The Night the Lights Went Out in OR

Yes, I know there should be an article like the word the, but then it wouldn’t match the cadence with The Night the Lights Went Out in Georgia by Reba McIntyre.

As discussed in the Monday Musing on 8/14/23 hot enough for you, it is high summer here in North Carolina. Hot days and afternoons often spawn late-afternoon thunderstorms. You’d think this would cool off the temperature and bring down the humidity but you’d be wrong.

The hospital is an electrical power hog.

Think about it- all those rooms, all those corridors, all those automatic doors, all those lights, all the air conditioning, and don’t forget about all the equipment in the specialty areas like the laboratory and the operating rooms. All of it takes electricity.

What happens when the thunderstorm is so intense that it knocks out the power to the hospital? It doesn’t even have to be a close storm. The incident that knocks out the power to the hospital can be a car hitting a transformer. Or a squirrel getting frisky with the power lines as has happened in, well, everywhere. If you Google squirrel and power lines there are many stories from around the country and around the world.

My point is it doesn’t take much.

Luckily hospitals have generator backup. This is the very large generator that backs up specific electrical systems in the event of an outage. These are things such as the life-sustaining ventilators, minimal temperature controls, half-lights in the corridors and rooms, and are usually indicated by a red outlet. No generator is big enough to power everything the hospital usually uses the power for. If it was it would be ginormous and require vast amounts of gasoline to power it.

The operating goes on stand-by during generator use. This does a couple of things. It decreases the drain on the generator, and it maintains the patient safety while in surgery because they are not being operated on under generator power.

Because what would happen to the patient if the generator failed during surgery because the surgery was allowed to continue despite the loss of power and working solely under generator?

The room would turn completely black with no lights. The ventilator and anesthesia machine would not work, which means the patient would stop being ventilated and the anesthesia gases would no longer flow. The pyxis machine would not work, which means the CRNA could not get medication out of it to give to the patient. The OR spotlights would not work, which means the surgeon could not see what they were doing. The video tower would not work, which means the surgeon can no longer see what is going on during a laparoscopic case. The electrocautery machine would not work, which means any bleeding the patient has must be controlled with the old clamp-clamp, tie-tie, cut method of controlling bleeding. The robot must have consistent CO2 insufflation so that the patient is not endangered by the working elements or the trocars, which means sudden loss of generator power can lead to important abdomen things being punctured because insufflation cannot be consistent.

In a word, the OR would be fucked.

I do not use that word lightly.

There could be tears.

In my 22 years, the complete and utter loss of power has happened to me twice while in a surgical case. Both times the generator kicked in after what felt like forever, but was, in reality, less than 30 seconds. You can imagine the chaos.

No, Virginia, the operations that were not yet underway when the power failed and the generator kicked in CANNOT be allowed to go forward.

But, but, the patient took time off work, arranged a ride, and has been NPO for all that time? What am I going to tell them?

The hospital is very sorry but surgery has to be cancelled to KEEP you safe. Yes, the generator is supplying power to some systems.

FOR NOW!!! But what if it failed?

It is the operating room nurse’s job to imagine the possibilities. And one of those possibilities is the generator failing, perchance by running out of gasoline. If that happened at the wrong time, the patient would be in dire straights. Or dead because of what transpired in the paragraph that describes/supposes what would happen if the generator failed whilst doing a case under generator power.

Yes, it sucks, but would you like to toss the dice and continue for a chance to die?

No, I didn’t think so.