The Art of Sterility

Check out this blog post by Letitia Juday, one of our volunteers in Bolivia:

On Thursday, November 4, 2010, my life here in Bolivia, and my responsibilities at the hospital, changed suddenly and drastically. Having just left morning rounds to take Conta (one of the two Scottish volunteers helping out for two weeks) in to see a reconstructive surgery on a woman’s humerus, I dressed myself in my little booties and cap and mask like usual and entered the quirofano. I looked at the x-rays on the wall and saw where the woman’s bone was broken in two places close to the elbow, and I watched as the surgeon spread povidona over the woman’s arm to clean it.

That’s when it happened. Nelly, the woman in charge of the quirofano and the first surgical assistant, said something to the doctor about me helping him. Then she began speaking at me, but it’s very difficult for me to understand Spanish which is spoken from under a mask. She motioned for me to remove my ring. At that point I thought she was asking me to put on non-sterile gloves and help clean the woman’s arm. So I reached for the gloves.

“No, no, no!” She shook her head and gestured for me to enter the outer room…where the sinks are! I could not believe what was happening: I was being instructed to wash my hands up to my elbows, be sprayed with iodine, dry my hands with a sterile cloth, be dressed in a sterile gown and gloves, and be the second surgical assistant!

I had seen this done many times. The interns were always the ones who assisted Nelly and the surgeons, but of course, the interns have been gone for more than a week now. There are two interns left, our friends Anghelo and Vladimir, but their expertise is better utilized in the ER or with internalized patients, and they are not always there. I realized as I stood with my hands folded in front of me in all of my sterility, that I was the obvious choice because I speak Spanish and they wouldn’t have to pay me.

I pulled aside ligaments and other tissues with a separator tool (Nelly told me today what it’s called, but I’ve forgotten) and used the aspirator to suck up excess body fluids. I also was in charge of cutting stitches.

I’ve always wondered how, if I get tired of being on my feet long enough to watch most of the surgeries, the surgeons and assistants stand in their gowns under those bright lights for so long without getting tired. And I thought that I would never be able to do because the first time I watched, I passed out. And all the other times, I’ve gotten very tired. But I suppose I have become accustomed to being in that room. Although I was aware of feeling tired and hot, I did not come close to overheating or passing out. I had a job to do, and I fully enjoyed doing it.

The doctors temporarily clamped the bones together and then used screws and a long, narrow plate to permanently fix it. And her bone was fixed.

I wondered if this dream-like experience was a one-time opportunity, or if I would get to assist again. Friday came and went with no surgeries. We had a lovely weekend visiting some Incan ruins, going to the movies, and going to church. But I stayed up late Sunday night and woke up Monday feeling slightly under the weather. So I decided to stay home from rounds and not go over to the hospital until Tuesday. But at 9:00 AM, the Scots came running in, and I heard four beautiful words, “You’re needed in surgery.”

I forgot all about how tired I was and ran to my room to put on my scrubs. Then I ran over to the hospital and went straight to the sink to wash my hands. When I went into the quirofano with my arms dripping iodine, there was Nelly smiling at me (well, her eyes were, anyway- it’s hard to smile at people with a mask on) and holding the sterile towel for me. The surgeons greeted me cheerfully, trying to pronounce my name, which they had learned Thursday, in English. That day I used separators and braced a man’s ankle in various positions as the doctors fixed both the talus and fibula. I learned how to properly trade places with a surgeon (back-to-back) and how to properly hold the scissors and cut stitches. Once again, I was fascinated.

On Monday, I asked the surgeons and Nelly if they wanted me to buy a cell phone so that they could call me at any hour of the day or night to help, and they said “Absolutely.” So Tuesday I bought a pre-paid phone at La Cancha (a large, market district of the city). Tuesday passed with no surgeries, but this morning I was eating breakfast, about to go over to the hospital for rounds when our house phone rang. Leta answered and then turned to me and said the beautiful words, “Tisha, you’re needed in surgery.”

Today, it was a C-Section! I went over long before the surgery started, so Nelly and I got sterile before the surgeons arrived, and she taught me my first thorough lesson in the art of sterility. She told me how to dress myself, how to put sterile gloves on the doctors, how to put the sterile cloths on the table and arrange the gauze and bowls. She taught me the names of instruments as she pull them out and she taught me where each belonged on the table. She taught me about the various types of sutures, and how to open the kit and grab the curved needle with the forceps to get it ready. Then she taught me how to cover the patient with sterile cloths and prepare the electro and the aspirador.

It’s difficult to learn from people who speak Spanish behind masks, but I tried to follow instructions when I understood them and not move if I didn’t. The other obstetrician arrived, we began the surgery, the baby came out, Nelly and I handed it in a sterile cloth to the pediatrician, the placenta came out, and the doctors stitched up uterus, the peritoneal lining, and the muscle and fat layers. Then Nelly was left to do the final skin sutures. After she began, she handed me the tools and told me to do dentrodermico sutures. But I said, “Okay. Teach me how.”

“You mean you don’t already know?”

“No. I can do simple stitches, but that’s all.”

“Oh, well, then give them back. You just watch this time.”

So I watched very closely. At the rate Nelly is rushing me into things, I might be doing sutures before long. But I’m in no hurry; and if I do end up doing them, it will only be under Nelly’s close supervision.

I feel like Nelly’s young padawan, and she is my master. So far, I have been gaining confidence in the art of being sterile. Next, I hope to learn the names of instruments, anticipate surgeon’s needs, and learn to suture. I am so thankful that Nelly fully intends to teach me everything I need to know to be a competent second surgical assistant, and she now has my cell phone number, so tonight, for the first time, I am on call. If there is ever an emergency surgery, I will receive a call and have to go straight over to the hospital. I’m not wishing for bad things to happen, but hopefully my cell phone will be necessary someday soon.

I never expected this glorious responsibility. I never expected to hear so often, “You’re needed in surgery.” I hope I learn as much as I possibly can as I enjoy a front-row seat to these fascinating operations.

Read more about Letitia's experiences on her blog: http://pakasqa.wordpress.com/