This particular travel shift I am working mid-shift 10-10:30, which means I am the break and lunch bitch. Some days this can be a slight break, others a nightmare. Arriving to see three morning breaks, and I began my day. Business as usual with some nurses pretending a 15-minute break is an actually 30, and act offended when you leave in a hurry. Working through my morning breaks I get a call from charge, “can you go be a set of hands in OR 15?” Verbalize I will head that way, then begin to wonder what I am going to walk into, a patient crashing and burning, a nurse crashing and burning, or a combination of both?
Walking into the gastric sleeve I quickly scan the room to get my bearings on what’s going on, the Davinci robot is docked, the screen shows the bowel and stomach, and I see some bleeding. The nurse in the room asks if I will go get some Floseal (blood clotting product). I agree and run and grab that and anything else I can anticipate see the surgeon may need in dealing with bleeding. I wonder halfway down the return walk if the nurse had gotten the instruments to open the patient up.
Arriving back in the room, the nurse is now full blow anxiety attack and doesn’t seem to be processing any critical information. I decide to go to the head of the bead and assess the patient’s vital signs. Anesthesia is slightly stressed, but handling things up top. The nurse isn’t used to these types of complications, as gastric sleeves are typically very fast, gain access into the stomach, place special tubes down the throat to measure the stomach with and run a stapler to remove excess stomach. What I am gathering is the there was some small bleeding, and the surgeon appears distressed over his staple line.
I offer to go get the open instruments, as a traditional approach may become necessary if he is unable to visualize exactly what he needs to see or what has happened to the patient. Bringing in the Bookwalter (instrument pan for open) and get it counted. Feeling like that is going to be the best course of action in preparation. Yet the surgeon seems frozen at the Davinci console, no movements indicating that he is going to be scrubbing back in to open the patient up. At this point the nurse in the case seems to be frazzled. The loss of control of her typical days of 4-5 gastric sleeves, business as usual is written all over her face. The inability to be flexible in the moment that the “routine” surgery does not go routine.
I leave the room after I feel like the nurse has what she needs in the room to get through whatever pops up and continue to watch the case from the board. Seems to be no movement, hours go by, and it begins to approach the time this nurse will need to be relieved to go home. Dreading that walk to the board to see who is assigned to it. Knowing that I’m sure it’s me, I arrive to find it is in fact a fellow travel nurse. I am filled with a sense of relief. Although I know what kind of dumpster fire is probably going on in there, I say to that nurse to call me if he needs help.
Unbelievably he called me within minutes, shocked that my casual offer was taken up upon so quickly I proceed to OR 15. Arriving in the room I expect the belly to be wide open, bowels out, work being done, that is not the case. The surgeon is still sitting at the Davinci console! Unbelievably, 10 hours of sitting at the robot at this time. He is asking for the circulator to call fellow general surgeons, thoracic surgeon, to see if they can assist him. This particular surgeon has not spent his time making friends, and that is why I believe all of the surgeons said “NO”.
So here sits the general surgeon turned Bariatric specialist, in a console, stuck, unsure of what to do, no friends to call for help, and the patient in limbo. I ask my co-worker “what are we going to do, this isn’t safe for the patient”, we begin to reach out to the charge nurse for guidance. No one has any answers, everyone seems as stuck as the surgeon at the console. I was wanting to ask the surgeon why he won’t open the patient up, why he won’t look at the potential damage he caused and try to fix it! Then it hits me, he doesn’t know how.
To spend all of your energy on one particular area of surgery, the Davinci, he has lost his skills in the other basic surgeries. The idea of taking a scalpel an opening this patient up was too anxiety provoking for him, because I guess he knew deep down he didn’t know how to fix it. So we sat, stuck in a room, stuck on the robot, patient stuck in limbo.
Finally, the surgeon reaches out to University hospital down the road, inquiring about a OR to OR transfer, something I had never seen until this particular day. He called and spoke to a team of surgeons, and they agreed to accept the patient and asked the surgeon to “Draw a map” of what he had done. I was shocked, that this was the plan of care for a patient that had now been under anesthesia for 12 hours, that he will now pack her up with a doodle and send her on her way.
As we undock and the surgeon closes, I ponder if this is the new way of surgery. That this tool that can be used to facilitate so many great surgeries, will cripple the flexibility required for a truly great surgeon. Sending a patient 12 hours later on an ambulance stretcher with a doodle in hand to get a repair done that any general surgeon should be able to do. I understand that to get great at something you have to practice, but to leave behind the rescue skills. The skills to be able to open up anyone with a knife and find the bleeders by hand, to use the tools quickly to make life saving decisions, cannot be lost to the DaVinci. Davinci is a tool, the gifts and skills still have to learned and developed to be the safest surgeon these patients need, for when things will go south.