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– After a whole day, I feel like a shirt thrown into the drum of a washing machine. Strongly “whirled”. I think about the procedure performed until I fall asleep, and if something goes wrong, I think all the time and do not fall asleep anymore – says prof. Opole. Three doctors, three different episodes and the naked truth – what is it like holding a scalpel in your hand?
- Some operations take record long times – even over a day. How do surgeons handle it?
- Prof. Adam Maciejewski says that you just don’t feel time. – You don’t even think about physiognomy – the years at the table are getting used to it
- Doctors do not hide that sometimes, after long and complicated operations, they feel like “high”. – Work gives you power, adrenaline is buzzing – says the doctor. Łukasz Nazarewski
- You can find more such stories on the TvoiLokony home page
Losing to the stress of everyday life, we can always think about those who are worse off. Usually they are in the first place … For years, surgeons and treatment specialists have not left the list of the most burning and addictive professions. They work not only with people, but also with people. Adrenaline, cortisol and Maslow’s reoriented hierarchy of needs are part of their profession. However, I would not be myself if I did not ask my interlocutors whether you can live with stress? After how many hours on your feet do you feel like sitting down? And when do a cramped stomach and a dry throat make themselves felt?
Surgeons’ unusual normality
While working on the text, I talked to many surgeons. Everyone told me one thing: HIM you should talk to. The problem was that with the Polish “super surgeon” – prof. Adam Maciejewski, a specialist in general and oncological surgery, had one association: inaccessibility. On the other hand, why not give it a try… I sent the email on Tuesday night and it was over on Friday.
– I approach the terms “super-surgeon” or “miracle worker” with a great distance. Personally, I don’t like sticking patches. I’m just a surgeon and that’s where I put the dot. Besides, the times of the soloists are over – you can’t do everything with a pair of hands. Surgery today is primarily a team. And I think there is strength and future in it.
About the team of prof. Adam Maciejewski was heard by the world in May 2013, after the first ever face transplant surgery that saved the patient’s life. Seven months later, surgeons from Gliwice performed a second, this time planned, face transplant, and in April 2015 they performed the first allogeneic complex neck organ transplant.
– Do I remember May 15, 2013? Generally yes, but there was not much time for great emotions. We had been prepared for the first face transplant for many months – we practiced every move on the body. When it started, each of us was really doing our job, and time was passing very fast. Afterwards I went home and “greeted the door”. It turned out that I left my keys at work. I came back to the hospital, I came home, and I couldn’t sleep anyway … I think that I felt physical exhaustion only after two consecutive days.
Years at the table
The records that make up the headlines show how flexible the limits of human capabilities are. So what was the longest score on the operating table? 103 hours, more than four days in a row. The operation took place in Singapore and involved the separation of 11-month-old Siamese twins fused with heads. 20 surgeons took part in it.
The Polish record for years belonged to prof. Zbigniew Religa. The heart transplant performed in 1987 took 23 hours and was documented in the photo of James L. Stanfield, a National Geographic photographer. Transplanting the new face to Grzegorz Galasiński took over 27 hours, exactly XNUMX hours.
- See also: He was an unbeliever, but they called him Saint – prof. Zbigniew Religa repaired thousands of Polish hearts
– Is that my record? I don’t know, I’ve never counted. I can say that you just don’t feel time running out. You don’t even think about physiognomy – the years at the table get used to it. And I try to compensate for stress with sport that allows me to keep in shape. I am already in my age … It is definitely a job that moves home. It’s hard to mentally get out of the hospital. On the other hand, I love what I do and have never regretted choosing medicine. I will say more, sometimes I feel like I’m not working.
It’s a bit like chess
With prof. Maksymilian Opolski from the National Institute of Cardiology in Warsaw, a cardiologist specializing in interventional cardiology and imaging, we meet “on the phone”. He’s got 25 minutes, he’s back from the clinic.
– You know, I wouldn’t want it to be a cliche. A reportage about surgeons and treatment specialists who become addicted. Such a landscape after the battle. Today, we compensate for professional stress differently: sport, family, relationships – he says.
