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.
FurBabyMom, MSN, RN
1 Article; 814 Posts
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.