The Surgical Nurse

Why having intuitive and skilled nurses in the operating room can make surgeons look good

“Micro scissors, please,” I requested, as I meticulously proceeded to split the sylvian fissure, a crevice which, when opened, separates the frontal and temporal lobes, providing a navigable labyrinth to deep targets without violating the substance of the brain itself. We were operating on an aneurysm of the anterior communicating artery that had ruptured. Opening a swollen and angry brain is way more complex than tempering a docile one. A neurosurgeon’s touch must be gentle and precise. Developing the right touch is the biggest challenge.

We performed the operation under the magnification and illumination of the microscope. It’s a big, burly gadget, often draped in a sterile plastic sheet that floats between the surgeon’s and patients’ head empowering us by enhancing sight well beyond the physiologic limits of the unaided eye. Five mm arteries appear like the huge underground pipes that transport water from one part of the city to the other. Even the slightest undue amount of traction or an inadvertent poke can result in the pipe bursting and an overflooding of the brain akin to the Mumbai monsoon.

Dissection in these cases often involves three basic manoeuvres: cutting with a pair of micro scissors, spreading the arachnoid with bipolar forceps, and probing with a slightly curved dissector. These steps are either repeated or alternated as the surgery is displayed on a giant screen for everyone in the room to see what’s going on.

The surgical nurse is supposed to place instruments into your outstretched hand in exactly the same position that they are supposed to go into the brain. We don’t have the luxury of taking our eyes off the microscope as one hand holds onto a suction device that serves the dual role of clearing collected fluid, with its shaft providing gentle retraction when needed. Undue retraction can avulse the dome of the aneurysm causing torrential bleeding. The other hand receives and returns instruments.

If an instrument is not placed precisely and with the right amount of pressure in a surgeon’s hand, it accentuates the stress and strain of an already difficult operation. One needs to look out of the scope or shuffle with the instrument in hand, to get it right, disturbing momentum. “I don’t have eyes on the tips on my fingers,” my boss used to say when nurses didn’t place instruments correctly into his palm. And when I used the same dialogue as I started operating independently a few years later, the nurse would almost smack the instrument into my hand – a silent but stinging way to put me in my place.

Skilled nurses often make ordinary surgeons look good. They can follow an operation and give the surgeon the correct instrument without them even asking for it. In my earlier days (and occasionally in my recent ones) nurses would suggest what next – which instrument to continue the operation with. For an average surgeon like me, “Don’t give me what I ask for, give me what I need,” is a constant plea to my maker and my nurse.

The reality of aneurysm surgery is that technical skill and surgical experience do not eliminate the risk of intraoperative aneurysm rupture. The dangerous combination of aneurysm fragility and surgical manipulation sometimes precipitates rupture and the neurosurgeon must prepare for this catastrophe. This is when the surgical nurse

exemplifies their deftness. A systematic contingency plan has to be discussed before every operation, with both the surgeon and nurse envisioning an intraoperative disaster in every conceivable form and then develop strategies to deal with it.

And that’s exactly what happened in this operation. After an hour of perfectly executed steps, the aneurysm ruptured, flooding the brain with blood. When this happens, there is an intense rush of emotions: surprise, confusion, regret, tension, anger, and even frustration, and every surgeon goes through all or some of these depending on their levels of experience. These moments demand calmness, clarity, and confidence. We must continue to think and operate simultaneously.

The nurse promptly handed over a third suction, allowing me to tamponade the bleeding with a cottonoid. A pre-loaded temporary clip was slieghtfuly transferred, which reduced the flow of blood to the aneurysm and allowed us to visualize the site of rupture so that we could place a permanent clip to secure the aneurysm. The nurse almost guided my hands naturally through the critical steps, transforming an emotional response into an intuitive one, resulting in a successful outcome. “The difference between triumph and disaster isn’t about the willingness to take risks,” says famous writer-surgeon Atul Gawande, “it’s about the mastery of rescue.”

I leaned – metaphorically, not literally – a lot on my nurses as a young doctor. What I gleaned from them in my training couldn’t be learned from textbooks or even other doctors. I started my training in neurosurgery as a registrar in the neuro ICU at the Christian Medical College in Vellore. The nurses taught me little tricks such as how to insert lines, adjust ventilator settings, manoeuvres to reduce intracranial pressure, and even decide on the right time to get a scan done in critical patients. They would even allow me to get a few winks of sleep while they salvaged a critical patient overnight and were happy to hand over the credit to me in front of the chief the next morning.

