How can you operate for hours? Surgeon Mariëlle answers pressing questions about the operating room.

When you're a patient undergoing surgery, you usually don't notice much of what happens in the operating room. But have you ever wondered how surgeons can operate for hours? And what if, as a surgeon, you get thirsty or need to go to the bathroom during an operation? Plastic surgeon Mariëlle Jippes (39) will explain it to us in detail.

Jippes is a plastic surgeon at the Queen Beatrix Regional Hospital (SKB) in Winterswijk, one of the highest-rated hospitals in the Netherlands. Jippes previously worked in Rotterdam, and although she once had to look up Winterswijk's exact location on a map, she now speaks highly of the regional hospital in the Achterhoek region.

Jippes knew early on during her medical training that she wanted to do something surgical. "Where did that come from?" she laughs. At the time, the young doctor observed all sorts of disciplines, including trauma and neurosurgery, but ultimately, plastic surgery appealed to her the most. "I still enjoy it every day. My profession is very diverse. In a large or academic hospital, you choose a specific direction. But because I work in a regional hospital, I do practically everything. I operate on hands, tendons, nerves, or bones. Sometimes I'm working with screwdrivers and hammers," she says enthusiastically.

"But I also do breast and skin reconstructions. My profession is very positive. Even though skin and breast reconstructions are related to cancer, I get to contribute something positive and create something beautiful. I see great results from what I do, and people are incredibly grateful."

Metro also previously spoke with general practitioner Staf Hendrickx , who warned about the abundance of ultra-processed foods. Doctors Mariëlle Vehmeijer-Heeman and Fieke Slee-Wijffels also told Metro about the importance of first aid knowledge for young children .

Incidentally, it's important to emphasize that Jippes is a plastic surgeon at the hospital, not a cosmetic doctor. The surgeries she performs always have a medical indication. "Many people think that a cosmetic doctor is the same as a plastic surgeon. But a plastic surgeon typically takes eighteen years to train, while a cosmetic doctor often only has basic medical training. Sometimes that can sound misleading. That doesn't mean cosmetic doctors aren't good at what they do, but there's a big difference between a plastic surgeon and a cosmetic doctor."

She continues: "Moreover, the distinction between cosmetic and medical isn't so clear-cut. Health insurers are becoming increasingly strict about what is and isn't considered medical. If a complaint or condition doesn't fall within very specific regulations, it can suddenly be considered uninsured and therefore cosmetic care. This is true even if the patient does have medical complaints. Within our hospital, we also offer cosmetic care under the name 'Fraaii'. Generally, in the Achterhoek region, you notice that patients only come when their complaint is already more severe, and that also applies to cosmetic surgery. The procedures here are often truly functional."

Jippes explains what her so-called operating room days typically look like. "The briefing starts at 7:50 a.m. and the surgeries last until 4:00 p.m. Unless there are emergencies or delays, it can happen that you're still working into the evening. Some surgeries take a long time, for example, because one patient needs multiple procedures. In those cases, we might set aside a whole day for them. And there are complex cases where we have two plastic surgeons at the operating table."

But the surgeon emphasizes that she's not operating non-stop. "I'm not a machine, and I also have to eat, drink, and go to the bathroom. That's why I take breaks during surgeries. Even if they're short. And yes, that means you leave for a while and come back later." Jippes understands that this might sound strange. She laughs and explains a bit further: "When I tell people that, they often respond, 'But there's someone on the operating table, isn't there?' That's true, but it's not like the entire operating room just walks away and the patient stays behind. An anesthesia nurse and an OR assistant always stay with the patient."

Jippes says she sees quite a few people a day. "During the outpatient clinic days, I estimate how long an operation will take. We also work with a system that calculates our workload. From that, I can determine how many patients I can operate on in a day. And then it depends on whether they're major surgeries or smaller procedures." For such a smaller procedure, a patient doesn't need general anesthesia; they're given a local anesthetic. "That means I might perform twelve procedures in one morning. That's really working hard," the surgeon jokes.

She continues: "With these kinds of local procedures, I sometimes feel like a happy hamster on a running wheel. We use two operating rooms and two anesthesia rooms, for example. I walk around in circles between those rooms and treat multiple patients at the same time. I'm like a happy hamster on my medical wheel."

