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Life Inside the OR: An Outsider’s Perspective

When I started my career seven years ago, it hadn’t crossed my mind that at some point I would spend nearly 12 hours – overnight hours, to be exact – inside an operating room for anything other than a potential surgery of my own. That is, until I had the opportunity to don paper scrubs, a facemask and hair net, and observe a life-changing procedure –with a film crew in tow.

Anyone who watches medical dramas on TV can imagine what it must be like in an OR during surgery, but unless you’re a surgeon, nurse, anesthesiologist, radiologist, or some other member of a surgical team – or in my case a lucky PR person – you really have no idea.

Around this time last year, I was going into the OR to watch a double hand transplant—the first bilateral hand transplant to be performed on an international patient in the United States, a 28-year-old woman from France—which my crew would be filming for educational and research purposes. This was my second foray into the OR, following a 2015 shoulder surgery which I observed, along with a photographer and reporter from the Philadelphia Inquirer , but this would be far longer and less routine, and with a much larger team—more than 30 surgeons, anesthesiologists, nurses, residents, and medical students from across Penn Medicine.

The evening started with a level of excitement buzzing through the hallway. Members of the team lined the hall as they waited for the lead surgeons to arrive and dole out marching orders. They were eager to operate, observe, and learn, just as I was eager to watch them do it.

As soon as one of the lead surgeons started speaking, a hush fell over the room and the team focused intently. In this case, there was going to be a rotating schedule of who would be in the OR at any given time. As an outsider, this seemed a bit strange at first, but it became clear that each subgroup had its own very specific specialty that would be required at certain points during the procedure.

Things got underway once the patient was brought in and prepped; then came the donor limbs. They were wheeled in by the lead surgeon, on ice, in a cooler, and if there’s one thing to compare it to, it’s the parting of the Red Sea. All of us awaiting the arrival stepped cleanly out of the way, creating a path right to the door. And into the OR they went. 

Once scrubbed and gowned, the teams were off. They worked in perfect succession, huddled over the patient, robotically calling out for new instruments and dressings. From behind the OR doors, inside looked quiet, bodies buzzing from group to group taking instruments from nurse to surgeon. But inside, the rumbling of the surgeon’s voices, the hummed discussions of the anesthesiologists, and the beeping of the patient’s vitals, all rang through the room with focused, fervent order.

Six or eight hours into the surgery, I recall overhearing one surgeon remark to another who was scrubbing in for his portion, something along the lines of, “I bet there’s not too many of you out there who perform this technique in transplantation, is there?” To which he responded, “not too many of us at all.” It was a pretty simple exchange, almost forgettable really, but I found it very interesting in that moment. Of course, I was impressed with everything going on around me, but it was almost as if every person there was impressed with or inspired by the level of expertise of the person next to them.

There is a difference between hearing about a 12 hour surgery, and seeing one take place. As the minutes ticked by I started to watch a little closer, not focusing more on their hands or their techniques, but rather on the structure of the teams, the time spent outside the OR doors. The smaller groups that were addressed at the outset came in and out of the OR on a rotating basis. Some stayed put at the beginning and left part way through to sleep, while others arrived in the middle of the night after getting some shut eye earlier on. Even our lead videographer stepped out of the OR for a bit to shut her eyes – for which we practically had to physically pull her away from the camera, as she was so engrossed in capturing every detail of the procedure. And others, those who had to be accessible for a majority of the surgery, found time to shut their eyes on gurneys in the hallway, or in chairs just outside the operating room a few doors down.

It all really made sense at that point. Smaller teams rotated in not only because of their specific areas of expertise, but also to offer relief to their colleagues and ensure the patient’s safety throughout the procedure. The team had been training for months for this procedure technically, but also from a logistical standpoint, so that the patient would be in the hands of a rested, capable team at all times.

It’s interesting when you think about it. From my perspective, I always knew these surgeons and medical professionals were extensively trained in their fields; they’re experts at their techniques and at delivering the most comprehensive care to each and every patient. But seeing this, watching them work so intently, it became clear that there is an added layer of physical and mental ability that I hadn't realized. These surgeons and clinicians – particularly those who perform more advanced procedures or who specialize in transplantation (procedures which can happen at any hour) – have to be able to work for many, many hours on end and do so flawlessly and safely each time. At each step, they perfectly plotted and rotated in and out with precision.

There is little else I can compare it to than watching an orchestra perform. Each person works individually, smaller teams work in tandem, and collectively they operate in perfect synchrony. And at the end of it, there was not a rush of exhaustion or a mass exodus back to their beds, but rather, there was an overwhelming and palpable sense of accomplishment, a little relief, and that buzzing excitement came rushing back down the halls.

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