Getting Started in the Operating Room

Some people think that it's not important for anesthetists to make small-talk with their patients before surgery begins. They believe that we should just start an intravenous (IV) and then inject the sleep medicine. Many of us, however, try to have interesting conversations with patients or make them laugh before their surgery. It really helps them to relax and makes the whole surgical experience better.

It's also important to start the IV on the first try. The pain and distress of multiple IV pokes (with bloody welts at each site) is not a recommended relaxation technique. It's also upsetting and embarrassing for the anesthetist. But some people are difficult to get an IV in --the very obese, those with dark skin pigmentation and those who are born with tiny veins. The cold operating rooms, fear and lack of fluids suffered by the patient before surgery cause the veins to become even smaller--making a successful IV insertion even more difficult.

A few days ago, a tall (six foot two inches) slim, athletic woman limped into the operating room to have her Achilles tendon (at the back of the ankle) repaired. She had a beautiful smile and warm, friendly eyes. Some people can enter a room and make everyone feel good. She was that kind of person.

Let me add that because I am five foot six inches tall, almost every woman is considered tall to me.

As she lay down upon the operating table, we started our conversation. How did she hurt herself? Basketball. What position did she play? Guard. What was her favorite NBA team? No favorites. She thought that most pro's didn't have the dedication and love for the game that amateurs have.

When I started to get my IV ready, a look of concern crossed her face. "I've got terrible veins. They usually try at least three or four times before they get it in."

I began my routine for difficult IVs: carefully search for the best possible vein, swaddle the site with warm blankets, apply a very tight tourniquet, ask her to vigorously open and close her hand, use the smallest IV catheter.

She looked anxiously at me with the first poke. Luckily, it was inserted on the first try.

"That's why I don't mind being called a good little prick." I said. She smiled as she fell to sleep and was smiling when she awoke in the recovery room.

Welcome to Operating Room Confidential

What really happens in the operating room of a hospital? Everyone watching shows like ER, Grey’s Anatomy and House think they understand what goes on. But they don't. They don't know about things like operating room curses and superstitions, the characteristics of a good surgeon, the personalities of the specialists caring for them, and the patients that doctors fear. I'm writing a book that will come out in April 2010 called Operating Room Confidential, and it reveals, for the first time, the inner truths about the operating room to the reader: the quirky, strange, hidden rhythms and routines that occur inside and around the O.R. But I'll also be posting some of the stories, anecdotes and trivia that didn't make it into the book here. So stay tuned to find out everything that goes on when you go under!