Or Eyes: How to Avoid a Trip to the Or

By Kathleen E. Volpe-Schaffer

Unbelievably real operating room cases brought to book format told from an OR nurses professional point of view so you too can learn to prevent the sometimes disfiguring and disabling effects of some of the most common diseases affecting people today; Diabetes, heart disease and some cancers are just a few. Were going to amputate his penis, the source of his infection said the surgeon as I passed him the scalple. But were only going to amutate the distal 1/3 the surgeon continued. Oh thats just great I thought to myself in disbelief. I would not have believed it if i didnt see it with my own OR EYES!

• Language: English
• Publisher: iUniverse
• Release date: Jun 13, 2012
• ISBN: 9781450250504

Kathleen E. Volpe-Schaffer

I, Kathy Volple-Schaffer have been a practicing professional RN for over 30 years with the bulk of my professional career spent in the operating room as a professional OR nurse. I have a BSN degree from Thomas Jefferson University '88 and a Masters of Science from Rutgers University '99. I sat for the professional family nurse practitioner's licensing exam in 1999 and passed, but I do not maintain or practice as a FNP anymore. My professional career was cut short due to multiple sclerosis so I view this book as a continuation of the nursing practice I loved. The cases I participated in the OR affected me so much that those events motivated me to write this book and to communicate to all and empower people to take charge of their health by learning the easy way through my OR EYES, the title of my book. I've seen the worst of the worst and at times I could not believe what I was seeing in the OR if I had not witnessed it with my own "OR EYES". The health promotion measures I teach about are regarding some of the most common preventable diseases or conditions affecting populations worldwide, or at the very least disease conditions that could be easily overcome if detected early. For example: Breast cancer, Diabetes, drinking & texting while driving, organ donation issues, smoking and lung cancer, abortion, obesity, AIDS and the importance of eating a healthy diet are issues communicated and discussed. The most important factors I demonstrate are how all of these diseases and or tragic events are almost 100% preventable and or easily managed if people are made aware and knowledgeable of self risk management. I was born in Philadelphia, Pa., but now reside in Southern New Jersey with my family- my husband Vincent, my mother Theresa Volpe, my daughter Natalile Schaffer and my puppy Molly, a Bichon Frise.

Book preview

Copyright © 2012

All rights reserved. No part of this book may be used or reproduced by any means, graphic, electronic, or mechanical, including photocopying, recording, taping or by any information storage retrieval system without the written permission of the publisher except in the case of brief quotations embodied in critical articles and reviews.

iUniverse books may be ordered through booksellers or by contacting:

iUniverse

1663 Liberty Drive

Bloomington, IN 47403

www.iuniverse.com

1-800-Authors (1-800-288-4677)

Because of the dynamic nature of the Internet, any Web addresses or links contained in this book may have changed since publication and may no longer be valid. The views expressed in this work are solely those of the author and do not necessarily reflect the views of the publisher, and the publisher hereby disclaims any responsibility for them.

Any people depicted in stock imagery provided by Thinkstock are models, and such images are being used for illustrative purposes only.

Certain stock imagery © Thinkstock.

ISBN: 978-1-4502-5049-8 (sc)

ISBN: 978-1-4502-5050-4 (e)

iUniverse rev. date: 6/7/2012

Contents

Dedication

Introduction

Chapter 1

Chapter 2

Chapter 3

Chapter 5

Chapter 6

Chapter 7

Chapter 8

Chapter 9

Chapter 10

Chapter 11

Chapter 12

Chapter 13

Conclusions

Writer’s Biography 

Dedication

This book is dedicated to the health and happiness of the human race.

