Behind the mask: Surgery is precise, polite and a bit sad, nothing like on TV

FARGO-The first surgeries are always scheduled for 7:15 a.m. The patients arrive at 5 a.m.In truth, though, they have been arriving for a very long time. First, discomfort. Then doctor. Diagnosis. The news seems catastrophic. The body needs to be...
Dr. Erik Fetner, right, and surgical resident Dr. Elleson Schurtz perform a laparoscopic colon resection at Sanford Health in Fargo. W. Scott Olsen / Special to The Forum
Dr. Erik Fetner, right, and surgical resident Dr. Elleson Schurtz perform a laparoscopic colon resection at Sanford Health in Fargo. W. Scott Olsen / Special to The Forum

FARGO-The first surgeries are always scheduled for 7:15 a.m. The patients arrive at 5 a.m.

In truth, though, they have been arriving for a very long time. First, discomfort. Then doctor. Diagnosis. The news seems catastrophic. The body needs to be opened. Referral. Surgeon. Surgery. Our hearts say nothing like this has ever happened before.

In truth, surgery happens every day.

This morning, the schedule at the Sanford Medical Center in downtown Fargo includes an inguinal hernia repair, septoplasty/turbinoplasty, hypospadias repair, and laparoscopic cholecystectomy. In other words, a hernia repair, a sinus repair, the correction of a birth defect and a gallbladder removal.

All that before most of us get to work.

There are 35 cases on the board today. A slow day, I'm told. A bit less than average. The last surgery is a laparoscopic nissen fundoplication, a procedure to treat gastroesophageal reflux disease, at 5 p.m. In between, there will be a redo aortic valve replacement (heart surgery to replace a damaged valve with an artificial valve) and a scoliosis correction (spinal implants, rods and screws to correct scoliosis). There will be three operations to treat prostate cancer, two gallbladder removals and another hernia repair.

However, everyone knows new cases will be added. By 10:45 a.m. there will be five. By noon there will be six.

It is, after all, an ordinary day.

I'll admit I expected drama. I expected the knife-edge tension and world-ending risk of bad television. I expected running in the hallways, or at least walking fast.

Forget Grey's Anatomy. The operating room is a long way from the hype of television. This is not the ER, though patients brought to the ER sometimes find their way to surgery quickly, often with a stop for imaging along the way.

What I find is a world of polite gravitas. Surgery is meticulous, choreographed, patient and exact. Surgery is deeply planned. Every patient requires unique focus.

There are 13 operating rooms downtown. When I ask if they all are used every day, Stacy Lund, director of surgical services, laughs. "Oh yes," she says. "Oh yes."

The new campus will open with eight surgical suites on the third floor and five on the second. In time, the second floor could host 16. Sanford, like Essentia, serves the whole region. There is always a need for more space.

In OR 10, soft reggae music plays from overhead speakers while Dr. Erik Fetner inserts a cauterizing and dissecting tool into a patient's abdomen as part of a colon cancer surgery. Surgical resident Elleson Schurtz holds a retraction tool. An anesthesia monitor displays the patient's respiration and heart rate. A video screen shows the work being done. The room is quiet but not tense. The room is deeply aware.

Down the hall, Dr. Luis Garcia performs a laparoscopic bariatric surgery. His team stands close. Sanford is a teaching hospital, so there is often one student in the room. Today, Kathryn Johnson, a third-year medical student, watches Garcia intensely. There are monitors on every wall. Every person in the room can see every moment of what's going on.

In yet another room, Dr. Thomas Noah sits 6 feet away from a patient, his hands working the controls of a DaVinci surgical robot, his face immersed in a monitoring hood. I watch on a video screen as the robot's tools dissect tissue during prostate removal. The robot allows for extreme precision, the ability to get into smaller spaces without a large incision. The rest of the team surrounds the patient, all hands on deck.

The rooms are darker than I expect. Bright light shines on the patient, on the area being treated. The rest is removed from distraction. Very much like a spotlight on stage, I think. The surgeon's light illuminates the heart of the drama, and sometimes the heart itself.

Of course, there are extraordinary days, too. There are days for transcatheter aortic valve replacement, mitral valve clipping, cerebrovascular neurosurgery. There are days for pediatric orthopedic surgery and days for surgical oncology. There are days when the ER calls-something on the roads or the fields has gone terribly wrong, or someone's temper has failed-and the completely unplanned is now on a gurney and heading for help.

The longest surgery in the books is HIPEC (hyperthermic intraperitoneal chemotherapy), also known as heated chemotherapy or chemo bath, which can take up to 18 hours. The shortest is the insertion of ear tubes. Eight minutes.

Sanford has 152 surgery physicians, 386 full-time surgical employees. Last year, systemwide, they completed 26,271 surgeries. Of those, 3,593 were not scheduled the day before.

"We plan for emergencies," said Farrah Marsh, patient care manager. "We have at least two rooms open every day for emergencies, with surgical staff on call from every specialty. We're just waiting for those cases to come. And they are used all day long."

"Is there really anything such as a routine surgery?" I ask. I am thinking about all the ruptured appendixes, the torn ACLs, the operations that seem to be present in every room.

"No," both Lund and Marsh answer quickly.

"Absolutely not. We've done it enough to be experts, but every surgery is specific to what that one patient needs," Lund says.

 

I try to find words for the mood in each room. Focus, absolutely. Confidence, yes. But not arrogance. Trust. Respect. There is a sadness to the work, though. When the surgery is over, the patient and family will meet with the surgeon to get the report, but the patient will never see the team again. The team never gets to know the patient. All the patient sees in the brief moment before the anesthesia sets in are eyes between hat and mask.

All day, every day, there are men and women and children in surgery, their hope in the surgeon's light. Then they are off to recovery. All day, every day, there is a group of men and women working in that light, the body open before them.

W. Scott Olsen is a professor at Concordia College. He is the author of several travel/adventure books. His recent work combines nonfiction and photography to illuminate common but usually unseen places.