Its plot is the heart, or rather narrowed coronary arteries, which it enters without cutting through the sternum. He rarely uses the scalpel, and much more often holds the catheter and guides. He spent the longest time at the table for eight hours.
– I specialize in complex coronary procedures, in particular in opening chronically closed arteries in the heart. This applies to symptomatic patients with advanced atherosclerosis of the coronary arteries, often after unsuccessful procedures or disqualification from surgical treatment in other centers. Treatments are long and unpredictable, they require precision, proper planning and making the right decisions at the right time. This reminds me of the chess I played as a child – you analyze the image of the vessels and plan the chess opening, the middle game, the endgame, and in each phase you focus on different elements. It is said that without intuition there would not be many mats and there is something to it… In the course of treatments, the subtlety of hand movements sometimes has to be replaced by roughness. It is important to feel.
Like Lady Godiva
Until a few years ago, when he was driving to work, he would listen to motivating music. His playlist was opened by Queen’s “Don’t stop me now”, and closed by Billy Conti’s “Gonna Fly Now”, recalling Rocky running up the steps of the Philadelphia Museum of Art. A simple patent for a fighting mood. Today, sitting behind the wheel, he thinks more often about what awaits him, analyzes all possible scenarios of the procedure.
– The “day before” looks normal. I don’t prepare in any special way. We perform treatments in lead aprons that weigh a few kg, so I try to be in shape. I swim regularly, three times a week, 2 km on average. When it comes to hunger or other physiological needs, as an operator you don’t think about them. They don’t exist… And I just like surgical stress. For me it is a passion, maybe more of a “healthy obsession”. As I always had an aversion to Mondays, now I’m looking forward to them. The day after the treatments is similar to the others – the only difference is that afterwards, I feel like my shirt is thrown into the drum of the washing machine. Strongly “whirled”, but let me tell you it’s a good feeling. I think about working until I fall asleep, and if something goes wrong I think all the time and I don’t fall asleep anymore. Besides, the performed procedure is never the end. I always call patients and ask questions – says prof. Opole.
You enter through the window
When I ask about the features that determine “being good”, prof. Opolski mentions without hesitation: patience, mental resistance, good physical condition and perseverance. The last one reminds me of the approach: when they throw you out of the door, you enter through the window. As abstract as it sounds, there is something to it …
– Historically, the effectiveness of complex interventional cardiology treatments was low – the initial strategy was approximately 50%. was successful. Everything was changed by the “hybrid algorithm” introduced by the American cardiologist – prof. Brilakis. He was the first to suggest that in the event of a failure of the percutaneous restoration of the closed coronary artery, change the chosen strategy and act dynamically. Psychologically, it is interesting because in life we usually do the opposite. Defeats demotivate us and make us feel helpless. I see their positive side in my work. Failure does not have to be the end. Conversely – it may be the beginning of another treatment technique. I think this is a recipe for success: maintaining self-confidence despite temporary setbacks.
He stays and does not let go
I’ve always had trouble asking difficult questions. I knew one thing: better not to start with them, the logical solution seemed to be the very end – a short moment before disconnecting the connection. As if it would be easier for the vocal cords … – What happens to the psyche when the patient dies?
– It is always an unimaginable tragedy, but death is an extremely rare complication. In my practice, we often encounter the fact that the procedure turns out to be ineffective, i.e. the patient’s condition does not improve. If the patient has good clinical indications and not all the possibilities have been used, one tries again. Most often it succeeds, although sometimes you have to accept failure – says prof. Opole.
– Failure of the procedure is a difficult experience, especially since I look at it through the prism of the health of the patient who I was unable to help. It stays with me for many months and does not leave me alone. I analyze all the details, I wonder what would happen if I chose a different solution at a crucial moment. Nevertheless, I try to draw conclusions and, like artificial intelligence, create a model for the future. So seeing in another patient a similar image of the vessel, it is easier for me to assess the potential risk and act in advance.
snu melody
We know Łukasz Nazarewski, a specialist at the Clinical Department of General, Transplant and Liver Surgery, from high school. He has always dreamed of an operating table, and he is one of many. We haven’t seen and heard each other in a decade. I knew one thing: his life is in order.
