Mock surgery, part trois

Yesterday I was the "surgeon" for Chester's mock procedure.

To don sterile clothing, start with a bonnet covering all of your hair; no cute bangs hanging out please. Then a mask to completely cover nose and mouth. Those of us who wear glasses have a special issue with getting the top of the mask snug so we don't fog up the glasses.

A surgical scrub consists of washing every part of your hands and forearms. You start with the little pick thing and clean under your fingernails. Next, wet hands and use the soap impregnated sponge as follows: consider that your fingers, hands and arms have 4 sides -- front, back, edges. You can scrub by time or by count; I find counting easier. Ten strokes up and down the back of pinkie finger, ten strokes up and down outside edge of pinkie finger, ten strokes up and down palm side of pinkie finger, ten strokes up and down edge between pinkie and ring finger. Repeat for other 4 fingers, then repeat on palm,then distal 1/2 of forearm, then proximal 1/2 of forearm (should take about 5 minutes). Then start all over again with the other hand. Rinse with elbows bent and fingers higher than elbows at all times (so any drips go toward the elbow). Open sterile towel and dry one hand and arm with one side of the towel, other hand and arm with other side of towel, never going back over a clean spot with dirty towel. Try that sometime; it is even harder than it sounds.

Open a sterile gown without letting it touch your clothes, the table, the floor, anything at all, and handle it only from the inside while putting it on. Keep your hands inside the cuffs, no fingers peeking out. You really need a dresser at this point, to stand behind and tie the neck ties without touching the front of the gown, then the waist ties, then a little "tug" at the hem to make it feel straight.

To get the feel for closed gloving, put on an extra large sweatshirt with arms long enough to cover your hands and try putting on rubber dish washing gloves while keeping your fingers covered by sweatshirt sleeve until they are inside the gloves. It is something like that.

Once gowned, hatted, masked and gloved, the surgeon has to stand with hands clasped together in front of the body to remind her not to touch anything that is not sterile. And so I stood until B let me know her patient was deep enough for me to start.

Skin does not feel like any of the materials we practiced on. Sticking a needle through skin is much harder than you would think.

Mock surgery, part deux

Today's procedure went so much better than anyone (teachers included) had expected. Actually, we didn't really know what to expect. Thumbelina was the kitty that exploded off the table last time students tried to anesthetize her. We decided to try "kitty magic" for her pre-anesthetic meds. This is a cocktail of Ketamine-Buprenorphine-Domitor that I gave IM. Although I had Propofol ready to administer if necessary, "Thumbs" was intubatable within about 20 minutes with no additional meds. After having her on isoflurane for about 5 minutes, I reversed the Domitor with Antisedan and did have Narcan available to reverse the Buprenex if necessary. It was pretty easy to keep her at a surgical plane of anesthesia with 1% isoflurane. I had Atropine drawn up and ready but she maintained a heart rate of 120 and respiration rate of 35-40 throughout the procedure so didn't use it.

B put in a 24G IV catheter like she'd done it all her life, completely bloodless and on the first stick! R was our surgeon this time and almost finished putting in her stitches when I (and one of the teachers) started to get a little worried that our cat might be a little too deep. Lesson to be learned here -- a little too deep at 1% iso can become totally awake at 0.5% in no time flat! The team that does her actual spay next week should probably read our notes. Although, during an actual surgical procedure they will probably want her to be that deep. K was our floater this time and did a great job keeping us all supplied with the stuff we'd forgotten to set up in advance. Its a good thing we had her.

Tomorrow it is Chester's turn. And I will be the surgeon this time. I'm nervous about 1) putting sutures in real live skin instead of our training "legs" and 2) having to use Dr Mac's favorite suture material which is a mono-filament. Better practice a little tonight.

More tomorrow ...

Mock Surgery, part une

Our team had their first Mock Surgery today and it went amazingly well. R was the Lead Anesthetist and is very meticulous, which helped a LOT. My task was to calculate a fluid rate for the pump as well as a manual drip count; insert the IV catheter and hook up the fluid drip set; shave and prep the surgical site and generally support the anesthetist; K was our Mock Surgeon and had to scrub in, gown and glove and suture along a sharpie pen line (hence the Mock -- no incision); B was our floater and did a little of everything to help all of us. While Lex was under anesthesia we took the opportunity to shave some of the fur mats on his belly and butt and to express his [quite impacted] anal glands. Neither of these would have been easy to do while he was awake -- rather protective of his nether parts is our little Lex.

Next week our Mock patient will be one of the cats, Thumbelina. And I will be the Lead Anesthetist. And I am scared shirtless about it. Stay tuned.

Reflections on Independence Day

The first Independence Day occurred on February 17, 2007. My divorce had “cooked” for six months and was now final. How to commemorate the day? the fact? Emotions were labile. Grief for the death of a 30 year old relationship. Elation at being alive. Fear of the future. Joy of recreating self. Big emotions and big segues among them.

The first Independence Day I spent, alone, in Half Moon Bay. I ate at a restaurant alone, with no partner, no companion, just a woman all alone all by herself, enjoying wine and salad and pasta and her own company. Next, I went to a day spa for a completely and totally indulgent massage and then a facial. My minions catered to me, soft music, incense, warm oils, soothing hands, all focused on my pleasure, my contentment, my relaxation. Rejuvenated, and feeling pretty sassy to boot, I shopped from one end of Main Street to the other, buying a lovely ring set with abalone here, a wind chime fashioned from colored glass there. The next step was a walk on the beach, alone, watching kite-flyers and children playing and picking up seashells and sea glass as I wandered. Driving out of town, on the way home, I stopped at one of the hundreds of flower vendors and bought a dozen roses. Just for me. Just from me.

It was very important that the day be spent outside of the company of my friends. Several had offered, requested, to come with me. But it was essential that I be able to establish true independence and be comfortable with myself, alone. For 30 years I had been the junior partner of a collaboration that steamed backwards and forwards across the continent with no thought of my needs wants desires. For 30 years I had believed when told “you don’t want that”, “you need this”, “you don’t feel that”, “this is best for you.” Damn. I had believed instead of thinking for myself. I needed to get back to the woman who knew what she wanted and went for it. And I did.

The second Independence Day (the first anniversary) was shared, verbally, with friends. I didn’t feel such a strong need to assert my independence this time around. I could feel it. I had internalized it. No need to crow and shout and make political statements. I am Independent. I am Strong. I have my Self back.

The third Independence Day didn’t even get celebrated on the day. My personal, private, celebration happened on the 14^th when I spent a night in Las Vegas by myself: dinner, strolling through the casino, all without an escort. Whoa! That’s Independent! There was another celebration though, attended by three of the most important men in my life. It involved cards and good wishes and celebratory thoughts and physical intimacies and all sorts of wonderfulness that is just between me and my sweet lovers.

I wonder what next year will bring? Stay tuned.