Live surgery

Yesterday I received an e-mail, saying that there was a surgery planned for today 1106 and that the patient met the inclusion criteria of one of the studies that is currently ongoing. If the parents consented to including their child in the study, I would be able to be there in the OR as well. (The time appeared to be strange to me, so I confirmed that it actually meant 6 minutes after 11, and it did. They plan these things like flights at an airport.) Since I think I can handle bloody butchery surgery, but am not absolutely sure of it, I asked for a small innocent little procedure to start with, so they gave me a T&A (for the poor bastards out there that don’t know what that is (which up to yesterday would have included me as well), it means a tonsillectomy & adenoidectomy).

Today somebody escorted me to the ‘surgery wing’ and I discovered that my ID badge also gives me access to this part of the hospital. Since they have 28(!) ORs you can imagine what an incredibly hectic area that is, and I realized again why I did not get into the profession of cutting people open.
I was quite surprised to see that the parents were asked for consent only right before the surgery. Apparently from a logistic point of view that is the best they can do. I was lucky enough that the parents did consent, so I could get out of the white lab coat they gave me into some scrubs (oh yeah, I did look the part. But mostly female staff there, so still no Grey’s Anatomy scenes). The kid was the very cutes 7-year-old boy you have ever seen. I watched them perform some of the pre-op tests that were part of the study and realized that that went quite a bit different than when my tonsils were removed. All I remember is at least 4 people forcing me down in a chair while putting the smelly gas thing on my face. Here they asked if they could sit on his bed, if they could touch him and if he could please be a good boy and do some of the things they needed him to do.
And then we moved to the OR, since for the simple procedures they don’t have a sterile OR, the kid could bring his own blanket and stuffed animal and his parents could watch while they ‘put him under’. It was quite funny to see the effect of the ‘laughing gas’ on the kid. He was sitting on the bed with his knees pulled up, but when he stopped laughing and was really under, I was surprised to see that somehow he just stretched out automatically. Then the parents had to leave and we rolled into the OR. The anesthesiologist continued hooking the kid up to all these machines and iv anesthesia and one of the people in there put an iv on the stuffed animal of the kid, so that it would look the same as he would when he’d wake up. For a bunch of other people it was unclear what they did there exactly (but then again, they may have been thinking the same about me).
Then the surgeon came in. She stated the name of the kid, his characteristics (like age and allergies), and the procedure they were going to perform. Everybody that was present (or at least the ones that had an official role in there, so that excluded me) had to explicitly state out loud that they agreed. And when they were all on the same page it started.
It was interesting to see how a trial is performed in such a clinical situation. I thought the trial would be carried out by the surgeon performing the surgery, but it is not (or at least not here). The investigators from the study team inform the surgical team the day before by e-mail that the patient they are about to operate on is eligible for inclusion in their study and what, if the parent consent, would be required as part of the study. So what tests would be performed prior to or during the surgery, the dosing regimen that would have to be used and the blood sampling. But this is all done by the people that do the study and they are not part of the surgical team. The surgeon came in and started doing her job. Blood samples were taken by the study team from a vein in the foot, so that the surgeon and the scrub nurses surrounding her could continue what they were doing, while another person of the study team was taking track of the blood samples and the details of dosing and sampling. So it was not just extremely cool to be there, it was actually a good learning experience as well.
A this point I do feel that I can handle more extreme surgeries, because from that point of view it was a bit less exciting. The surgeon has of course very limited space to perform her job, and I was scared to come too close, because I did not want to get in the way, so there was not very much for me to see. Depending on the experience of the surgeon a T&A only takes between 6 and 45 minutes and the surgeon on duty today was quite experienced. So I already missed the first tonsil coming out, because I was looking at the blood sampling at the feet. Then when somebody told me to pay attention for the other one, I blinked and missed that one too. The adenoids tend to block the nasal cavity, I did not see them come out either, but I was lucky enough to still be able to see them suck out the snot that build up behind them.
I also followed the kid to the recovery room. He was still intubated, but when we arrived there he started to really struggle, so we had to keep him down and they had to extubate quickly. It seemed cruel to me to have him still intubated when he woke up, but spontaneous movement is apparently a sign that his ventilatory muscles can sustain breathing, so they prefer to wait for that. Additionally, I was told that patients even if they move and open their eyes usually do not remember that. And indeed after about a minute he would be sleeping again. I think it took at least 10 to 15 minutes of him sleeping and occasionally struggling. After that he was conscious enough for them to call the parents back in. I was told that he would stay there at least 1 to 1.5 hours, until they would discharge him and he could go home. I did not wait for that however, I went back to modeling business, since one of the anesthesiologists that I’m helping here is on a tight deadline and needs help analyzing her data.

Monday there is a scoliosis surgery (straightening of the spine), this one is bloody and butchery and takes about 6 hours at least (it is so bloody, that when modeling PK data from these kind of surgeries, you might want to add in an additional clearance route to account for the drug that is lost with the blood (if you do not understand that sentence: congratulations, you’re not a nerd)). Anyway, I might be able to witness that one, or at least part of it, too! Too bad I cannot take one of those tourist pictures with me putting on a big smile and two thumbs up in the bloody scene.