There’s no denying surgery can be stressful. We’ve all heard horror stories and have watched what can go wrong in a procedure according to movies and medical dramas. In the real world, does this actually happen? Are doctors and nurses really telling us the truth when it comes to surgery?
Here are 10 questions patients have timidly asked me as a surgery nurse that we all worry about, but are often too afraid to ask.
- Choosing Anesthesia
“My friend/family member recommended I get ‘this’ for anesthesia. Why doesn’t my anesthesiologist let me choose?”
Patients worry about what they are given for anesthesia (medications or methods to create absence of pain). You may be given multiple options. There are various methods and what is recommended depends on many factors. Your anesthesiologist reviews your case ahead of time. They assess your health history and medications, weigh your risks, and study your procedure. Using their medical expertise, they will recommend the method that will be the best option for you. They only offer certain options because they are protecting their patients.
- Being Judged
“I didn’t shave… will the doctors and nurses think I’m gross?”
“I’m insecure about the size of my ‘downstairs’… will the nurses laugh at me?”
“I’m self-conscious about my weight. Does the surgery team judge me if I’m overweight?”
No. None of us care if you have shaved, the size of your genitals, or if a you are overweight. Something you need to understand is that we see many patients. A single operating room can average anywhere from 7-15 surgeries a shift, the Surgery Department usually has multiple operating rooms, which has the capacity for a dozen to over 100 surgeries a day. Your surgery team goes into something I call “operating mode”. Once you enter the OR, you are our job. While we’re all human, we detach ourselves from emotions and become a well-oiled machine that works together to repair the human body. We are aware you are a person, but emotions tie strongly to memory. With emotions set aside, we do our job the best we possibly can. We have seen it all, so we don’t care enough to make it a memory.
“My biggest fear is that I poop on the OR table. Maybe I won’t eat at all the day before so this doesn’t happen?”
Surprisingly, this is the most commonly voiced fear I hear from patients. First of all, depending on the surgery, it is rare to poop or urinate on the OR table. It does happen, but we anticipate it. I probably have one patient a month who defecates/urinates on the OR table, and that’s a “maybe”. If they do, they usually already have digestive or bowel issues.
It isn’t difficult to clean up. The best part? No one remembers! No, seriously… no one. In the hundreds of surgeries, I can’t remember the name or face of a single patient who defecated. My coworkers say the same thing. We have much more important things to worry about than poop.
- Eating Before Surgery
“If I eat or drink before surgery, and I lie, is it a big deal?
YES. It is a very big deal. Many patients are under the false impression they are not to eat so they don’t poop or urinate while asleep. This is false and not the real reason we ask you not to eat or drink. If you need general anesthesia, you could “aspirate”, which is accidental inhalation of vomit into the lungs.
If you have anything in your stomach, you increase the chance of vomiting. Since you are unconscious, given multiple medications, and cannot swallow, that vomit can enter the lungs. Even if you are young and healthy, this will limit the amount of oxygen to your organs and tissues. You can also get aspiration pneumonia, which is very serious and may require being admitted to the Intensive Care Unit (ICU).
- Driving After Surgery
“I feel fine, and my surgery was hours ago. Is it really that dangerous to drive myself home?”
While you are “awake” when discharged, the effects of anesthesia can last in the body for hours to days. In some patients, it has been reported to last even longer. Just as it is dangerous to drink and drive or use narcotics when operating machinery, it is very dangerous to drive yourself home even a short distance. Anesthesia can alter your judgement and motor skills.
- Waking Up During Surgery
“I’ve heard horror stories of waking up in the middle of surgery… are they true?”
“I have a friend who said they remember waking up with a tube in their throat. What are the chances that will happen to me?”
I have never witnessed a patient “wake up” in the middle of surgery. This is a huge misconception and many anesthesiologists will tell you the same thing. Your vital signs are being constantly monitored by your anesthesiologist. They are the first to be aware if something is “off”.
When you are under “general anesthesia” you will have a breathing tube inserted into your lungs to help you breathe. When the procedure is over, your anesthesiology will start giving you medications to “wake up” from anesthesia. Once they see signs you are breathing on your own they will “extubate”, or remove the breathing tube. Some patients can be a little awake at this point, but they are not in the “middle” of surgery or still in the operation. Many accounts of being awake during surgery are mistaken for this period.
- Surgeon’s Honesty
“How do I know they are not lying to me about what happened during the surgery?”
“How do I know they are not ‘drunk’ or so sleep-deprived they are unsafe to operate?”
Legally, your doctors (surgeon and anesthesiologist) have to disclose the details of your procedure. It isn’t just a surgeon who is doing the surgery. A surgery team consists of 1-2 surgery nurses, a surgeon, an anesthesiologist, a surgical technologist, and an OR aid. Depending on the procedure, there may be additional members. If something goes wrong, we are all responsible for your outcome. We care about our patients, and we are not going to be held responsible if we believe a member of our team is doing something “immoral” or “incorrectly”. One of us will speak up. We would rather have you be angry and frustrated by cancelling the surgery than put your life at risk. We can also lose the licenses and degrees we worked years to achieve.
- What if I Don’t Wake Up?
“I’m scared of dying. How often do patients die?”
Surgery comes with risks. This will be outlined extensively by your surgeon. Surgery can be unpredictable, but more often predictable. It is rare for a patient to die from a scheduled procedure without being warned ahead of time. The majority of patients who die are already in a position where their health is deteriorating or emergency surgery had to be performed.
Your doctors will be liable for your death. They are the ones who will have to tell your family you passed away under their care. They are the ones who risk losing their licenses and practice after over a decade of medical school. They are not going to recommend or do an elective procedure if they think it is a very high risk.
- Sterile Instruments
“How do they make sure everything stays ‘sterile’?”
Your surgical technologist and nurse are responsible for checking the sterility of all the supplies and instruments opened. When sterilized, there is a small “indicator strip” that is placed inside the container or covering used to wrap the instruments. This strip will change color when placed in an environment at a certain temperature/parameter for a certain period of time. In other words, the sterilization method (if done properly) will be indicated by the strip. If the strip doesn’t change color, it is assumed the instruments are not sterile and another set is opened. Sterilizer logs and receipts are also filed and kept by Sterile Processing, the department responsible for cleaning and sterilizing instruments and supplies.
- Leaving Objects in Patients
“How do I know my surgeon didn’t leave an instrument inside of me?”
“Is it easy to leave a surgical item inside someone after surgery?”
This is extremely rare. The surgeon, surgical technician, and OR nurse do a final count of sharps, sponges, and instruments before closing a surgical incision. If an item is missing, an x-ray machine will take an image of your surgical incision. In order to be approved for surgical use, an item has to be considered “x-ray detectable”. This means an x-ray will be able to show an image of where the item is if it is left in the human body. Even sponges have a blue, x-ray detectable piece.