Chapter 9: Welcome to the Jungle: The Five Senses of the Operating Room

If you parachuted into the Amazon jungle tomorrow, you might expect all of your senses to be stimulated by the new environment. Your nostrils would filter the pungent smell of leaves rotting on the jungle floor. Your eyes would take in colorful parrots darting between the trees. You might even “taste” the warm humidity of the air as you breathed it in.

The operating room is a lot like the jungle in that it stimulates all of your senses. From the moment you walk through the door of the OR, your five senses will kick into overdrive. Here’s what to expect.

When you first enter the OR before the start of a case, you will see a whirlwind of activity (Figure 9.1). While there won’t be any parrots in sight, you will see many people swooping from pre-op holding to supply room to operating suite, often carrying armloads of supplies and paperwork. You will score points with the circulating nurse if you offer to help carry some of this equipment, but be careful where you set it once inside the room. Don’t touch or approach anything blue in color (Figure 9.2), because blue represents the sterile field.

The OR may be second only to the Amazon for richness of color. You won’t be bedazzled by the gorgeous blooms of tropical flowers like you might in the jungle, but you will take in a variety of hues, including the blue of the gowns worn by surgeons, residents, and scrub techs, the gleaming silver of stainless steel instruments, the red of blood spilling from the surgeon’s incisions, and the pink, yellow, and white of tissues inside the body (Figure 9.3). In terms of the visual experience of the OR, seeing the inside of a person’s body is perhaps the most fascinating aspect of this setting. Visualizing a beating heart marks a profound moment inside any OR, no matter how many times you’ve seen it. Your sight contributes a great deal to the richness of the OR experience (Figure 9.4).

What the eyes giveth, the nose may taketh away. In the jungle, the lush green of the flora may look breathtaking, but the stench of rotting plant material might leave you breathless for a moment. The OR is no different in this respect. Smell may be the most visceral of all senses, evoking responses ranging from nostalgic to nauseating. Before you enter the OR, prepare yourself for the myriad new odors you’ll be encountering.

The electrocautery device (often called by the brand name “Bovie”) burns human tissue to stop it from bleeding. When the surgeon employs this device your eyes may register innocuous gray-white smoke rising from the surgical field, but your nose will inhale the acrid odor only burning human flesh can produce. You may find the smell disgusting or nauseating at first but if you stay in the OR environment long enough, you soon will not give electrocautery smells a second thought (Figure 9.5).

Of all the unpleasant odors that can occur during surgery, one of the most horrific must be that of dead tissue, especially in the abdominal cavity. It’s an unpleasant moment when the surgeon’s knife pierces a distended belly and the smell of necrotic bowel escapes into the air of the OR. Even seasoned nurses and doctors may retch and turn away. In anticipation of this possibility, many operating room personnel smear pungent ointment like mentholated petroleum jelly above their lip or inside their surgical mask prior to a potentially smelly case. If your nostrils are filled with the strong smell of menthol it’s hard for your olfactory system to simultaneously process the purulent odor of gangrene.

Luckily you are more likely to notice the scent of the antiseptics used to clean the OR than to be subjected to a particularly foul-smelling case. And while the aroma of electrocautery abounds, it need not take you by surprise. The buzz of the instrument actuating will prepare you for the smell to follow.

The jungle is never silent. Monkeys howl from the treetops, cicadas buzz in the canopy, and water trickles over rocks. Likewise, the operating room generates a constant hum from equipment and people. Some ORs may be quieter than others, but every operating room gives your hearing a workout.

As a surgical case gets underway, the environment can be very noisy. People might be dragging large pieces of equipment into the room. Monitors will emanate their characteristic beeping sounds. Alarms may clang. Voices are often raised over the din of activity as everything is put into place.

Once the patient enters the room things usually quiet down significantly so the patient doesn’t worry they might be interrupting a party. The noise level of a surgical suite often hews to the surgeon’s preference. If the surgeon likes it quiet for concentration purposes or if something critical is occurring during a case, there will be very little background noise. If the surgeon has a more boisterous personality, then you may find the music turned up loud and the personnel chatting and laughing almost as raucously as howler monkeys. Often for routine cases you’ll find that the OR noise levels are somewhere in the middle, though they can change quickly.

As you walk through the jungle, you’ll feel soft grass beneath your feet. You’ll brush away branches with your hand. You may even grip a heavy machete to chop away vines. Likewise, in the OR everyone uses their sense of touch to some degree, depending on their role.

The circulating nurse feels the stiff smoothness of sterile gown tags as she assists surgeons and residents into them. The nurse also holds packages that crackle, like suture packets, and bundles soft as a bunny, such as sterile trays in blue wrapping. Because the circulator passes materials to the sterile field, he or she may handle warm instruments fresh from the sterilizer or cool syringes filled with liquid.

Of all the tactile sensations one may experience in the OR, the most important is that of the warm, reassuring hand on the patient’s shoulder or arm as the patient drifts off to sleep. Nothing beats that skin-to-skin contact.

Surgeons, residents, and scrub technicians experience a different kind of human touch: they actually handle tissues and organs inside the body. Feeling adipose (fatty) tissue between your fingers or touching someone’s lung creates sensations that are difficult to describe.

Of course, anyone within the sterile field also senses a heat that may rival a jungle’s environment. Swathed in layers of clothing and toiling under bright, hot lights, the surgical team can begin to feel steamy quickly. For this reason many ORs set the thermostat very low, which can make those standing outside the field feel chilly. In ORs designated for burn or trauma or for pediatric patients, the thermostat may be set very warm to help the patient maintain their temperature. Yes, the operating room involves more tactile sensations than you might imagine (Figure 9.6).

In the jungle you might taste bitter berries or imbibe sweet coconut milk, but here the OR differs greatly from its Amazonian counterpart. Taste is perhaps the least-used sense in the operating room, because it is not a place for dining or drinking. No one should be chewing gum or sucking on a hard candy while in the OR, including those circulating outside the sterile field. We don’t need something like the famous Seinfeld episode with the Junior Mint to happen!

Nonetheless, the smoke caused by electrocautery can indeed evoke a taste sensation. It is not unlike the taste of secondhand smoke, except the tang of electrocautery is much more ash-flavored than cigarette smoke. Anyone who spends much time in the OR gets used to the taste of electrocautery fast.

If thirst can be considered a “taste,” then you likely will experience it. Those who stand gloved and gowned under the hot lights of the sterile field can get thirsty quickly as they perspire. Some people may also experience dry mouth during a procedure, whether due to dehydration or a fight-or-flight stress response triggered by something like the scent of gangrene.

It may not resemble the Amazon rain forest, but the operating room can feel like a jungle to newbies. Engage all five of your senses to fully experience this wonderful environment—and rest assured you’ll live to tell about your new adventure.