The first time Anthony Palmer assisted on an intradural spinal tumor surgery, the spinal nerves looked like fiber-optic cables, he thought. The delicate operation went against everything he had been taught about spinal surgeries. He had supported surgeons performing procedures to stabilize the spinal column in the past, but the procedures never involved touching the spinal cord itself. The risk of cord or nerve damage was too high.
After joining MD Anderson as a surgical technologist, Palmer had a courtside seat to a neurosurgeon doing just that – venturing into the spinal column to remove a cancerous tumor.
“It was so fascinating,” Palmer says, remembering the intradual tumor case as one of his first “wow” moments at MD Anderson. “I thought that was just the best ever.”
An integral member of the surgery team
Once an operation is underway, the surgical tech (also called a scrub tech, or scrub for short) typically is the only member of the surgical team permitted in the sterile field at the patient’s bedside with the surgeon and any residents or fellows. The scrub tech maintains a clear line-of-sight with the surgeon and anticipates the surgeon’s next move. With experience, the scrub will pass the correct instrument or supply without the surgeon even having to ask.
“It’s like they’re making music,” says Lystra Swift, perioperative nursing director. “The surgical tech’s ability to anticipate the surgeon’s next move is huge.”
Dennis Veals, a senior surgical tech who’s been here more than 20 years, not only knows the names of the complex instruments used by neuro and orthopaedic surgeons; he’s also familiar with the extraordinary procedures they undertake.
For combination cases where a patient might require plastic surgery immediately following orthopaedic surgery, for example, Veals prepares multiple pans of sterile instruments.
“I tell my trainees to use whatever instrument Dennis gives you because that’s the right instrument even if it’s not the one you asked for,” says Valerae Lewis, M.D., chair of Orthopaedic Oncology. “Dennis and Anthony often know what instrument we need before we ask for it. We couldn’t do what we do so well without the support and expertise of our surgical technologists.”
“The techs truly are Making Cancer History®,” adds Charles Levenback, M.D., professor in Gynecologic Oncology and Reproductive Medicine, and chief quality officer. “Big case or small, routine or new, long or short, there simply is no way to proceed without their expertise.”
The role of surgical technologists in modern health care emerged during the world wars of the 20th century. Surgeons needed medical assistance in the field. So they turned to military medical technicians, which resulted in an entirely new allied health profession dedicated to maintaining the sterile field around the patient at all times. The role was formalized when certification became available through national accreditation organizations.
Anticipating the unknown
On most days, Brian Garcia is the first surgical tech to arrive to the operating room. He scrubs in (something he’ll have to do again before every case) and he pulls instruments and supplies for the day’s surgeries, including contingency materials that might be needed for unplanned procedures.
“Every day is a balancing act,” he explains. “You could come in with one case and one doctor and immediately after the incision or new imaging scans, it can turn into a case involving four or five doctors.”
The wild card is the nature of cancer itself.
“Because of anatomy, tumor, disease, radiation – normal tissue isn’t as it may seem for everybody,” says Samantha Conklin, a surgical tech familiar with laparoscopic and robotic urology cases. “A case that may take two hours on a relatively healthy person can take hours longer here.”
Surgical techs keep pace with improvised surgical decisions by maintaining a highly organized sterile field of instruments.
Surgical technologist Marina Lozano understands that anything we can do to help minimize the patient’s time in surgery is important and having the correct materials available is a critical part of that.
“You feel empathy,” she says. “Some of our patients are very young. I have compassion for them because I know it could be me or a family member on the table one day.”
A longer version of this story originally appeared in Messenger, MD Anderson’s quarterly publication for employees, volunteers, retirees and their families.