For the purposes of design research I observed a nephrectomy performed on a patient whose kidney had failed and was filling with liquid. Imaging showed it was quite bizarre compared to the other, healthy kidney, and we (engineer and myself) were walked around the operating room and shown the ropes.
The last time I saw a scalpel it was my first Graphic Design class at UIC and a fellow student, Pedro, had brought disposable scalpels instead of the required X-acto knife. My metalhead friend Jake and I both quizzed him about it, wondering if he was a serial killer or just nuts, and it turns out he’s just a nurse and happens to love heavy metal.
Back to the OR, there were no scalpels or sharp instruments as all the incisions and cutting was done ultrasonically occasionally aided with argon, they actually shield the ultrasonic cutting with argon gas similarly to shielded welding done in metalwork.
We have had a handful of lapro tools on hand for research purposes but were exposed to a great deal more such as the Covidien argon shielded cutters, staplers, and the fearsome “morcelization clamps.” The kidney had a number of stones that had developed, some the size of small styrofoam peanuts, that had to be excised with the kidney through a less invasive hole than standard open surgery would allow. In lapro, most of the surgery is conducted through about three ports near the stomach area only millimeters in diameter, so for removal of something like a dissected kidney you need to open one additional larger incision in a cosmetic location on the hip where it is less noticeable.
There were some hangups which are quite common according to the residents in the room such as losing suction for the morcelization, not having a certain forcep and when a nurse rotation changed the original nurse wasn’t available to say where it was, people rushing around turning machines (doppler ultrasound) on and off, etc.
There was also a degree of lighthearted pride in the profession that was quite inspiring. On the OR doors there are plaques stating “HAVE A NICE DAY,” and the surgeon had a bluetooth speaker playing a playlist off his iPhone the entire time (not jambox, some unidentifiable somewhat ugly device).
That was sort of a surreal experience. Songs I definitely remember him playing in no particular order:
Karma Chameleon, Bob Marley - Everything Gonna Be Alright, Louis Armstrong - What a Wonderful World, the Police, mostly 80’s pop stuff on the whole. Karma Chameleon is a song I specifically identify with my sister and a year in our life we spent basically moving everything from our house at the time to a storage unit.
The interesting bits:
Positioning the patient takes an inexplicable amount of time. The table doesn’t tilt and in nephrectomy and a lot of lapro surgery, the patient needs to be 30 degrees up on a side with both arms slung over, obviously tubed/sedated. Once everything’s underway there is no problem but there is a lot of crafty fixes with common disposable tools to position the patient and ready them for surgery. Tourniquets are made with tied up gloves, jigs are created out of different taped up things.
Surgery is like being in a professional kitchen except all the bullshit roles aren’t allowed to come in the room, ever. It breaks down into classes depending on knowledge and experience and everything, I mean everything, is experiential. Lots of new people on staff were being trained on everything from kidney dissection to nursing to someone who was in the lapro machine buying/rep position for the hospital, not the lapro machine company rep. Lowest totem pole people get barked at when things aren’t exactly laid out as they should be and everyone is laughing their heads off when everything is done right. At one point a neighboring nurse came in to complain we were having too much fun.
Everything is mechanical. Lapro, despite being cool and new and exciting, is still in the dark ages compared to where I imagine surgery to be at. Its really exciting to be working on medical projects here because you get to see just how messed up and backwards things are. The best parts of design and observatory research are seeing everything people do to compensate for poor design. Often you can just see failure points but you can’t see the whole system for it until you’re participating on site.
I am trying to be objective in my experiences as a medically incompetent observer- nothing actually went wrong and safety/confidentiality were all observed. There was just a completely different atmosphere than what I imagined and certainly from anything I’ve ever seen or heard about. Its just a job. The surgeon just happens to be actuating two foot long ultrasonic scissors in one hand through a tiny hole in an abdomen while following it with a two foot long camera in his other hand from another port higher up in the abdomen. Its bizarre and unwieldy. Its not perfect. It WORKS though, very well, and the results are stunning compared to open surgery for the patient and doctors both.
Furthermore being in there made me all the more interested in learning why people are terrified of doctors, nurses, hospitals and medicine. Why they question these sources of information, experiences, etc. Not that they’re infallible, but there is so much distrust to wade through before it begins that some of the doctors and residents talked freely about how its hard to get a patient to even get onboard a necessary noninvasive test for cancer other preventable screenings.
All told. Great day. Aside from waking up too early.