The Small Things

I'm finally in the Stanford operating rooms now. After spending a month on acute pain, I'm slowly relearning the basics of anesthesia in the big house. So much of what matters early on is logistic and not medical. My first day in the Stanford OR was so hard because I didn't know how things worked here. Small things like familiarity with the anesthesia cart has everything to do with efficiency. I can tell you what each drawer in the VA anesthesia cart contains. I know exactly where to reach for each medication. But I had to familiarize myself with the set-up at Stanford. Medication vials look different. Each drawer contains different equipment. Even small things like the patient gowns are different. Why does this make so much of a difference? Patient gowns at the VA unbutton at the sleeves but they don't at Stanford; this means that IV's have to be threaded into the sleeve so taking off the gown doesn't get in the way. The first day consisted entirely of learning these details.

Other things I didn't anticipate also posed challenges. The anesthesia machines were different, so I had to re-orient myself to where data appears, how to change settings. Figuring out paper charting and billing feels like a hassle. And simply understanding the process by which a patient in the holding area is deemed ready for surgery, getting them to the right OR (for some reason, OR 21 is nowhere near OR 15-20), and identifying the right PACU slot was time consuming. There was little orientation so being thrown into the mess was a little terrifying, but that's simply part of learning a new system.