The Responsibility of a Health Care Worker

The time had finally come, the moment I’d been waiting for my whole life. I had just finished

scrubbing (performing my surgical handwash) and it was time to take my first steps into the Operating

Room (OR). Ever since I was a young girl, I had wanted to be a doctor. When I was 12 years old, I knew

I aspired to be a surgeon. I had dreamt of this moment for so long, I needed it to be perfect, not just for

me, but for the patient to have a fast and good recovery as well.

I thought to myself, What if I mess up? What if I can’t stop shaking? What do I do if something

goes wrong?

Naturally, I started thinking of everything that could go wrong and what I would do in that

situation. I knew I was prepared, but I still felt so blindsided. I began to recite the steps and the

instruments used in an appendectomy to myself.

First step: Use a scalpel to incise the epidermis and the dermis. Second step: Use Bovie Pen to

dissect and manipulate tissue of the external oblique aponeurosis. Third step: Use forceps to grasp the

peritoneum and incise with a 15-blade.

I continued on like that and went through the whole procedure in my head, throwing in

everything that could possibly go wrong. I was quaking with fear, but I knew it was time to go in.

The moment I stepped into the OR, all my fears went away. I stopped shaking and my shoulders

were relaxed, I felt safe here, like I was home. I went to my back table and began to open the sterile

supplies. Everything was going so well. I was ahead of schedule and had not dropped or contaminated

anything. As any good Surgical Technologist would do, I opened extra things to be ready just in case

something unexpected had happened. I was only expecting to use three 5’0 Prolene sutures, but I opened

five just in case some sutures didn’t hold. The average number of lap pads used in an appendectomy was

six, but I opened ten just in case we came across a bleeder. At first, I was very proud of myself for this,

what’s so bad about preparing for the worst?

Next, the Circulating Nurse came into the OR. I was panicked about what I should say. I took a

deep breath and tried to remember some social skills.

 I started, “Hi, I’m Tazia, the Surgical Technology student from SLCC. I’m excited to be working

with you today!”

She responded, “Hi Tazia, I’m Jen, your Circulating Nurse. I see you’ve already started, good

work. I’ll just be here to observe you for a few minutes, continue on.”

I started up again, I began to do my pre-operative counting.

One, two, three, four, five sponges, check. One, two, three hypodermic needles, check.

Right before I could start to count the suture needles, Jen stopped me.

“Why are there five suture needles? Most surgical technologists only open three in preparation

for an appendectomy.”

At first I was excited, I wanted to share how good I’d done by over preparing for the case. “Oh, I

just opened extras so that the surgery would be more efficient. I was thinking it would take time to open

extras if we ended up needing them, so I did it in advance to save some time.”

Jen looked concerned as she said, “Yes, I definitely see why you would do that, but did you know

this patient is self pay?”

My enthusiasm quickly vanished, I hadn’t even considered that. Self pay means that the patient is

uninsured, every hospital bill they get will have to come out of their pocket. Earlier, I was so proud to

open extra supplies to save time and unnecessary hassle. However, now I felt ashamed. I had opened two

extra 5’0 Prolene sutures and four extra lap pads. This meant that I had just added $120 to their OR bill.

This may not seem like a lot of money, but the average OR bill for an appendectomy is $33,000. This is

without any complications or additional costs.

Now knowing they were self pay, I immediately cut back on unnecessary instruments.

I said to myself, I can stay an extra 20 minutes if it means saving this patient some money.

I felt bad knowing the patient would have to pay an extra $120 just because I wanted the surgeon

to believe I was competent. With every sterile instrument I opened, I thought to myself,

Do we really need this instrument? Should I wait to open this?

 I became less efficient, but I knew it was for the good of the patient. After what seemed like

forever, the orderly finally arrived with the patient. Guilt ridden, I avoided eye contact and kept my head

down. I kept working like nothing was wrong. I was curious who the patient was, so I looked up for a

split second. I saw that she was a woman, probably in her early 30’s. I began to think of countless

scenarios of why she was uninsured.

Did she not have a job? Was she careless and never thought to seek coverage?

I was very curious, so I asked the circulator if I could see her chart. In the previous

hospitalizations section, it listed two C-Sections. This meant she had kids and most likely a family, so I

was even more confused on why she didn’t have insurance. I kept reading and I eventually found my way

to the income section. I was infuriated! Every guess I made about why she didn’t have insurance was

completely wrong, I felt so shallow. She made too much as a construction worker to qualify for medicare.

Yet, she also did not make enough to afford private insurance.

I began to think, How is this possible? How can she make too much but not enough at the same

time?

I was so confused and angry. This mother had to pay roughly $33,000 just for the surgery, not to

mention the $100+ spent in the PACU (Post-anesthesia care unit) and the $2,800 spent just staying one

night in the hospital.

“How is it okay she has to pay for all of this without any government help? Can you help me

understand why it is fair that she can’t qualify for anything?”, I asked the surgeon.

He didn’t say much, but it has stuck with me to this day. He calmly stated, “I can’t help you

understand, because it isn’t fair. The system is broken. What you and I can do is help the patient in every

way, as much as possible, and that is our responsibility as health care workers.”