In December, I served on a medical mission trip to Honduras. I had the privilege of working alongside world-class surgeons and surgical teams from across the country. It was my first time traveling overseas on my own, it was my first time serving on a medical mission trip, and it was an incredible, humbling experience.

Honestly, I could write an entire series of posts about the planning, preparation, and execution of this trip. I was so impressed with the team from One World Surgery (OWS). They made the whole process relatively painless. From the time I submitted my application to the moment the bus dropped all of us off at the airport to go home, the OWS team was there to help. They were friendly, answered every question (even the ones that kept getting repeated), and were a great resource for all of us throughout the trip.

And while I do think I’ll write that series of posts at some point, there’s something else I want to share with you today.

First, you have to know that I signed up for this trip on the recommendation of Dr. Michael Redler. He and I had only met through my podcast, First Case. Dr. Redler had been a guest on the show a couple of times, and he encouraged me to join his team. He also made sure that my application was accepted so that I was able to be included on this mission. He and I had only ever spoken about the OR, he didn’t really know if I was any good at circulating or not, and I felt a tremendous amount of pressure to live up to whatever expectations he might have of me.

The OR in Honduras was different, but it wasn’t…

Working in the OR in Honduras was a mixture of so many different experiences and emotions. It was exciting and new, but it was also an unknown environment that created feelings of nervousness and uncertainty. It required flexibility, adaptability, understanding, and an appreciation for the unique situation we were working in. And yet, for as different as it was, it was still an OR. An OR that was dedicated to the common goals of safe patient care and positive surgical outcomes.  Which is no different than our ORs in the States, right? Providing quality surgical care and improving the lives of others is something that transcends geographical boundaries and cultural differences.

When I walked into the OR for orientation on Sunday morning, I was amazed by what I saw. Honestly, I don’t know what I was even expecting, but what I saw was a well-organized surgical department with shelf after shelf of instrument trays and sterile supplies. They even had pictures of the contents of the trays hanging on the racks so you could confirm you were getting the right tray before you opened it! I also saw that equipment storage areas are always a mess and never big enough, no matter what country you’re in…

My assignment for the week

I was assigned to OR 1, and I would be working with a lovely surgical tech named Shannon. Shannon and I would be working with Dr. Redler and Dr. Scott Sigman throughout the week doing orthopedic cases.  As I looked at my room and at my assignment, I noticed that while the lights on the ceiling were a little older, and the scope tower was a little dated, my room was well supplied with everything we needed.

Shannon made sure that the cases were pulled as close to Dr. Redler’s preferences as possible. When I found out that Shannon was also Dr. Redler’s regular scrub back home, I breathed a sigh of relief! Despite being in a new environment with different equipment, our cases were destined to go more smoothly with her in the room. That didn’t mean Dr. Redler always got what he wanted, we were limited to what was available, but he understood that, and our team had the advantage of Shannon’s expertise as we prepared for each case. And even though I had never worked with anyone in our room before, I felt more prepared and at ease knowing that Shannon was in the room with me.

Let the surgeries begin!

Monday morning finally came, and it was time to start operating. Our room had 2 knee scopes and 2 ACL repairs scheduled, and we started the day with a knee scope. Now, no one really expects the first case, or even the first day, to be perfect. Despite its familiarity, it’s still a new OR with different equipment and sets than we’re used to, and we’re a team of people who haven’t all worked together before. And yet, our first case went so smoothly, you’d have thought we were a team that had worked together for years. It was impressive how well everyone worked together and how “easy” that first case was.

Unfortunately, that “easiness” from the first case didn’t quite carry over into the second. Our second case was an ACL repair, and as a more complex case, we experienced the hiccups of learning to work together in a new environment.

