Behind the MASK: On duty with a surgical nurse...

With a welcoming smile, Sue Keck, greeted Robert Puls and wheeled him out of his hospital room and down the hall.

Keck then opened the door to The Finley Hospital surgery department by tapping a button on a wall and angled Puls' cart toward operating room No. 6.

She chatted with the 78-year-old patient during his journey to surgery.

As a surgical nurse, Keck considers herself the patients' advocate in the operating room.

"You're there to protect your patient," she said. "I like helping the patient have a good quality of life. Our care centers around them."

For many patients, surgery represents a journey into the unknown.

"The patient is frightened," said Jean Hayes, director of preoperative services.

During that time of foreboding for the patients, Hays said a surgical nurse's impact is greatest.

"You're the person behind the mask," Hayes said. "You're the patients' advocate, but how many people remember the nurse in the operating room? It's sort of an unsung hero thing to me."

The patients' fears give surgical nurses the opportunity to calmly offer comfort and care.

"Even if you can't see the face behind the mask," Hayes said, "you can see the compassion in their eyes."

Once they had reached the operating room bed, Puls had some fun with his surgical nurse.

"Hey!" he said to Keck with mock seriousness, "You didn't warm up the bed!"

Given the breadth of a surgical nurse's responsibilities, it might come as a surprise that pre-operation bed-warming is not one of them.

"I'm in charge of my room," said Keck, 55, a surgical nurse at Finley since 1986. Her varied duties in the operating room reflect the surgical nurse's leadership role.

During Puls' case - a cataract surgery performed by Dr. Bryan Pechous - Keck and another nurse, Jane Shroader, laughed at their patient's good humored comments about the cold bed as they placed a series of monitors on his chest and arm.

Keck then prepared trays of drugs and assisted the surgical technicians in collecting the necessary sterilized instruments.

"Everyone has a job to do," Keck said. "We all really work together."

Helping to gown the doctor and technicians, Keck then turned her attention to readying the phaco emulsifier, a machine designed to break apart cataracts.

Puls' case was the third in a trio of cataract surgeries Keck would work this particular morning.

During the second cataract procedure, for 47-year-old Jan Bjerke, Keck spent most of her time charting: recording exact times and other relevant details of the surgery.

"You have to get your times down," Keck said. "You have to note who is in the room, the medications used and the implants used. The doctor may want to refer to that years later."

After several minutes, the groaning whir of the phaco emulsifier came to an abrupt halt.

"All done," Pechous announced as he lifted the drape that covered all but Bjerke's right eye.

Four minutes later Bjerke was recovering back in her room.

"The procedure itself doesn't take that long," Keck said. "Often the procedure can be completed so fast you don't have time to get your charting done."

For Puls' case, Shroeder handled most of the charting while Keck worked closely with a surgical technician, assisting the technician by positioning trays of medications and instruments while opening such supplies as the foldable lens that was inserted in the eye.

"I don't think there's anything boring in surgery," Keck said. "Every day there's something new. It's very challenging."

Hayes said "it's a very dedicated person who works in surgery."

"You have to be a very good technician, knowing how to run the equipment, read the monitors and quickly assess the situation. It involves a lot of skills.

The central focus remains the patient's well-being.

"However long that patient is in our care - it could take 30 minutes or it could take six hours - the nurse never leaves the patient," Hayes said.

Keck dreamed of a career in surgical nursing when she was in high school.

"I was 14 or 15 and I had my appendix out," Keck said. "Right then, I knew it was something I wanted to do."

She didn't immediately take up nursing as a career. Instead she got married, raised her children, then went back to school as a nontraditional student to receive her nursing education.

"I put it on hold for a lot of years," Keck said.

At Finley, her primary responsibilities include assisting on eye surgeries and ear, nose and throat cases. However, surgical nurses are often asked to work on a variety of procedures when the need arises.

"I work in ophthalmology a great deal but I do a little bit of everything," she said.

During Puls' surgery, Keck's eyes scanned the operating room and its personnel.

"You have to watch for any break in sterilization or break in technique," she said. "Infection control is a big issue, and you're there to protect your patient."

Puls' case, like Bjerke's, was over in minutes.

Soon Keck was helping to clean the room she had begun to set up for surgeries nearly three hours earlier.

"It takes several years to become comfortable in the operating room," Keck said. "It's on-the-job training.

Keck also gave a short report to the nurse on Puls' floor, filling her in on pertinent details of the surgery.

"We have a great group here and we do work as a team," Keck said. "You're not an island. You need to work together.