But how do you stay focused during surgeries? "People might think it's strange, but some things are done on your spinal cord. That means you can talk, and yes, you can even ask each other about their weekends on the operating table. Then I don't have to be hyperfocused, and I'd even describe it as relaxing. But for some procedures, I have to concentrate really hard. There are actually three categories: procedures on your spinal cord, the concentration category where you can still talk, or full attention during difficult and complicated procedures. Then I tell everyone, for example, to be quiet."

Jippes continues: "But there are plenty of moments when you're talking with your colleagues. Then I'm focused on the operation, but the steps are completely ingrained in my system because I've done them so often. Just like brushing your teeth, you don't think about it anymore. I know exactly what I have to do, and my whole body responds to it."

Everyone has a bad day now and then, but what if the surgeon is having one? "During the morning briefing, we always ask if everyone is 'fit to perform.' For example, are you having back problems or do you have a cold? Then you can mention it. As a team, we'll take that into account. In that respect, I'm a real open book with my colleagues. If something's going on in my personal life, I'll share it at work too. Which is quite strange, of course, because we discuss those kinds of things on the operating table as well. And then the patient is just sleeping soundly. Think of it like that chat at the coffee machine."

The surgeon points out that things aren't the same in all hospitals. "I work in a regional hospital, where everyone knows each other. We genuinely help each other. For example, if I need a break in the operating room but can't get out, a colleague will bring me a glass of juice with a straw. Then I can occasionally get a drink through my mask."

Jippes lists everyone present in the operating room. “I always have a colleague from the anesthesia department who puts the patient to sleep. There's also an additional anesthesia assistant present. That assistant always stays in the operating room. There are also operating room assistants present. One of them walks around, is not sterile, and can point out things if necessary. The other operating room assistant is sterile. For some procedures, such as breast reductions, I have two assistants at the operating table. But at teaching hospitals, for example, there can be many more people in an operating room. Then it can get very busy with all the doctors in training observing.”

The surgeon calculates the average number of people she operates on each week. "I work 3.5 days a week. That means one week I work four days and the next week three. In a three-day workweek like that, I probably treat twenty people with local anesthesia and operate on seven people under general anesthesia. And then I have an outpatient clinic day in between. Then I see about 45 people, which is quite a challenge."

"We're just like people," the surgeon says, laughing as she describes her work. But where's the balance between being a doctor and being a human being? "I work long hours and do demanding work. That's why I have to be in good shape. For me, exercise is an outlet. And I have a family at home with two children, almost 6 and 10. Without my husband, the whole house of cards would collapse. He does so much. If I were to do this work full-time, it would be too much for me. Now I also have the opportunity to read a book every now and then, work in the garden, or be in nature. And I cherish my date night with my husband on Thursday evenings. I would recommend that to all parents: to schedule a time to eat together, exercise, or have a cocktail."

"My fellow plastic surgeon has also become a good friend," Jippes continues. "We worked together in Rotterdam, and she convinced me to come to Winterswijk. I can talk to her about all the things we experience. There's a lot of gray area in our profession. You can't always simply go left or right. You make so many decisions. And sometimes you ask yourself, 'Did I do it right?' I can spar with her about that, and that's very precious to me."

Has Jippes ever had to postpone a surgery? “I experienced that once. I had just returned from vacation and my stomach was quite upset. I had to leave the operating room because I felt unwell, and it only got worse. Then I had to decide not to continue with the surgery. I found that very difficult. I called the anesthesiologist to cancel. But of course, I also knew all the stories of the patients who still needed surgery. They had waited a long time for their surgery, and because of me, it couldn't go ahead. I found that awful. Fortunately, all the patients were very understanding. You're just human. But doctors struggle with getting sick. You're there to make people better, and we can't always grasp the fact that we can get sick ourselves. I know a lot of doctors find that difficult to accept.”

And in case you've ever forgotten the person behind the doctor, Jippes has something to say about that. "No doctor would intentionally do anything wrong. The intention of every doctor is to make someone better. Never to harm you. Sometimes, there can be quite harsh judgments when a doctor makes a mistake."

She continues: “I recently read a nice article in the Volkskrant. In it, three specialists spoke very honestly about a mistake they once made and the impact it had on them. "I think it's very difficult for doctors when something doesn't go the way you'd like. You always intend to do it right. But sometimes things don't go the way you'd hoped. Although I always try to be honest with my patients, people often don't get angry. They're disappointed or sad, but they appreciate my honesty. And I continue to connect with my patients. If I hear someone in the outpatient clinic talking about their son's wedding, I remember that and try to ask about it later. I find it's precisely the human touch of care that I appreciate."