Had an amazing day yesterday – one of those days that reminds you how much we can do in medicine when we all work together.  I am hoping to write it up as a case study – if not – I will tell you more about it here.  (The patient was exceedingly gracious when I asked permission.)

But this morning, I was back in the operating room with Dr. Cuauhtemoc Vasquez.  (If he is tired of me – he sure doesn’t let on..)

I finally had the opportunity to get some of the pictures I’ve been trying to get on every visit to his OR – to show readers the heart, and the pulse of cardiac surgery..

There’s a running joke in Mexicali – if you need help in the operating room, any operating room, in any of the hospitals in the city; just holler for Lupita because she’s always there.

Introducing Lupita Dominguez, surgical nurse

All kidding aside on the popularity of the name “Lupita” among operating room personnel, there is just one Lupita that I would like to talk about today,  Lupita Dominguez, who is Dr. Vasquez’s surgical nurse.  In the months, and the numerous occasions that I have been a guest in Dr. Vasquez’s operating room, I’ve had the opportunity to observe and appreciate the hard-working Lupita.

Lupita Dominguez with Dr. Vasquez

Teacher, Coordinator and Mind-Reader

Most people don’t know it – but Lupita has the hardest job in the operating room, and probably (in Mexico) the most poorly paid.   They say a good scrub nurse has the instrument in the surgeon’s hand before he knows he needs it – and from what I’ve seen, that’s Lupita.  She’s here an hour earlier than the rest of the surgical team, getting everything ready, and she’ll be here after everyone else escorts the patient to the intensive care unit.

Here she is, a blur of motion as she takes care of everyone at the operating room table

As I watch again today, she is ‘running the table’ and anticipating the needs of not just one demanding cardiac surgeon, and an additional surgeon, but also one surgical intern, and another student.  With all of these people crowded at the table, she still has to follow the surgery, anticipate everyone’s needs and keep track of all the instruments and supplies in use.  In the midst of this maelström, the scrub nurse has to ensure that everyone else maintains sterility while preventing surgical instruments from being knocked to the floor, or otherwise misplaced (a difficult task at times).

Here she is demonstrating how to correctly load the needle, and pass sharp instruments

She’s forever in motion which has made taking the few photos of her a difficult endeavor; She’s shaving ice for cardioplegia, while listening to the circulator, adjusting the OR lights, and gently guiding the apprentices.  She’s so gentle in her teaching methods that the student doesn’t even realize she’s being led, and relaxes enough to learn.  This is no easy task, particularly since it’s just the beginning of the July, and while bright-eyed, pleasant and enthusiastic, the new surgical resident is inexperienced.  Her own student nurse, is two parts shy, but helpful enough that near the end of the case, (and the first time since I’ve known her), Lupita actually stops for a moment and flashes me a wave when she sees the camera faced in her direction.  I’m surprised, but I manage to capture it.

a very rare moment – Lupita takes a millisecond to say hello

She is endlessly busy, but ever uncomplaining – even when a scheduled surgery takes an unexpected turn and extends to twelve or even fourteen hours.  Bladder straining perhaps, baby-sitter calling, but Lupita never complains.  She’s not unique in that – scrub nurses around the world endure long hours, tired feet and legs, hungry bellies, full bladders, and aching backs as they complete their days in the operating room.  But she does it with good nature and grace.

Lupita assisting Dr. Vasquez during surgery

The surgical nurse

In the United States, this important job has been lost to nursing, a casualty of the ongoing shortage.  Positions such as scrub nurse and others like it have been frequently replaced with technicians who require less training and thus, less compensation that nurses.  Maybe the nursing profession doesn’t mourn the loss; but I do.

as you can see – here she is, ‘behind the scenes’ so to speak..

But in Mexico, and many other locations, this position remains the exclusive domain of the nurse.  Nurses such as Lupita, spend three years studying general nursing in college, before completing an (optional) additional year of training for a specialty such as the operating room.  After completing this training, these nurses spend yet another year in public service.

The idea of the public service requirement is honorable yet almost ironic (to me)  at times, since the majority of nurses in Mexico will spent their careers in public facilities, and by definition (in my mind at least), nursing is an occupation almost entirely devoted to the service and care of others.

Working conditions vary but some constants

Depending on the country, the culture, and the facility; conditions may vary; nurses may get short breaks, or be relieved during particularly long cases.   The only constant is the cold, and the hard floors, and rickety stepstools[1].  While the nurses here tell me that the workday is only seven hours long – I’ve been in the operating room with these ladies before, and watched a supposed ‘seven-hour’ day stretch to fifteen.   But it is just part of being a nurse.

[Usually I tell people when I am writing about them – but on this instance – there was never an opportunity.. but she (and all the nurses in the OR with Dr. Vasquez) certainly deserve mention.]