Introduction

We can all agree that being sick is not a pleasant experience. Needing an operation and going to the operating room is an even less joyous occasion. Everyone has a story to tell of their operation. Some are scary and some are funny, and some are just plain weird. Being nervous about being a patient in the OR is expected. You wouldn’t be normal if you weren’t a little on edge. But don’t worry, because the outcomes are almost always good. I’ve scrubbed and or circulated for hundreds, if not thousands of surgical procedures over my operating room nurse’s career and I have never ceased to be surprised and amazed with each experience. Over the last three decades many operative procedures have been altered, modified, shortened and tweaked in order to provide better patient outcomes. Hospital stays are shorter, despite being more expensive, but that’s another topic. Patients are happier about shorter hospital stays. It used to be, say in the 1970s that if you were diagnosed with breast cancer, regardless how small the mass, your only option was to have a mastectomy, the total removal of your breast. Today lumpectomy, the removal of only the tumor and some surrounding tissue is the choice of many women and long term prognosis has improved despite less invasive procedures. Today, often times it is undetectable to anyone that you had any breast surgery at all, provided you’re not standing there naked. But hospital operating rooms are busier than ever. We keep doing the same procedures over and over. The baby boomer bulge of the population, those born post WWII from 1945 to 1965 is aging and obesity and Diabetes are on the rise exponentially, as well as the surgical procedures needed to allay the effects of these conditions. Even though surgical procedures and methods have changed over the decades, the patients’ stories and the reasons why they are visiting the operating room have not. These medical conditions and the stories that precluded their visits to the OR have moved me in such a way that I have no excuse not to share them with you, primarily for the sake of education and disease prevention. I’ve seen too many scenarios that could have turned out differently if only the disease, the cancer, the diabetes, or the lump was caught earlier, or if only someone told them what to look for. My goal is to inform people on how to take control of their lifestyles by recognizing the risks of disease development and thereby avoiding that dreaded trip to the Operating Room. All of the patients I talk about have a story to tell and they speak to the major health issues that impact our society today, just as strongly as they did 30 years ago. These diseases and conditions are still as controversial as they were 30 years ago. AIDS, abortion, breast cancer, obesity (on the rise), diabetes (on the rise too), and organ donation are just a few scenarios explored. The sad story is that even though great strides have been made in the early detection and treatments of these conditions, their numbers are not really dwindling. The real horror story is that the incidences of these conditions are increasing. So I asked myself, Why?

The Nursing profession is responsible for many actions related to health care but probably one of the most import functions of nursing is disease prevention via health education. So I’ve decided to take a different approach; I can teach others what I’ve seen and know though my experiences as an OR nurse; to teach from my nursing perspective, to teach from a personal point of view from inside my patients’ bodies as they lay on the OR table, and not as a text book set of rules because these are real people. I want you to know these people personally, exactly like I did and maybe the impact will be more empowering. Many people think Oh, that only happens to other people, not me. And some people will make up some home made reasoning as to why that condition doesn’t apply to them. I’m too tall or That only happens to that group of people, or the best excuse and state of denial is the line That doesn’t run in my family!

Yea, right! Life is full of twists and turns and decisions must me made and sometimes we incorrectly or unknowingly take the rocky path. That is the goal of this book; to empower people to choose that right, that smoother road and to make those easier and better decisions toward the goal of optimal health. One of the best things we can do is to learn from our errors, our mistakes. But an easier and less painful route to take is to learn how to not repeat the follies of others. I call these Other Peoples’ Mistakes or OPMs; for example, smoking. I’ve come across a plethora of these incorrect life choices impacting life’s outcomes and I wish to share them with you in order to empower you. We are all potential OR patients and we need to be armed with the best possible information so you too can avoid that trip to the OR. Take it from me, I’ve seen the worst of the worst in the OR.

I’ve compiled various surgical scenarios from my nursing and operating room experiences, taking an almost historical perspective and incorporating different yet common diseases that I’ve seen firsthand, on the OR table and have witnessed through my OR EYES and participated in surgically treating. Examples are procedures treating the consequences of diabetes and breast cancer, lung cancer, drunk driving and organ donation, abortion, and drug abuse just to name a few. My hope is that this book can be a learning experience for anyone who reads it, without having to experience it. I have witnessed the most distressing worst case scenarios through these OR EYES. A few are absolutely disgusting. Some have a funny side, but many in my opinion are horribly tragic and I would have not believed it if I didn’t see it for myself with my own OR EYES. The saddest thing is that in most of the diseases referenced here, all were and are preventable conditions or at least easily managed if detected early. Hopefully this book will help to provide awareness of preventative pro-active solutions that can easily be incorporated into your everyday activities which will prove to provide wellness and longevity. We’re all OR patients sooner or later, but hopefully later; correction- or hopefully never!

