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Healthcare innovation seems to happen daily, procedures and possibilities changing so quickly that it's often forgotten how far the field has come in such a short time.
That history lives on in the minds of our longest-serving healthcare workers, such as Toronto Western Hospital's (TWH) Carol Spiegelberg, who evolved in their practice of medicine as things changed, but are quick to recall steps in procedures that might baffle some today.
"In the Operating Room (OR), some of the suture needles had to be quickly threaded with silk by the scrub nurse," Carol recalls. "In neurosurgery, for example, it was one needle, with one silk strand for one stitch for closure of a craniotomy.
"The needle boat would circulate and nurses had to constantly pick out the needles and thread them while the operation was happening – and the surgeons would get very impatient if we were slow."
50 years service, all as OR nurse
In November 2016, Carol celebrated a milestone very few employees at any organization achieve: 50 years of service, all of them as a nurse in the TWH OR.
It was a career that began with nursing school in 1961. In those days, the large teaching hospitals in Toronto had their own nursing school – at TWH, nurses were formed at the Atkinson School of Nursing – to help care for the many patients admitted to the wards.
"This was before patients could be in and out of hospital for surgery in a day, so TWH had almost 900 beds back then," explains Carol. "I was one of 83 girls from all over Ontario to graduate as a Registered Nurse (RN) in 1964; I still have the pin and the black velvet band I was given to put on my nurses cap which denoted my RN status."
A small town girl who always knew she wanted to be a nurse, Carol took an immediate liking to working in the OR when, during her second year of nursing school, her rotation introduced her to the fast-paced work of surgical services. These were the years before the existence of UHN, when TWH provided all medical services and surgeries, including a cardiac centre, obstetrics, organ transplant and many more that have since migrated to other sites.
"Hardly anyone applied to work in the OR when they graduated because everyone was so intimidated by some of the surgeons," she says. "But I knew that's where I wanted to be, in the middle of that exciting world, so I applied right after graduation and never looked back.
"I will never forget scrubbing in for my first procedure, a gall bladder removal," she continues. "I was so worried I would mix the dye they used to image the bile duct wrong."
As a nurse in the OR, Carol, now 73, had a front row seat to the many advances in surgical medicine that came to change practice and patient safety over her five decades of nursing.
In 1968, TWH performed Toronto's first heart transplant, an event that brought much excitement to the hospital, especially the OR where Carol's good friend was the scrub nurse for the procedure. Unfortunately, the patient died soon after surgery as anti-rejection drugs were still in their infancy.
"The outcome was, of course, very disappointing, especially after all our rehearsals to ensure sterile linens and room, all of which was very labour intensive work back then and also done at the hospital itself," recalls Carol.
'A family affair at TWH'
Still, she went about her work in the OR, relishing every minute. But a career is but one facet of a person's being, and her time at TWH also came to enrich her personal life.
Though he also worked at TWH in finance as comptroller, and later as V.P. Finance, Carol met her husband, Keith, on a bus while going to her hometown of Glen Williams for the weekend, while he was also going home to Brampton. They married soon after – a marriage that also recently celebrated 50 years – and had three children; all of whom were born at TWH before obstetrics closed in 1979.
"It really was a family affair for me at TWH," Carol declares. "Both my work and home families were made here."
Though she took time off while her children were little – "maternity leave didn't exist in those days" – as soon as her youngest started school, she went back to nursing. Carol can honestly be considered part of the original wave of women determined to find ways to balance both work and family.
"None of the women who lived on my street in those days had jobs so formal daycare didn't really exist because mothers stayed home with their kids," says Carol. "I started working night and weekend shifts which helped keep my skills current, and then I'd sleep from 8 a.m. until noon while the kids were at school."
By then, TWH had become part of the University Health Network (UHN) and Carol who had previously served as OR nurse manager for the eye, ear, nose, and throat service, went on to manage neurosurgery – the service that she says truly won her heart.
Nursing itself also changed during those years as professional standards and competencies were introduced in the 1980s to improve patient safety, and nurses came to be recognized more as partners with physicians in care delivery.
"It used to be that you'd scrub in to an OR procedure and the surgeon would silently put out his hand and you had to know exactly what instrument to place in it," she says. "It was just a different time, but now it's nice to see nurses voicing their knowledge and judgement."
After managing neurosurgery for three years, she stayed on in the OR as the Clinical Support Nurse, relying on her extensive knowledge and experience to nimbly fill in for several different positions in the OR.
But as time went on, Carol gravitated towards roles in OR education. In 2004, she started working with the Clinical Educator in the mentoring program, shepherding new nursing graduates through their OR nursing course, and orienting and training newly-hired graduates to the unit.
Carol greatly enjoyed this role but still felt the need to diversify her work. So in 2006, while still working as a mentor, she applied to the Late Career Nursing Initiative (LCNI) – a program for nurses over the age of 55 sponsored by Ontario's Ministry of Health and Long-Term Care and championed at UHN by Dr. Joy Richards, Vice-President, Patient Experience and Chief Health Professions – to get the skills necessary to digitize her OR expertise.
The LCNI offers retraining for nurses with years of knowledge and experience to adapt and enhance their skills in order to support specific projects that could better their unit.
With the support of the OR Patient Care Manager, Rose Puopolo, Carol, worked with her colleague, Shirley Yeung, to create the TWH Operating Room Virtual Library on UHN's intranet. The library is a resource for OR nurses to look up surgical procedures once they have received their schedules and read up on the room set-up, instruments to be used and a general outline of a procedure.
The garden is calling
Spiegelberg and Yeung completed the library in December 2016, cataloguing over 85 different surgical procedures and keeping the content up to date.
And with the end of that project, came the end of Carol's last chapter at TWH but the start of her first chapter of retirement for which she has many plans.
"Garden, garden, garden," Carol says. "But also continue to travel, sing in my choir, spend time with my husband and family. I always have something going on."
She has much excitement for this new phase of life, but it's obvious she takes many fond memories with her from TWH along with great pride in both her 50-year contribution and how the organization helped her achieve it.
"I'm going to miss TWH, this hospital really was my life," she says. "I'll miss my colleagues, the camaraderie, how we worked together to fix problems. I'm so proud of this hospital – I always say it's the best!
"It's been such a privilege to work here and keep learning while I did. Who else at 73, would have been able to do all this?"