PASS ME THAT SCALPEL!

OR, MY BRIEF TOUR OF DUTY
IN THE OPERATING ROOM

Kathleen M. Orozco

The day of my surgical interpretation assignment at the DuPage, Illinois Central Hospital dawned auspiciously enough. Just another ordinary, balmy spring morning, wasn't it? Or so I kept telling myself.

I felt as prepared and confident as possible, given that plucked out of court, my usual milieu, I was now being catapulted into six years of medical school compressed into two weeks. The adrenalin was flowing and the knees holding steady-- but was there a slight rubbery sensation there? Only time would tell. For now, fortified by a strong cup of coffee and the hazy memories of "Part I--Total Hip Arthroplasty" and "Part II--Total Hip Arthroplasty Revision," videos I had viewed over the two nights preceding surgery, I got behind the wheel at 6:30 a.m., prepared for the pleasant suburban drive to my surgical date with destiny.

As it happens, knees were not the topic of the day. Hips were. Two of them. Non-cemented total hip arthroplasty, to be exact (técnica no cementada de artroplastia de la articulación coxofemoral.) Could I really do this, and make sense out of it in the same precise, complete manner as the surgeon? In spite of my accelerated course of study, doubts started to creep in.

And speaking of the surgeon, the situation was not as critical as I had imagined it to be when first approached about this new experience, along with my excellent colleagues, Roberto Mendoza and Kevin DeVany. On the morning scheduled for "our" surgery, we did know certain things about the procedure. Chief among them (and the most reassuring, from my standpoint) was that nobody's life was at stake. Our clients were a group of physicians from Spain sent over to learn how to perform the extended osteotomy procedure (osteotomía) on their own future patients.

There were still many unanswered questions to contemplate. For example, we still did not know whether our interpretation (performed in 30 minute rotating shifts) was to take place in the actual operating room, or in the surgical amphitheatre. Nor was it at all clear whether we would wear surgical greens and scrub down along with the operating room personnel. The husband of a colleague, a registered nurse, had helpfully pointed out that 1) it was probably best, if "on site," not to gaze directly upon the incision except as necessary to interpret; 2) sights, sounds, and smells (electrocautery device, blood and other bodily fluids and cavities, suctioning equipment, etc.) might provoke unexpected reactions in the uninitiated; and 3) I might want to position myself against a wall or other firm surface capable of supporting my weight in case of...well, best not to think about that possibility! I was still in the process of deciding whether his comments fell into the category of "helpful" when the red and white sign announcing the Emergency Entrance and Visitor parking lot of the hospital hovered into view.

A reassuring sight was the appearance of Kevin and Roberto at the designated meeting place. This turned out to be a large conference-style room set up for a lecture presentation on the second floor of the main hospital building. No operating table, bright lights, or surgical instruments in sight--only several rows of seats with headsets placed on them, with two large monitors positioned at the front of the room for long- distance, close-up transmission of the procedure.

A brief conversation with my colleagues resulted in a good battle plan for the day. We felt considerably buoyed by Roberto's medical studies in Guatemala in another life, by scenes remembered of our trusty videos (courtesy of the Harold Washington Public Library), and by a reasonably well-thought out, though woefully incomplete, glossary of terms I had prepared for the occasion. Thus equipped, we started to acclimatize ourselves to a state of the art interpreting booth provided by the hospital, and surveyed the lay of the land prior to the arrival of the participants. Seated in our relatively spacious cubicle, we started to synchronize our medical terminology while filling in some glossary entry gaps. Kevin and I had had some study time together at the library to bone up (no pun intended) on the procedure, the removal of a previously inserted prosthetic hip joint in two patients, to be replaced with a newer, better designed prosthesis, and Roberto had studied on his own. So these few minutes of preparation time prior to the surgeon's opening presentation, as our audience started taking their seats, were invaluable to the accuracy and precision of our work.

