My question was stimulated by an acquaintance who was in the OR for about 12 hours getting a heart transplant (pretty please everybody - do whatever is appriopriate in your neck of the woods to say you want to donate your organs after death! She managed to survive 2 years on the transplant list, over a year of it with an LVAD).
For extremely long operations, how are bathroom breaks dealt with? Seems to me if you are concentrating on something that long you also need to just take a break to relax for a few minutes. Do surgeons take relaxation breaks? Do they just leave the patient alone with someone to keep an eye on the instruments and scream if something goes weird or what?
I’m not sure that everyone is there for the entire time. There might be one main surgeon to open the cavity, one to install the heart and then another one to close things up.
Yes, there are times when the lead surgeon is not required. I don’t know the details about when or why as I’m not a neurosurgeon, but my uncle, who was, has told me about taking smoke breaks during long surgeries.
The surgeon is not the only one in the room with the patient; there are OR nurses (both scrubbed in and not scrubbed in), the anesthesiologist(s), technicians for any special support equipment like bypass machines, X-ray machines, ultrasound devices, laser or robot systems, etc. People are frequently coming and going over the course of a long operation. OR nurses will rotate in and out over time according to whatever the policies are at that hospital - they are typically not allowed to exceed a certain number of hours without relief. Anesthesiologists also cover each other for breaks every couple of hours - as in someone else takes over watching dials and turning valves for a while if things are stable. For cases that are known in advance to be lengthy, these things are planned out ahead of time. If something surprising comes up, word gets around and colleagues may wander in to see if their help would be appreciated.
Surgeons normally stay through the whole case. Focusing for long periods of time isn’t that much of an issue - the time usually seems to fly by if you are doing the cutting and sewing; not so much if you’re holding retractors. I’ve personally stood in one spot for twelve or more hours at a stretch on many occasions, and I’ve got the shitty leg veins to prove it (I think my personal record was a 17-hr liver transplant case as a resident. That one was rough). If you really must pee, you cover everything up with a moist cloth and dash out and deal with it, then rescrub and come back in. This takes five or ten minutes, tops. Having someone else come in to continue/finish operating on a routine case is rare unless there is an emergency and the surgeon is incapacitated. For really long procedures (frequently the complex ones) there may be more than one surgeon involved right from the start, either working together so they can individually break out briefly, or working in planned stages one after the other. I’ve never had trouble going a long time without getting a pee break; you make sure you pee before you start and don’t have the Big Gulp before the start of the case. I have heard anecdotes about surgeons operating with a urinary catheter/leg bag on for lengthy cases, but only in a third-hand urban legend kind of way.
Surgeons will step away from the table briefly to sip a drink or wolf a bite of food held by someone who is not scrubbed in (done away from the patient to avoid any Junior Mints incidents). A surgeon may also have residents or surgical assistants who essentially start and finish the case, leaving the critical/interesting bits for the head honcho. Closing up multiple feet of incisions is a tedious and less-critical process that can be farmed out to an assistant.
Cases will occasionally make the news in which a surgeon steps out of the OR and does something irresponsible, like run to the bank or go out for a drink. That is malpractice. Pausing a long case for five minutes to pee/grab a Snickers/take an ibuprofen is not, provided you are at a point in the case where that is reasonable. Usually, though, it is in everyone’s best interest to move things along with as few interruptions as possible.
Hell, I’ve had a three-hour root canal and the surgeon stepped out for a break after two hours. Her assistant took over for a bit, but IIRC she didn’t really do much other than poke about.
In one of Tom Clancy’s books, possibly *Patriot Games *, a scene is described where British surgeons in London leave an eye operation half way, on the table under anaesthesia, to go out for a pint and lunch. I found this difficult to believe. Does anyone have any information on whether this is likely?
I know someone who had a surgery that was scheduled to take 24 hours. It started one morning and, at 3AM the next morning, they interrupted the surgery because his heart was giving way and they let him come out of anesthesia and sleep a while (I am not clear how this was done; they couldn’t have closed him up) and then restarted in the afternoon and finished about midnight. He is still recovering.
He got so much wrong about the NHS in one of his later books, red rabbit I think, that I stopped reading his books.
When I worked for the NHS drinking during work hours was a disciplinary offence, and that was for non-clinical staff.
Even if you disregard the safety issue, there is a financial cost of leaving a patient on the table whilst you pop out for a pint, it costs a fortune to keep someone anaesthetised.
Tom Clancy played extremely fast and loose with facts, he even fell for dowsing rods in Rainbow Six.
The surgeons I encountered today didn’t take lunch breaks to eat, let alone have a pint.