OR By: B.D. Colen

This is one of the most interesting memoirs I've read in a long time. The Pulitzer Prize Winner "O.R.," by B.D.Colen, is about exactly what happens through the course of 24 hours in the operating rooms of North Shore University Hospital in Manhasset, N.Y.. ( Some of my Aunts in Long Island used to work in that hospital but not in the O.R..) The events in this book are not over dramatized like a lot of T.V. renditions - blood, screaming, etc. The stories are all true using the real names of the Surgeons, Nurses, Anesthesiologists, and support staff. All the conversations depicted are actual accounts. Anybody that has known somebody who has had surgery, is about to have surgery, or are curious about what happens in the O.R. once your loved one is rolled away, will be totally intrigued by this book. I picked it up just to flip through it and found it very hard to put down. Its fascinating and I found myself wanting to know how the patients were doing. Mr. Colen chronologically takes you through one entire day in the 16 O.R.'s at North Shore. He spent six weeks observing every detail of life in the O.R. The day starts at 6:30 A.M., when alls quiet and the night shift turns seamlessly into the day shift. B.D. Colen makes a point that I thought was very interesting, the world of the O.R. is a world all unto itself where real miracles happen and where - when you give yourself over to that world - you are in their total control because you are unconscious. One nurse said that up in the O.R. they don't get very emotionally involved with the patients because they only know them for about 15 minuets - before they knock you out that is. That doesn't mean though that they are detached. The actual details and procedures of the surgeries, and the equipment used are explained in fascinating detail -all of them. You follow a number of cases from start to finish. Colen included patient interviews before they had their surgeries - their concerns and fears, so you learn a little about the patient's lives. You find yourself caring and hoping for them. He also interviewed the surgeons, anesthesiologists, and the nurses so you learn about their lives, their experiences, and what makes them tick.

When the day shift comes on sometimes there are on going cases that the day shift just picks up and continue from the night shift. The O.R. doesn't really have days and nights it seems more an on going 24 hour cycle. They leave notes for each other to let the next shift know whats going on and what equipment needs cleaning or restocking. Just an aside- during surgery there is a nurse whose job is to catalog all the syringes, drapes, sponges, drugs drips, etc. given you while your procedure is being done and they bill you for it. Don't you think they could just include all that in the cost of the O.R.? Anyway, the actual O.R. is just a green tile room, now, with no windows. Dr. Mountain remembers a time when they used to do surgery with the windows wide open with the outside air blowing in! Can you imagine? He said somehow they managed. Only one of the 16 O.R's is set aside for cardiac procedures. For the most part everything in the O.R. is extremely well orchestrated. What surgeons, anesthesiologist, nurses, and technicians are going to be in what room, at what time, doing what procedure on which patient. The nurse coordinator is responsible for all this. Sometimes operations go long, sometimes they are shorter than expected. Some surgeries are 5-6, or more, hours long. The surgeons don't just cut into you. They carefully dissect you. The head surgeon Dr. Tony Tortolani , Chairman of the Department of Surgery, a cardiac specialist , says the night before a surgery he carefully plans each step of what he is going to do, reviews the anatomy, and goes to Mass each morning before he does surgery. Dr. Tortolani grew up in Eastchester. He said he was a very average student and had his parents listened to his H.S. guidance councilor they would have directed Tortolani to go to trade school.

Each case you read about is really so interesting, each surgery so incredible. Here are a few. One 17 year old guy - Andre - was in a car accident . He had been comatose for four days, on a ventilator, being fed through a tube, and had a heart attack while in his coma. Neurosurgeons had done emergency surgery to relieved the pressure on his brain, but now his left leg had become gangrenous and he was back in the O.R. for amputation. Even though medicine has advanced a lot since the Civil War, surgeon Dr. Larry Scher said the operation is still virtually the same. Andre's doctor had called for amputating the entire leg but, Dr. Scher felt that he would save the knee if he could. Dr. Scher said that if this kid wakes up he'd want to walk and run and he'd want a prosthetic that would let him do that, so he saved the knee. God bless him.

Baby David, eight days old, had a deformed heart. The blood vessels leading to and from his heart were attached opposite the way they are supposed to be. It is called transposition of the great vessels. De-oxygenated blood coming from the body returning to the heart was being returned to the body instead of going to the lungs for oxygen, and the oxygenated blood was being returned to the lungs. The only reason David was alive was because he also had a hole in his heart from which some oxygen was seeping through. David was in surgery for four and one half hours in which time pediatric cardiac surgeon Dr. Vinnie Parnell was able to reverse the two blood vessels, attaching them properly,and stitch up the hole. He said David will now live a long healthy life. Wow! Baby Rashid was born with a severe cleft palate. He basically just had a hole where his nose and mouth should be. Pediatric Plastic Surgeon Dr. Pamella Gallagher somehow with a scalpel and tiny sutures, like an artist, created for this baby a top lip and a nose. When she was finished she whispered, " Welcome to the world new baby. Hopefully, you will be more welcome now."

This next case makes my throat hurt. Lillian Paskow, a fifty something woman, had always been a heavy smoker with a real gravely voice. She had a sore throat that would not go away. She waited to long. By the time Dr. Micheal Setzen saw her her entire voice box was riddled with cancer. Sadly he said, if he had seen her much earlier he could have lazered away the cancer as an out patient but now her entire voice box had to be removed. Lillian's interview with Colen was heart wrenching. She knew she would never speak normally again but it was remove her voice box or death. Her surgery went very well and she is fortunate to have a very supportive husband. She will have to learn how to control grunts of air through a mechanical box. I hope she can master it. I'll never, ever smoke!

Here are some of the O.R staff's thoughts. Dr. Torolani says most of the surgeons are very shy people. Anesthesiologist Dr. La Porta says the surgeons have enormous egos. They have to have super confidence because they can't open you up and say things like - I didn't expect any thing like that. They have to know what they are going to do - and do it. Its Dr. La Porta's job to anesthetize you, make sure you feel nothing, support your breathing, monitor your blood pressure, fluid levels,etc., and then wake you up again remembering nothing. He loves his work and is honest when he says that with all you can do with anesthesia they still don't know exactly how the gases work. I liked Dr. La Porta. He sounds like a very dedicated guy. He goes to visit all his patients the night before before their surgery so they won't be so afraid - especially children. He grew up very poor. He never wastes money. His wife always complains he's too cheap. Poor guy bought a nice house and was afraid to live in it, so he's working really hard to pay off the mortgage early. Some of the nurses complain that some of the doctors are condescending and they won't work with them. Those doctors don't last at North Shore. One very talented O.R. nurse wants to be a pastry chef. As Dr. La Porta points out - we're all just people.

I could go on and on. The cases were so interesting. This book was fantastic, filled with miracles and the people that deliver them. An amazing - and real- read. I recommend this book to anyone who is not squeamish (H.S. and up.) One of the most reassuring things I read was said by Dr. La Porta. He said, with all the advances in anesthesia there are very few deaths in the O.R.. If somebody dies somebody really messed up. I loved this book. I recommend it highly.