– “Sorted out” was in my plans. This is a job that grabs you – there is no special place in it for “work life balance”. You are late for dates, you forget about family meetings, you come home after three days. Most of the surgeons in my year are now divorced. On the other hand, it’s really hard to say sometimes: I’m done, I’m leaving. Especially when they bring in a patient who is bleeding profusely and the nurse can’t find anyone on the other team and finds you. You have one option: return to the block. After all, you didn’t graduate from medicine so as not to help – he says.
– Anyway, even when I’m physically absent from the ward, mentally I’m at work. And this will be confirmed by most surgeons. We catch the fact that after hours, sitting in a friendly circle in a bar, we quickly switch from private topics to professional topics. Being a surgeon is simply addictive – on the one hand, I do work that is stressful, and on the other – it gives me incredible power. Sometimes, after six hours of surgery, you are so “surgically high” that you can continue to operate … You are buzzing with adrenaline, something is happening, there is action … And then you come home and you have a descent. Either you fall on the bed and you can’t fall asleep, or you fall asleep so hard they can bang and you won’t wake up. We can fall asleep, even when going to donate organs. And let me tell you that the howl of the ambulance is like a melody to sleep for us.
The bladder is roomy
Łukasz stood at the table for the longest time for almost 12 hours. He started operating before nine and finished after eight.
– It was a severe case – a patient with a tumor of the bile ducts that infiltrated the liver vessels. We had to remove the bile ducts, the right lobe of the liver, the portal vein fragment, and then reconstruct the bile drainage from the liver and the excised portal vein fragment. Most often, however, the operations I take part in are shorter. Typically 3-4 hours. What about the physiological needs? They fall into the background. Especially if you are an operator, time passes quickly. When I was assisting, I looked at the clock more often and thought, “Jesus, when is the end.” Now I’m so busy that I don’t feel hungry or thirsty and my bladder… is roomy. Besides, none of us is a masochist and we don’t drink a liter of water just before …
There is more discipline and self-control in Łukasz’s life. He doesn’t smoke or drink, and he regulates his emotions in an unusual way – while driving.
– I do not honk, I blaspheme. The navy blue Opel goes too slow – a bunch, silver Skoda forces priority – a bunch, white BMW forgets about the turn signals – a bunch. Maybe I won’t quote. I drive home, park and feel lighter. The tension comes off me like air from a balloon … In addition, I am de-stressed by what other people who do not sit with their hands in their intestines on a daily basis, i.e. trips to the cinema, meetings with friends, trips for a few days. Only for this I have little time.
The needle vice does not hold
Stress levels among surgeons have been studied in various ways. The pump tells us the most about what they feel when they hold a scalpel, i.e. monitoring the heart rate and pressure during surgery. At times, the heart rate is above 150 / minute and the pressure is above 200 mmHg.
– Is it beeping? I don’t know, I’ve never measured it. Personally, I am stressed by the realities of work more than the operations themselves, which bring me satisfaction … It is said that it is good where we are not present, but many things lie in our health care system. And it doesn’t matter if you work in a county hospital or an academic hospital. All centers are under-financed – there is a shortage of staff, no tools, no materials, no medicines. I am to operate and I hear that there is no anesthesiologist and the operation will not take place. Or I have an operation and I get a vice in my hand that doesn’t hold the needle. I am asking for an exchange and the scenario repeats itself … Sometimes it is also the case that I finish a six-hour operation and go to the second room on the way to an emergency operation. I leave the block, and in the ward more patients admitted as part of the emergency room are waiting for me. It’s eight in the morning and we have three transplants involving the entire team. So after a day, most of which I spent at the operating table, I have been transplanting organs until late afternoon. And these are not accidents at work, this is what everyday life looks like. In such conditions, the scalpel holds worse …
We encourage you to listen to the latest episode of the RESET podcast. This time we devote it to the problems of the perineum – a part of the body just like any other. And although it concerns all of us, it is still a taboo subject that we are often ashamed to talk about. What do hormonal changes and natural births change? How not to harm the pelvic floor muscles and how to care for them? How do we talk about perineal problems with our daughters? About this and many other aspects of the problem in a new episode of the podcast.
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