How do surgeons hold out on surgeries more than 6 hours long? originally appeared on Quora: the knowledge sharing network where compelling questions are answered by people with unique insights.
Answer by Dave Light, Head and Neck Surgical Oncology, on Quora:
I'll toss in my two cents on long surgeries. People tend to think the operating room is a quiet and serene place; depending on the surgeon who is technically in control (not the anesthesiologist), it might be totally the opposite. In my OR I have music playing. We talk constantly about "stuff," not necessarily about the procedure.
If the surgery is long but "routine" (and many of mine are), we tend to not even notice the time flying by. If the procedure is not common, we tend to flip and things get really quiet, so much so that everyone comments about it.
I know of surgeons who have an RN start an IV in them so they don't dehydrate and lose focus or have to stop. Not me! For me, I had a special "chair" made that allows my weight to be shifted forward onto my ribs so I don't have it all on my back (my back is shot). I also scrub out routinely for potty breaks and even have food brought up so staff can eat.
The staff rotate in and out so they don't get too stressed. For me the worst thing is not having my staff up to par. If my staff are on their "A game" then things go smoothly, so I do everything I can to make sure that happens. No staff stress allowed!
I also do not allow Administration/Managers in the room. I have my staff (made up of half a dozen nurses and techs), plus the general run-of-the-mill staff, whoever is assigned, plus my resident(s), plus the anesthesia team.
A simple rule is that if you can't play your "A game", no penalties, no concern--just scrub out and the others will take over. They still get paid, they don't get yelled at, but at least they don't stress me out, and the patient never suffers. I also wear super comfortable clothes and shoes.
My "chair," actually a leaner, has wheels so I roll all around, which I sometimes do to drive the gals crazy. To me, no expense is too great for the team since we do this 60-70 hours a week. If my staff want loops, they get them. If they want headlights, they get them as well. Special gloves, done. Special masks or bubbles, done.
I think the OR needs to be treated like a real theater with the team playing actors in various roles. My OR is dead serious but definitely a comedy/drama. When I started (before the advent of staff litigation), we all used to "act" and talk just like we would at a BBQ or social event. Jokes, stories, etc. Now we need to tone it down a bit since some jokes are deemed inappropriate and the legal eagles frown on staff litigation.
Way too much TV and Hollywood has been imposed on the OR suite. It simply isn't true. The only part that is true is the grilling of the residents at the beginning of each case. I want to make sure mine know what we are doing and I bust some buns on basics. Then, after that is done, we are just co-workers doing a job.
I also mandate that my patients are moved every 40 minutes so they don't get pinched nerves, occluded vessels, skin abrasions, blood clots, or the like. We simply back up and let the nurses who are not operating along with the anesthesia team move the patient and we step (or roll) back in and start back up again. This gives everyone a little break.