Time for a crazy, chaotic case

I left the room more times than I can count during that case. While we had the right sets, we struggled to get exactly what we needed. For some things it was simple, like needing a different Penrose drain or a new shaver.  But for everything I had to run out and get, it wasn’t just a matter of running to that spot and getting it. I had to find it, or find someone who could help me find it, before I could bring it back to the room. At other times we needed different instruments than the ones we had, and I was relying very heavily on the OR Charge Nurse to help my find the needed trays or peel-packed items. And as I hunted and searched for instruments, supplies, or implants, my stress level just continued to rise.

Inside, I was a stressed-out, hot mess. I was dealing with an ENORMOUS amount of personal pressure and performance anxiety. I did NOT want to make a mistake, look stupid, or embarrass myself in front of everyone. No one in the room knew me, and I desperately wanted to do well and demonstrate that I really was a competent OR nurse. At one point, I was so stressed from the constant running and chaos of the case that I couldn’t even get a peel pack opened. Granted, peel packs don’t always cooperate, even on a good day, right? However, in the moment, it felt like my external struggle with that peel pack was a representation of the internal stress I was experiencing.

Why won’t the peel pack just open?!

Dr. Redler was standing there waiting as I struggled to open the peel pack – which always means that the pack isn’t going to open, right? However, he picked up on my stress and reminded me that it was ok and everything was going just fine. And in the grand scheme of things, it really was. The patient was doing well. And even though I was running, I was always coming back with the new item that was needed, or an acceptable substitute. The only one really super stressed out in this situation was me.

I realized I desperately needed to take a step back and take a deep breath. The chaos associated with the case was related to a new environment with new equipment, not because I didn’t know what I was doing. The fact that I was running wasn’t a reflection on me, but on the complexity of the case and the environment in which we found ourselves.

We finally finished the case!

While the case didn’t go as smoothly as our first case did, we did complete it. The patient was able to get the ACL repair that they desperately needed, and we were able to move on with the rest of our day with the lessons learned from this case. No other case was as rough as that one, and by the end of the week, we were a well-oiled machine. It was an impressive transformation to observe.

But why did I tell you all of that?

Because, too often, we fool ourselves into thinking that the “experienced” nurse or scrub has it all together. “They know everything and nothing bothers them.” We falsely believe that we can get to a certain point in our career, or in our years of experience, where we won’t ever be nervous or uncertain.

And I’m here to tell you, that just isn’t true. I’ve been a nurse for 22 years. I’ve worked in the OR for 13. In that time, I’ve circulated, scrubbed, been an OR Manager, and an Orthopedic Team Leader. And yet, despite my years of experience, I still get nervous from time to time. All of us do. We all have experiences with new surgeons, new team members, new procedures, or new facilities that take us back to the beginning. We get reminded, sometimes rather quickly, of what it felt like when we were new to the OR and were trying to just get through a day without making a mistake.

That’s not to say that our years of experience don’t help. Because they certainly do. You will make it through orientation, you’ll get a couple of years of experience under your belt, and you realize that more things make sense. You won’t get as uncomfortable or feel as uncertain as you did at first. But don’t let that fool you into forgetting those feelings. The new staff around you are feeling them just as acutely as you did. And even the most experienced among us have those days where they’re just as nervous as the newbie working alongside them. It’s simply a part of the ever-changing nature of the field that we work in.

So, if you’re feeling overwhelmed, uncertain, or afraid of making a mistake, take heart. Take a deep breath and be encouraged.

You’re not alone. All of us experience those same feelings from time to time, whether we’re new or have 20+ years of experience. It’s ok. I’ve been there, too – quite recently, in fact. My trip to Honduras was a great reminder of this truth.

Remember – you’ll get through whatever you’re experiencing today, and you’ll learn some valuable lessons along the way. Those lessons and that experience will help you when you find yourself having these same feelings again. Allow those experiences and those feelings to keep you humble. Let them help you remember what it was like to be new and use that empathy to help make someone else’s experience better.  

Until next time,

Melanie

You can listen to my interviews with Dr. Redler on the First Case Podcast here:

1. Do Unto Others: Giving the Gift of Surgery
2. The Power of Communication: Unlocking Success in the Operating Room