Marlot Kuiper

182 Connective Routines This situation again shows that ‘the operation’, and performing the checklist routine shortly before the incision, is part of a complex web of multiple dependent routines. The anaesthesiologist has the responsibility for picking up the patient. Picking up the patient might be seen as a ‘practical’ task, but in reality it is a complex social activity, in which there is an important handover in which the nurse at the holding has to provide the anaesthesiologist with important information that has to be processed, and the anaesthesiologist has to ‘deal’ with the patient, which in some cases, might turn out rather complex. The example shows how the surgeon departs from her own point of reference in the conversation. From her perspective, the schedule is disrupted, and it takes the anaesthesiologist quite some time to ‘just pick up the patient’. She was not aware of the efforts that the anaesthesiologist put into persuading the patient at the holding, and she doesn’t show open to this either. Naturally, she quickly wanted to get going since the program was already running out of time, but herewith almost blew up the efforts that the anaesthesiologist put into calming down the patient. As shown in other situations as well, rather than overcoming professional boundaries and improving collaboration, the checklist is performed in a tense and ‘not connective’ manner. Frustrations and irritations between professional groups because of delays do not, to say the least, smoothen the performance of the checklist. ‘Doing surgery’ thus involves a lot of organisation and coordination. Many actants are involved in the process, and when there is just a tiny mistake in the chain, this can lead to problems with severe consequences. In paragraph 6.3.2 I illustrated the start of an observation day at St. Sebastian’s. Though the program had to start at 8.00am in both theatres, the briefing in OR4 had already been done by the surgeon and the anaesthesiologist in training before our arrival at 7.50am (“no particulars”), while in OR5 nobody was there at 8.00am so we had to grab a coffee. The following observation note reflects how the day proceeded at OR4, after two operations had been performed. The second patient just left the theatre and the cleaners are busy with preparing the theatre for the next operation. Dr. Herbers is about to move to the holding to pick up the next patient, but before doing so, he again quickly runs through the paperwork he used as a preparation for the operations. “has blood been ordered?” he asks. It comes up for discussion that the next patient has a very a-typical blood type. This type of blood is not standard in stock, so it has to be pre-ordered. Just in case of (unexpected) blood