms when they're caring for coworkers/hospital staff or family members. I find this interesting, as they vehemently insist there is *nothing* wrong with this practice, but they don't do it to people that know them. Oh...the things that most patients off the street don't know...

    Regarding anesthesia induction, I try, so hard, to help make it better for patients. I do not count during induction, I don't talk about things I don't need to be discussing during induction. We sometimes have a "lull" between pre-induction verification and anesthesia induction (finalizing meds drawn up, waiting for the assigned or available anesthesiologist). I make sure to talk to the patients during that time - usually something about pets, family, dream vacation, etc. I will tell them we're double checking everything before we start.

    The thing is - people all react differently under anesthesia. Some people are dosed with versed and remember everything, others remember nothing of the before induction activities. Unfortunately, awareness under anesthesia is a thing...and does happen. Also something people off the streets don't know/appreciate when they agree to have surgery.

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