Even today, there are nurses who offer me suggestions on how to make the operation better and I am indebted to them for those. They pick up nuances from working with other surgeons, find it relatively effortless to enhance the quality of the current case, and don’t hesitate to impart that knowledge. We are fortunate to be surrounded by nurses who are astute, wise, and compassionate. There must be a karmic connection for me to have been born on a day that’s celebrated as International Nurses Day, commemorating the birth of Florence Nightingale, the foundational philosopher of modern nursing, on the 12th of May in 1820.

There are some surgeons who will not operate on certain cases if their dedicated nurse is not available on that day. Some departments have that luxury, others don’t. “If you’re not in sync with your wife, it’s okay, but make sure you get along with your surgical nurse!” a famous surgeon once said in a conference when he spoke about how to deal with intraoperative aneurysm ruptures. To circumvent this, Prof. Yasargil, now in his 90s and who is hailed as one of the greatest neurosurgeons of the 20th century, was married to Dianne, the nurse in charge of his operating suite and who assisted him in almost all his surgeries for several decades. Now that gives work from home a whole new meaning.

38 Comments on “The Surgical Nurse
  • Suresh Nair says:

    Well written Mazda.
    You should have put in a line about Kerala nurses, who I am sure are the OT and ICU nurses at CMC. I haven’t heard about a word slieghtfuly which you used “slieghtfuly transferred ” in a sentence. Congratulations Mazda. Well written Nightingale Mazda. Keki and Khursheed waited for May 12

  • Dr. Neepa V says:

    Well written mazda..
    Indeed nurses assisting us in ORs are our second pair of hands and eyes..
    Having a skillful nurse assisting us in challenging cases makes half the difficulty easier..
    Kudos to all the hardworking nurses…keep up the good work…

  • Ralecha Mmatli Botswana 🇧🇼 says:

    A well written document which depicts the kind of synergy that MUST exist between the surgeon and the surgical nurse. If this link becomes weak or strained, there is a high possibility of unsuccessful operations. Basically the surgeon and surgical nurse twin- strike for a successful surgery. The article is very emotive too- I could visualize the surgery and the surgen- surgery nurse team.
    May God bless the surgeons and their support nurses to remain a partnership that cannot be broken for the sake of humanity.

  • Vipul Shah says:

    Dear Dr Mazda Sir..

    Extremely Happy as usual to read your piece on Nurses the Nightingale….

    Your Article is like taking your reader along with you in OT…

    It’s so much informative & useful for Non medical persons to understand the feelings you surgeons are going through during Surgery..

    I am reading as if watching a thriller movie

    Keep on writing Sir…

    God bless

  • Sunaina Saraf says:

    Hello Sir
    Always a pleasure to go through your post
    Very informative & inspiring
    God bless u always!

    Sunaina Naresh Saraf

  • Tozar Heerjee says:

    Thanks Doc for explaining the role of a good nurse in the operating theatre. Never realised their importance till now.

  • Dr Naresh Jani says:

    Great tribute to nurses and salutes once again your mastery in literature

  • Bikram says:

    “If you’re not in sync with your wife, it’s okay, but make sure you get along with your surgical nurse!” 😢 very true 😊

  • Dr Vineeta goel Radiation oncologist says:

    Enjoyed reading ur story. Very well captures all emotions of a difficult surgery in OT

  • Clera Menezes says:

    Well wriiten Sir…Love to read your Articals.
    While reading itself gives a feel and touch of surgical skills in reality .There are very few surgeons like YOU appriciate a surgical nurse and very few patients remember to thank theater nurses .
    Thank you very much for a beautiful artical .

  • Martha says:

    Very true Dr Mazda, when I was in Wockhardt Mumbai In 2019 I was thrilled with the care, love and professional touch of your team of which one of the Nurses names Ansu Anthony from Kerela became a close friend up till now.
    Thank you very much Dr for making us appreciate you and your able assistance the Nurses, Doctors, the Physiotherapist etc

    Beautiful article👏🏻👏🏻👏🏻👏🏻

  • Freny says:

    How well you have written Dr Mazda. Was reading your article like a thriller novel. Both the Dr. and the theatre nuses have hands of God.🙏🙏

  • Rita singh says:

    Dear doctor ur really a gem.Yes our nurses r mostly effecient n sincere but I believe any one would b good working with you.U r so ready to give credit to ur team.I am sure the nurses working with you to feel the same about u.Ur readers r being educated in free by ur such vivid medical procedures.Thanks a lot.

  • Benifer Irani says:

    Lovely appreciation of Nurses in this article.
    God bless !!

  • Ericson says:

    Good piece there Dr. Turel! Thanks for appreciating the roles of the doctors’ closest ally in patient’s management.

