Excerpt

Chapter Five

“We all make choices but in the end, the choices make us.”

Andrew Ryan

I was one small part of what was often a very complex patient equation that the surgeon was responsible for solving.  A part that didn’t have the added complication of personality, medication, rehabilitation compliance or accompanying co-morbidities.  I supported doing what it took to achieve the outcome the surgeon wanted, on a body that for those hours, was anonymous.

I was the only person in the room other than the patient, who didn’t have a formal clinical qualification.  Nor was I accredited or employed by the hospital. I had no legal responsibility in the operating room.  However, I was incentivised to sell my product.

Without doubt, I’ve rode the lucrative waves of commercial success.  However, always, my team and I took great pride in the integrity within which we conducted ourselves.  Patient first.  Always.

“Let’s bring our A game,” we’d say.  We tackled complex cases together as a team.  We worked incredibly hard to ensure our surgeons had a learning experience that set them up for success and gave the patient the best outcome possible.  We left nothing to chance and managed expectations closely.  A learning case was exactly that - a process of learning.  There was some trial and error, missteps and unfortunately, occasional disasters.

Innovation of medical technology would ebb and flow with the oscillating depth of regulatory red tape.  Generally, a young surgeon’s baseline operative technique was based on what they learnt during their training.  The more they performed a surgery a certain way, the greater the value of their experience bank. As their brain and hands became more familiar with a particular surgical technique, they developed neural pathways that improved their conscious competence.  They used less of their reactive brain, more of their observing brain and were more likely to effectively troubleshoot based on their ability to recognise “patterns” from their previous experience.  It would become automatic. 

Familiarity offered security.  It reduced risk and set them up to deliver the best clinical outcome for the patient.

When a new surgical technology came to market, it could involve anything from a slight modification of current technique, to a more radical process that required learning an entirely new procedure.

Change, regardless of enormity, would introduce risk.  A surgeon’s willingness to change their surgical technique was directly proportionate to the amount of risk they were comfortable exposing themselves or their patient to. 

A new surgical technique involving new technology is taught through the medical device industry.  The process of learning slow and delicate, requiring patience and tolerance by all. 

Initially, learning cases tended to be slow and clunky, as the team grappled with the workings of the foreign equipment.  The scrub nurse had to learn how to assemble the instruments as well as keep up with the surgeon’s pace, while the surgeon and their assistant had to understand the instrument function, all the while looking for the comfort that familiarity would bring. 

I always felt like I was being pulled in every direction during those labour intensive hours.  Helping the nurse find an instrument amongst a stack of heavy metal trays, answering a question asked by an impatient surgeon.  My eyes were everywhere.  A pair in the back of my head would have been handy on more than one occasion. Always, I had one on the surgeon, making sure they weren’t forcing something that wasn’t meant to be forced. Ready to leap to the rescue or intervene with a respectful, “Doctor, before you do that…” to prevent a disaster.  I detested disasters under my watch.  

Constantly, my brain made mental notes of changes required before their next surgery. 

T-handles not straight handles.  Straight not curved instrument. Leave the ratchet off. For Christ’s sake don’t give him that instrument again. I can’t forget. It will look like I don’t care.   

It often wasn’t until the first closing suture was called for, that I would feel my body relax for the first time in hours. In those cases, I became a people manager, a logistics supervisor, an educator, a coach, a counsellor, a mood stabiliser, a cheerleader, a solution provider and an endurance athlete all rolled into one.  The masked spinal surgeon didn’t just book my equipment, he booked me, along with my armamentarium of capabilities and bags of positive energy I brought into the room. 

At times I felt like a tightrope walker, treading a fine line between where my responsibility started and where it ended. It was a privileged and often difficult position to be in. A surgeon placed their trust in me to carry them across the learning ravine and bridge the gap between what they knew and what they had yet to learn.  How did I draw the line?  It wasn’t always easy.  Particularly if stress levels were escalating and the room was emotionally charged. I had to be clear on what was and what wasn’t OK.  I had to have boundaries in place that I needed to respect and adhere to. If I didn’t, no one else would either.

As a Medical Sales Device Representative I was considered a product expert, not the operation expert.  It was OK to admit I didn’t know something.  My communication needed to be factual and objective because that was the information my surgeon was relying on to make their intraoperative decisions. Often, I faced or saw other representative’s faced with gaps in their kits.  Missing implants that hadn’t been restocked from a previous case.  It was a T Road junction.  I had to either decide to let the surgeon know at the start of the case, manage his expectations and allow the boiling temperament to simmer or, run the gauntlet.  If I decided against telling them I had to hope like hell they didn’t ask for that size implant.  If I sprang the surprise on them intraoperatively in all likelihood the shit didn’t just hit the fan, I could be given a one way ticket out of the operating room at the end of the case.

An excerpt from My Beautiful Mess - living through burnout & rediscovering me

by Peta Sitcheff