Once things started up, the pace was brisk. I volunteered to take the first stint at the mike, and "our" surgeon, not yet on site, embarked upon an animated presentation of "Preoperative Templating," a detailed exposé of Patient No. 1's hip bone area, with X-rays exhibiting the isthmus (istmo), trochanter (trocánter), cancelous bone (hueso esponjoso/hueso canceloso), and other essential bone terminology. Meanwhile,"our" patient was being prepped for surgery, as we could observe on the two large monitors provided for this teaching procedure. I picked up steam as I launched into the problems this patient had experienced with his earlier implanted hip prosthesis, and why it was necessary to remove it and replace it with a newer model after fifteen years of use.

Although I felt pretty confident, I was quite content to turn the mike over to Roberto shortly after the surgeon, now suited-up, remarked that it was time for him to go upstairs to the operating room, and excused himself. Although we saw nothing more of him for that surgery, his voice soon came through loudly and clearly to accompany the image of the surgical incision area on our monitors. Amazingly, our participants actually appeared to be listening attentively. Kevin and I furiously scribbled lists of terms which Roberto was encountering, some of which had not come up before in the reading or video material. (bone stress-- fatiga ósea, hydroxipite--hidrioxopatita, bleeder--hemorragia, ingrowth-- integración ósea) (retractor-- separador). We were aided in this task by the Ruiz-Torres Dictionary of Medical Terms, by the English and Spanish versions of the glossy prosthesis company brochures, complete with parts and surgical instrument terminology, and by the well-timed assistance of Andrés, a bilingual hospital spokesman who discretely provided us with accepted translations of surgical jargon and difficult terms at key moments. Most appreciated!

Kevin outdid himself at the bone drilling ( perforación ósea) and electrocautery procedures, (electrocauterización) as well. Better him than me, I couldn't help thinking, being all too aware that my turn up at bat was fast approaching again. Quick now, was a "curette" a fresado or a cucharilla? And was brocas para tapones de cement o an acceptable translation for "cement plug drills?" Thankfully, I could postpone such weighty decisions. Patient #1's incision was being very neatly sewn and stapled up on the big screen, and a coffee break was approaching. We had survived our first surgery! The next item on the printed agenda was "A Working Lunch Surgical Demonstration--Case #2."

Soon enough, the small talk was over, and I was preparing for Patient #2, a woman in her early 50's who was to undergo a similar hip joint revision, or replacement, procedure. The antiseptic solution was applied to the surgical area, the scalpel made its neat incision, and a thin trickle of blood appeared. Did I lose my cool? Not a chance! I sailed through "bone tamp" (retractor óseo), "shaft reamer" (fresa del vástago), and "modular polyethylene liner"(inserto modular de polietileno), feeling more and more confident. People were actually listening to me! The only shaky moments ocurred when the surgeon's voice from the operating room was occasionally broken up in transmission, in spite of the best efforts of our superb on-site audio technicians. This was corrected without much delay, with apologies to the participants. Kevin and Roberto scribbled down on napkins and paper scraps the terms not previously encountered, leaving a paper trail. As they took their turns at the mike, I did the same for them. Teamwork is nine-tenths of the law in the operating theatre as well as in the interpreting booth--and I had two terrific teammates. We also benefited from the expert, professional assistance of the staff of the Foreign Language Reference section of the public library, who referred us to exactly the dictionaries and background material we needed to become familiar with, in both languages. Roberto and Kevin had also obtained some very useful material from the Internet.

The surgeon expressed his appreciation to us, and the participants, now on their way out, allowed as to how we had done a reasonably decent job of things, as Spaniards are constitutionally incapable of giving effusive compliments.

I am pleased to report that both Patient #1 and Patient #2 were given an excellent prognosis for complete recovery, and that all three members of the interpreting team survived the surgeries as well. An experience that, in retrospect, I would recommend to anyone who is looking for a true challenge--as long as you know your team-mates, are willing to stretch the limits of your knowledge a little with a well-organized preparation schedule, and relish new interpreting experiences which truly impart practical knowledge applicable in future assignments.

[For a Spanish<>English glossary of related terminology see Total Hip Athroplasty and Revision Surgery: A Mini-Glossary]

Kathleen M. Orozco is a federally certified Spanish interpreter who works in the Cook County, Illinois courts and as a conference interpreter in the Chicago area.