  • Gladys T K Kokorwe says:

    I always enjoy reading your articles. So informative and educative. Kudos to you. Stay blessed 🙏🏿🙏🏿🙏🏿

  • Gloria Msampha says:

    Great article. I’m sure the nurses will appreciate that you “appreciare” them. I was privileged to have had such good sympathetic after op nurses in the ward at Workhardt Hospital in 2019. I still keep in touch with 2 of the nurses once in a while. They are Angels especially if you are going through so much pain after an operation.

  • CHANDAN Sanjana says:

    Your comments abs appreciation of your OT nurses assisting you, will definitely bring them a lot of joy and happiness. I think everyone starting from the anaesthetist to the surgeon and his assisting staff are all unsung hero’s. 🙏you al

  • Khyati says:

    Dear sir

    Reading your article made me feel like I was standing next to you in OT and going through all emotions felt during operation by you and your team..(though I am non medical person)

    You take us on a journey through your pen..keep writing.

  • V G Ramesh says:

    Well written tribute to the surgical nurses, to whom all of us, the surgeons, are indebted. There have been many of them at the MMC also. You seem to add a new word or two to our vocabulary (eg. “sleightfully”), in everyone of your writeup. Great writing Mazda.

  • Vineeta Rao says:

    Another riveting article ,Dr Mazda ! Dedicated, trained, skilled nurses are the backbone of medical care . Iam sure all doctors ,especially surgeons rely on their support.

  • JCM says:

    Well written Mazda. Proud to have played a role in your journey.

  • George Koshy says:

    Loved that..going to share it with my nursing friends..

  • Sathish Kumar J says:

    Hello Dr. Mazda it’s a wonderful article you wrote, nurses are never been spoken . As a theatre nurse am so glad that you have expressed nurses importance and there part in the surgeries… Thank you for that.,, Hope u remember me I work in Neuro OR , CMC , vellore .

  • Prajakta Hindlekar says:

    Loved your article Dr Turel. Proud to be a nurse and a part of health care profession with colleagues like you. Thank you for you appreciation and acknowledgment. l am sharing with all my nurses .
    Best wishes .

  • Mahashweta Biswas says:

    Very well written article once again Mazda. It gives us an insight of how really important is a surgical nurse’s job who has to be efficient in passing on the surgical instruments in the surgeon’s hand. You have given them credit which is really very thoughtful.

    Well written article with a dash of humour Mazda style😊

  • Kashmira says:

    Dear Dr. Mazda, Your article is thrilling, humbling and awe inspiring – all rolled into one! Every week you manage to educate and entertain us readers:-) God bless you, the Nursing staff and all the associated medical & paramedical staff!

  • Siddesh P says:

    Every nurse must be feeling Happy & Proud for being a Nurse after Reading u r appreciation in u r article sir Verry well written. After reading the article Being a nurse ill always remember u r Birthday on the Nurses Day…

  • ADI Cooper says:

    Very Good Surgical work And Credit goes to Nursing staff, they’ve extremely good knowledge on what is the next Surgical is required By a Surgeon.
    Go on and Going on

  • Anuradha Karnik says:

    Another peep into the awe inspiring world of neurosurgery. Your article is well written with utmost humility. That you have dedicated this article to the nurses who skilfully assist you speaks volume of your character and goodness of heart. Keep up the good work always.

  • Jyoti says:

    You narrate medical surgeries in such a beautiful manner for lay people like us…I know if I ever need to be under a neurosurgeon it would be you Dr. Turel

  • Rekha Murty says:

    As always, riveting style of narration!
    Behind every successful surgery is a surgeon and behind him is an artful nurse!

  • Bapsy Bengali says:

    Your articles are always very interesting. Especially this article of nurses was very informative . Through your words, we felt we were right there. Thank you for sharing and God bless.

  • Marzian Mowji says:

    A good OT nurse is like an extension of the surgeon, a third arm you might say. It gives us all a great deal of confidance to know that sirgeons are assited by capable, well trained and intuitive nurses. We are all in safe hands.

  • Sharda Suresh Jagtap says:

    Very well written Dr. Mazda! Thank you for sharing especially nurses role and importance of intuitive and skillful nurses behind every successful surgery. Being a surgical nurse I would like to give you best wishes for giving us credit!

  • Dr. Rekha Sherbet says:

    skilled nurses are the backbone of medical care . I am sure all doctors ,especially surgeons rely more on their support.

  • Vispi Mistry says:

    Another brilliant piece from your pen Mazda, i am sure Florence Nightingale will be showering you with blessings from up there.

  • Di says:

    Kudos to all the dedicated and hard working nurses… they are the strong skilled soldiers in the battlefield of the operating room, supporting the surgeons… while reading this article.. one of the episodes in a TV series called The Good Doctor came to my mind where the surgeon was unhappy about how the nurse positioned the instrument. So important for the surgeon and nurse to be in sync… my sister and you share the same birthday.. caring like florence nightingale 🙂


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