Friday, 4 March 2016

Fortress OR

I am just at the end of my first day/24-hour on-call in the new operating rooms at Hadassah, and after the initial confusion and getting lost, which will probably last for a few months, I started to be struck by a few differences between here and how I imagine a typical OR area would be back in the UK.

Just to give you a sense of the place, it feels huge. I don’t actually know how many ORs we have there (I was doing urology in OR 46, but I think they start at 30). Each OR is large and airy, with multiple flat screens where I can project my anaesthesia monitor, or a live video of the surgery. The ventilators are state of the art, and my anaesthesia trolley contains 90% of the drugs I need, saving my lots of running around. The patient bed seemed so complicated I felt I needed a manual just to work out how to tilt it. It sets of an alarm if it thinks part of it may collide with something, and asks you to press again if you are sure you want to continue.  At one point it decided the right leg was going to hit something (not sure what), and the left one was clear, so it simply split them and lowered one only. I can see we are going to have a few disagreements, but hopefully in the end we will grow to understand each other.

The place is a maze. There is the same grass-green stripe along all the walls, and you really get little sense of where you are, or how anything is related to anything else geographically. I spent a crazy amount of time walking randomly around sometimes returning to where I started, looking for a particular spot (e.g. the OR where I left my patient).

But putting all that aside, I think with a very little investment of time on my part, I will grow to love the place. It feels so much cleaner and more modern than the old ORs.

And then, sometime around 1am when a friend was giving me a tour of the place, I started to notice some of the things that perhaps would not have been seen in the typical NHS Operating Room suits.

Firstly, we are level -4. That’s not a random decision: every Israeli OR needs to be in a protected area in case a rocket siren sounds in the middle of surgery – you can’t very well evacuate the patient in the 90 seconds before impact.

Then I started noticing the doors in the corridor. They are thick steel, with those twisting door handles that drive bolts up and down into the steel doorframe. I found one small corridor between the Recovery Room and the Family Waiting Room with 4 such blast proof doors, spaced roughly every 2 metres.

That started to feel a little strange, but after touring the ORs, we went upstairs (still 3 floors underground) to the on-call rooms and offices. Here the doors were normal. You know, with a normal handle and that thin vertical glass window extending most of the length of the window. The doors were painted metal, which is not unusual in Israel. And then I noticed a curious effect: when I looked through the window from afar, it felt a little like a fisheye lens. I first thought how ingenious this was: you could see someone approaching the door from afar and not push it open into their face. But then I noticed the effect became less as you get closer (which sort of defeats the object), and that there was a slight yellowish tinge to the glass. Then I realised when I had seen this before: it was looking at an angle through the windscreen of a VIPs bulletproof car in the UK.  I may be wrong, but I think someone may have put bulletproof polycarbonate glass into the doors of the anaesthetists’ offices.

Then there were lots of other little surprising touches we found as we explored. Such as the fully working shower-heads in the middle of a corridor (Nuclear, Biological and Chemical decontamination), and what looked like air filters (perhaps for the same reason).

That evening, some of the nurses had returned from a conference where a drug rep had brought food, and they kindly shared it with us in the staff room on level -3. Afterwards some of the people said they were going out for a smoke, and mentioned that there was a staff smoking area nearby. I asked about it (no, I don’t smoke, but I was curious) and was shown to the open window, where you could look down into a pleasant paved courtyard with garden benches. This was around midnight, so I can’t tell if the darkness was natural, but I realised that the courtyard must be 4 or 5 levels underground. I craned my neck upwards but could just see building all the way up. I still don’t know if the top of this void in the middle of our building is concreted at the top, or is open to the sky, but it looks like it would be a difficult trajectory of a missile to enter. I pulled my head back in, and as I closed the window I noticed that it too was in a blast-proof steel frame, with a thick steel shutter you could draw across.  

I don’t now entirely what to make of all this, and would love to chat with the seniors in the department to find out more. It seems overkill if you are trying to defend yourself against the not-uncommon missile bombardments from Gaza or Lebanon (these happen every couple of years). I have wondered if it was nuclear bomb proof, which is not as crazy as it sounds – most of us assume that Iran will get the bomb in the nearish future, and I have been told that the ICU at Rambam hospital in Haifa is in a nuclear bunker. Or maybe it is somewhere in between – I am not expert enough to know if the Scuds of the type fired by Iraq on Israel need this type of protection.

What is certain is that the hospital planners here have some extra dimensions to consider that the NHS management perhaps don’t.

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