Term Paper: Surgical Tech's Role in a Operating Room

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Ethnography

Defining the Scene

The cultural scene explored in this Ethnography is an operating room. The individual participants in a typical operating room setting are: primary surgeon, second surgeon, surgical assistant, surgical technician, anesthesiologist, nurse anesthetist, scrub nurse, and a circulating nurse. There is also a holding room nurse and a recovery nurse not specifically inside the operating room but involved nonetheless in the surgery and recovery. The participants require highly specialized training to be able to perform their chosen roles successfully. The common goal of all of these individuals is the successful performance of an invasive medical procedure, generally for the purposes of improving or even saving a life. The patient is for the duration of the procedure the total focus of every person in that room. Years of experience and dedication devoted to those hours in which a human life is genuinely and quite literally in their hands.

Paper Plan

Throughout the course of this paper I hope to elucidate not only the specific function of the aforementioned individuals but also the value which they have ascribed to their individual roles. Through first hand observation, I have had the unique privilege not only of observing 2 surgical procedures, one of which will be used as a vignette below, but I have also had the chance to meet and interview several of the regular participants in my chosen cultural scene. This provided invaluable information in truly understanding what I was experiencing as a member of the scene. Retrospectively, I am able to look back on the experience and think about what perhaps I could have done differently as well as what factors may have influenced not only the data but the experience itself that I was not aware of at the time. Finally, I hope to reflect on this incredible learning experience, appraising the social, cultural, and psychological value of my newly acquired knowledge.

Cultural Description

The best most succinct description of my chosen scene was made by the surgical technologist I had occasion to speak with: "In the OR, we're like a single organism, all connected working towards one goal the successful completion of which is central to our continued existence." Initially I didn't understand how that could possibly be when the diverse complex roles of each participant demanded autonomy and expertise in their own right. However, observing a procedure, the analogy made perfect sense. Once in the midst of a procedure, it's as though each participant is anticipating the needs and actions of each other participant. They are prepared for the best worst and most likely scenario and act as a single minded flawless and precise unit. The most staggering aspect of this whole event though, is that these teams are not always assembled of the same people. Nurses, anesthesiologists, surgeons, they are all interchangeable depending on the procedure, the day, the time, and the relative urgency of the situation. Essentially, each individual must know their role in any procedure they may be called into so well that irrespective of who comprises the rest of the team they are able to function with the same level of confidence and expertise.

A day in the Life

A day in the life of an operating room is not terribly indicative of the social scene in which I am interested. The room, is simply a sterile room with technical equipment until it is in use. Then, as though elevated to something more than a simple space with floor walls and a ceiling, it takes on a surreal energy, alive with the hurried hushed movements that will decide a patient's longevity in this world. An operating room will see several surgical procedures on a given day. Nearly analogous to a revolving door, any operating room will hold a diversity of procedures as well as outcomes. In the quiet though between procedures, it is simply a room.

Categories Informants Use

In this setting, the categories are pre-determined and very clearly defined. Categories are organized according to job, and tenure within that field. As I had assumed, it was the Primary surgeon who was leading the carefully choreographed procedure. Conducting if you will a multipart orchestra all with vital roles in completing the procedure successfully and keeping the patient alive. The primary surgeon was responsible not only for successfully achieving his goals in the procedure but also assessing: the relative efficacy of the anesthesia, the patient's vital statistics, as well as directing the secondary surgeon, surgical assistant, surgical technologist, anesthesiologists, nurse anesthetist, and scrub nurse, determining what order to utilize chemical agents, when to retrieve sterile instruments, as well as requesting additional materials and the removal of waste materials and no longer needed instruments. With that level of control even power, comes the heavy responsibility for being largely accountable for the success of the procedure and the life of the patient. Though it was undoubtedly the primary surgeon who held the role of leader during the procedure without the careful preparation of the surgical technician and the dedication of every other person in that room, there could be no successful surgical procedures. The primary surgeon is in charge, and will ultimately be the first held to account if something goes wrong, but his actions are very nearly of equivalent value to those of the other individuals physically acting upon the patient.

How informants find Meaning

Surgeon

The surgeon I was able to interview Dr. Johansen, was initially unsure how to define the way he found "meaning" in his work. "It needs to be done I have the ability and training to do it." There had to be more though, why did he choose to train for this particular role in so draining and stressful a position. "I've always been curious, beyond curious, about how it is that a collection of cells and chemicals come together to make a person. That curiosity never abated no matter how many answers I found in school. There was no other career choice for me. I am validated for every hour of study each time I see a patient going out those hospital doors better than when they came through them. Conversely every time I encounter a patient who I know will never go through those doors under their own power after being on my table it is that much more urgent to learn and continue learning so that if I ever encounter similar problems to theirs I can make sure that the patient comes out of it alive and healthy. Knowing that I can never have an off day, that I must always strive relentlessly for perfection, it's the lazy way of making sure I get the most out of life I guess. " Modest, this Surgeon understood the full responsibility of his position yet was humble, not at all the way I had initially imagined that someone holding such power would view their position. He found meaning in his ability to affect the outcome of a patient's life while still understanding that not all things were within his ability to control. It appears that his view of being a surgeon with the experience to be primary, was integral to the way he viewed the success of his life. Not a stance to adopt lightly or with anything less than total commitment to one's chosen profession.

Anesthesiologist

The anesthesiologist is responsible for making sure that the vitals of the patient remain within healthy parameters, also that the levels of anesthetic are high enough that they are not conscious and thus unable to feel the procedure yet not high enough to cause permanent damage or even death. The anesthesiologist must have a functional knowledge of the procedure in order to anticipate the biochemical effects of each movement the surgeons make in order to always be prepared to adjust chemical levels to keep the patient from feeling pain. A difficult and demanding job, I was interested to understand why someone would choose such a specialty. I was able to interview Dr. Millen and ask him why, of all the potential careers even within medicine he had chosen to be an anesthesiologist. "Well it's quite simple really, when I was a teenager I fell off my skateboard and broke my leg quite badly. Yes, I used to skateboard, I was pretty good too. (he chuckled) Well anyway, I was hurt bad, never really grasped pain until that moment. The bones in my leg needed to be surgically set. Of course all I cared about at the time was not feeling the pain anymore. Finally the anesthetist came in and knocked me out, I have never been so grateful for a needle in my entire life. If I can give that reprieve, however briefly, to another person who is in pain or who would be in pain without me that's good enough for me." Dr. Millen understands pain, he understands how devastating and demoralizing it can be to an individual especially when they are completely helpless to effectively alleviate that pain.… [END OF PREVIEW]

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