Chapter 1

Fed Up

I couldn’t take it anymore. I needed a change. My only question was whether or not I could handle all the blood, guts, pus and other oozing types of drainage the job would entail. But I finally did it. I couldn’t believe that I landed a job in an operating room. I nervously applied to a major inner city university hospital operating room and was hired immediately as full time R.N. I was especially surprised that I was hired without any operating room experience. They must be desperate, I thought to myself. There was always a shortage of nurses as far back in time as I could remember. I knew it was a done deal as soon as I flashed my state of Pennsylvania professional RN license in front of the recruiting head nurse’s bulging eyes as she snatched it from my hands. Val, the OR manager said to me with a big simile on her face, We’ll just keep this on file and display it in the nursing administrative office for legal and safe keeping reasons. That made sense to me, because I knew that all licensed professionals, nurses, doctors, physical therapists, social workers and alike must have their current licenses on file in the Human Resources departments, as it is a federal and state law. It is mandated by the Joint Commission on the Credentialing of Hospitals. This is a federal agency that oversees that the people you hire are really the people you hire, and that the person wielding the license is a state tested and professionally qualified individual. All professional licenses are color marked and printed on special paper to cut down on counterfeiting, just like money.

I went to work in the operating room because I was wiped out from my previous job as a surgical intensive care unit (SICU) nurse. Working in the SICU was an exhausting endeavor. Rotating shift work was wicked. I was working swing shifts from 11pm to 7am, and then jumping to 3pm to 11pm eight hours later in the very same day. I rarely worked the 7 am to 3 pm shift. It seemed like I was always low man on the totem pole. I was always paying my dues. But what made this so difficult was the fact that I always had to be as sharp as a tack because this SICU job required specialized and highly technically demanding skills, and there is no room for error. Running codes, watching EKG monitors, interpreting arrhythmias, taking vital signs, doing dressing changes, assessing urine out and fluids taken, and calculating IV drips, along with attending to your tracheotomy patient on the noisy ventilator were routine daily tasks.

Taking care of intubated respirator dependent patients was just a mega responsibility that demanded my most constant attention. God forbid if I rubbed my tired eyes or blinked at the wrong moment. One specific intubated patient will forever taint my memory. A twenty four hour fresh post-op open heart surgery CABG patient finally woke up. He had just regained enough consciousness to realize where he was and proceeded to just yank out his endotracheal tube (ET) from his throat and trachea. He did a good job except he did it when no one was watching. The tape securing the ET in place on his face kept it from being completely removed. So what happened next, he began to choke and vomit and he aspirated the vomitus from his throat and mouth back into his lungs. But he couldn’t clear his mouth because half of the ET was still in his mouth and partially in his throat, stimulating his gag reflex. He was vomiting violently. This was a bad sign because he was now attempting to breath in his vomitus with nowhere to go except back into his lungs. He had no control of his airway because of his misplaced ET. It was bad again because even though he had no food in his stomach, his gut was still producing the hydrochloric acid (HCL) needed for food digestion and the anesthetics used in surgery to decrease secretions had worn off. Hydrochloric acid in the lungs can be fatal. Digestion of lung tissue is a death sentence. It burns and damages and then scars the lung tissue which renders them unable to do their life sustaining job; breathing. The main culprit of HCL in the lungs is what is known as the development of aspiration pneumonia. The Ph. of stomach acid-HCl, is approximately 2.5, which is very acidic and it can be compared to inhaling bleach. Aspiration pneumonia is a chemical burn of the trachea, bronchus and the little alveoli sacs of the lungs. Aspiration pneumonia is the most lethal form of pneumonia. Up to thirty (30%) to fifty (50 %) of patients with aspiration pneumonia will die because of it, and or develop lifelong consequences due to its incidence.

