by the Hospital Senses Collective
Once, the operating theatre was a site of spectacle and entertainment; it is no coincidence that it is called a theatre. Members of the public would descend in crowds to observe, with fascination, to see a life saved or a life extinguished. Surgery was a kind of performance, and the operating theatre the surgeon’s stage.
Observers were invited to engage all their senses with the operating space: to view writhing bodies and glinting instruments shining in the gaslight; to hear groans and cries from the patient who may or may not receive some anaesthetic, or a saw, working on a bone. There would have been a bombardment of smells: the stench of sweaty bodies crowded together; burnt, cauterised flesh; the tangy metal of blood; foetid infection; excrement brought in on the sole of someone’s shoe. Before germ theory and the introduction of antiseptic surgery, the operating theatre may have been one of the dirtiest places in the hospital. Although nurses and surgeons began to wear white coats and coveralls in the late nineteenth century, it was not until then that hand washing was fully adopted. It was the middle of the twentieth century before it became common to wear masks and gloves.
This is in stark contrast to today’s operating theatre. Unruly bodies are hidden with sterile drapes used to conceal areas of the body not affected by the procedure. Yet, operating theatres are not completely devoid of the sights, sounds and smells with which they once were associated. They can still be noisy places, especially when surgical drills and saws are in use. Although the presence of sterilisation and antiseptics create ‘clean’ odours, the operating theatre can be a smelly place, too: after all, the body hasn’t changed. There are still bodily fluids, rotten bowels, infected organs, though they may be cleaned up and removed quicker than they used to be. Individual surgeons will have their own means of working in this world of strong smells, for example placing favourable scents inside their masks. They may also choose to play music in the background, and not always the predictable classical tracks: surgeons commonly work to pop and rock music.
Very few people have memories of the operating theatre. Patients are usually unconscious and on the few occasions they may be awake, it is likely that their senses are dulled. We often know the sensory experience of the operating theatre only second hand, through television, fiction, memoirs, or artistic representations of the space. That said, in an echo of pre-anaesthetic operations, there are increasing instances of patients being awake during their surgery. Examples include caesarean sections, keyhole procedures and some aspects of neurosurgery. One patient recently described their sensory experience of an awake craniotomy: ‘[I] felt my head vibrate a lot … they were cutting something with the drill, it shook and vibrated and so did my head’.[1] These patients don’t feel the pain of the procedure, but they can still feel and embody the vibrations and activity happening in the room as well as to their body.
Now, the operating theatre is minutely organised according to hygiene and cleanliness of the sterile field. Its organisation is likened to an aviation checklist and safety system, to ensure that medics are prepared for every eventuality. Once the surgeon has scrubbed in, they must ensure they do not contaminate themselves, and all the instruments are sterilised beforehand. The room is arranged according to the flow and movement of bodies entering and leaving. With all these necessary procedures in mind, the operating space itself takes on a specific identity. Once an instrument has been handled and used, it is no longer sterile and must be cast aside. Soiled swabs and sponges are counted in and counted out to be discarded safely.
Today, the operating theatre is largely out of sight. It is rarely a place that you can witness as a visitor, and, mostly, patients do not see or experience it, despite being central to the hospital’s purpose. We access stories of the operating theatre through the staff: sur- geons, anaesthetists, nurses, and cleaners. Is this invisibility the very thing that makes the operating theatre such an interesting sensory space?
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