Unfortunately, this patient did develop aspiration pneumonia and died a week later. His open heart surgery was a success, but he died because of a complication. His death became a morbidity statistic. Prevention of aspiration pneumonia is the main reason surgery patients are instructed to stop eating foods and drinking liquids 8 hours before receiving general anesthesia. After this unfortunate incident, we started partially restraining post operative patient’s hands, just enough so they could not reach their mouths and remove their endotracheal tubes.

Besides these ventilator dependent patients, just taking care of a patient’s individual needs, the turning and lifting of people who were two to three times my weight, and doing all of this for 2 or 3 patients at a time paved my way to the exit. I just couldn’t do it anymore. Of course the SICU where I worked was always short staffed; someone was always calling out sick. I learned early on that it was the norm in the nursing profession to work with a skeleton crew. There was always a nurse who was left over from the previous shift who was doing some form of limited mandatory overtime. Nurses quit as rapidly as they were hired.

I quickly discovered that working in a specialty unit like the operating room insured me less weekend duty as well as less rotation to holidays and to the evening and night shifts as well. Weekend rotation in the OR was only once every 6 weeks vs. every other as in the SICU. I could handle this I thought to myself. This is because in the OR, 99% of all the surgeries are elective and are performed on the weekdays. It was more or less a controlled schedule. After all, surgeons don’t like working nights or weekends either. Weekends and nights in the OR were minimally staffed. Only emergency cases like appendectomies, organ transplants, or trauma cases were penciled onto the schedule after 3 pm. So in essence, we OR nurses followed the doctors’ schedules. I liked that.

While working in the SICU I realized that my internal clock was whacked and severely skewed to the left. Sleeping 3 to 4 hours a day for three or four straight days, I found was not conducive to optimal health. I ate my meals on the run and I lost weight. I was six pounds lighter than what I was 6 months prior. Sleep deprivation made me feel sick in a weird way. I felt that my brain was atrophying. Lack of sleep is extremely taxing on one’s body. I didn’t start drinking coffee until I became a nurse. Caffeine was a necessary addiction, despite coffee’s bitter taste. But I discovered that I could fix that problem. I doused each cup of coffee with at least three heaping teaspoons of sugar and the more cream the better. Out of necessity, I think I invented the coffee milkshake back in 1976.

I realized I needed more normalcies in my life. I was consistently absent from family functions because of working crazy swing shifts. Christmas was just another day on my calendar when I would earn time and a half and be even more exhausted because everyone else in the SICU got off and I was doing twice as much work. I needed an out. I was frying myself to a crisp.

I looked weekly in the Sunday Philadelphia Inquirer newspaper scanning the nursing jobs, hoping to pinpoint a possible job interview. I needed so desperately to escape the stress of this SICU job. The year was 1977. Two weeks into my search I zeroed in on a position as a cardiac catheterization nurse at another University hospital. Despite the location of the University, I eagerly dialed the phone number. My interview with a cardiologist was scheduled for the following Friday. When the day of my interview arrived, I was pumped! I made sure that everything was perfect. I tweaked my resume to perfection. Being a veteran SICU nurse I knew that I was more than qualified. I even bought a new suit for the interview. I was optimistic.

I arrived a half hour early at 10:00am for my 10:30am appointment. I sat in the waiting room tapping my feet to the faint barely audible Frank Sinatra tune. Promptly at 10:30, I was ushered into the doctor’s office. I sat again, waiting patiently. When Dr. P entered, we exchanged the usual self intros and the interview began. He asked the usual questions like where I went to school and how long I worked in critical care. I thought I was doing just fine. Just when I thought he was going to offer me the job, the most unexpected thing happened. Dr. P leaned forward and with a stern look on his face, he said to me, I’m sorry Kathy. You are not what I’m looking for to fill the position.

I don’t understand, I replied.

Let me explain. I think you are more than qualified for the job, but it’s your age.

I thought to myself, What does my age have to do with anything? So I asked him, So, why should that matter?

I was 22 years old at the time.

His reply angered me. "What if you get