When surgery is performed outside of an operating room or appropriate surgical unit, because it's an emergency
Alternative name: ER is an OR, Operate In The ER or something like that. Indexes: Medical Drama, Rule of Drama, Artistic License – Medicine, Medical Horror, Healing and Curing Tropes, Doctor Index, Injury Tropes, Drama Tropes, Television Is Trying to Kill Us, WeAreNotAlone.Tropes Q To Z (PHEM).
Dr. Edwards: We almost did a thoracotomy in the ER.
Dr. Grey: Yeah, this bought us some time.
Dr. Edwards: No, I mean we almost got to do a thoracotomy, in the ER. Which, you know, would have been amazing. [...] 'Cos, I mean, how many times do you get to operate outside the operating room?
Dr. Webber: Okay, for the record, it sounds fun, until you do it.Your standard Medical Drama will have a lot of emergency surgeries, most of which take place in an OR (the cooler sounding name for a simple operating room). But then, not all medical dramas focus on a surgical team. And let's not forget about the Rule of Drama. One way to get the right pulses racing is to have a Matter of Life and Death time-sensitive surgery and no place to operate... except where you are right now. The most common perpetrators are in an ambulance or ER/trauma center (A&E/Casualty in the UK), but occasionally your doctors will have to operate in an abandoned warehouse, in the back of a taxi, or stranded in a forest. It is also done in non-medical shows, or by characters other than the doctors in the medical show if necessary (usually leading to a big story about fixing the fix), with the emphasis being on the emergency situation causing them to need to bend procedure. Often, a Backalley Doctor will have to operate in a literal back-alley, and rarely if ever an OR — since that's normal for him, and part of the characterization, those instances go there. This focuses on the story element of an unconventional surgery location and the associated drama, this drama constituting the danger of a necessary and immediate surgery; not having a suitable place and having to do the surgery out-of-OR; and the risks from performing surgery at that place. See also Meatgrinder Surgery, a similar trope about operating without proper surgical tools, and Open Heart Dentistry, for when you can't find an appropriate physician for the surgery but get someone else with advanced medical training. Super Trope to Instant Drama, Just Add Tracheotomy, when the specific surgery in this situation is a tracheotomy, and Self-Surgery, when the specific surgeon in this situation is the wounded body. In some cases this might overlap with After-Action Healing Drama, if the rush to get to medical personnel is forgone for a rush to just heal. And PSA: No matter how many episodes of Grey's you've seen, please Don't Try This at Home.
— Grey's Anatomy, "There's a Fine, Fine Line"
Examples:Film — Live Action
- An Army Ranger medic from Black Hawk Down tries to save a fellow Ranger with a horrific leg wound. The medic needs to install a bridging shunt in the patient's femoral artery to keep him from bleeding to death. The surgery has to be performed on a rickety table in a derelict building while the local warlord's mooks are searching for them.
- Homer Wells from The Cider House Rules grew up in an orphanage, and was being groomed to follow in the footsteps of Doctor Larch. While earning a living on an apple farm, Homer discovers young Rose is pregnant with her father's child. Because Rose is black, getting a proper medical abortion is highly unlikely. Therefore, Homer agrees to perform the procedure in the pickers' shack (the cider house), using the skills and training gleaned from Doctor Larch.
- Master and Commander: The Far Side of the World:
- One sailor receives a serious head wound during the first battle against the Acheron. The ship's physician performs open cranial surgery on the man on the main deck in broad daylight because operating lamps haven't been invented yet. This includes using a silver coin to patch the hole in the man's skull.
- Junior officer Blakeley suffers severe damage to his right arm after the third skirmish against the Acheron, which necessitates amputation at the mid-humerus without anesthetic, just a shot of whiskey. Blakeley is awake and aware of the procedure, including the dreaded bone saw. Hospital escort ships hadn't been invented yet, and a sick bay was a rare luxury too good for the Surprise.
- In the 29th Animorphs novel The Sickness, Cassie has to perform brain surgery on Ax in her barn in order to remove his Tria gland, as he's an Andalite and thus it would be impossible to get a surgeon to operate without causing a lot of problems.
- Casualty is set in an accident and emergency department, but the resuscitation room may as well be made an OR with how often it gets used for this. As the world's longest running medical show, it's hard to list instances, but one of the best has to be in the 2009/10 run when Sean and Nick have to operate on Adam, Jessica, and their kids after getting in a car crash that results in spinning off the road into a frozen lake. The hospital they work at does have an OR, but apparently emergent trauma has to go through the casualty before anything else.
- The Good Doctor: In the first episode, Shaun has to perform surgery using a bottle of whiskey in an airport. In the third episode he operates on an ex vivo transplant liver on the trunk of a cop car.
- Grey's Anatomy:
- Most of the time Grey's is focused on the ORs, but kudos go to the time that a man had to amputate his wife's leg down a sinkhole with Callie giving him directions.
- And let's not forget Meredith having to operate on Mark and Arizona in the forest after the plane crash.
- There's also a storyline where they have to train general practitioners from Syria to be able to operate in a war zone without proper tools — the trifecta.
- In season 12, there's an episode all about this. After a Code Pink is called and the hospital put on lockdown, the residents all get stranded with patients. Ben performs an unnecessary emergency caesarean in the hallway, while Steph laments that she almost got to do a thoracotomy in the ER — asking how often people get to operate outside of an OR, with Webber telling her it's not as fun when you have to do it.
- In one episode of M*A*S*H, the Catholic priest Father Mulcahy must perform an emergency tracheotomy by the side of the road in Korea using improvised equipment. He's given instructions over the radio by the doctors back at the 4077th.
- Surgeon Simulator 2013 plays it for laughs, by having Nigel - the highly inept surgeon you're playing as - performing surgery in various, less-than-ideal situations. This includes an ambulance with a crazy driver, him running down a corridor, or operating while in space with zero gravity.
- Trauma Center
- Trauma Team
- First response is all about this, light surgery to deal with problems on site ASAP and buying time for proper care.
- A few coleoscopy levels are set outside of the hospital, including one where you navigate through rubble at a disaster site.
- In 2014 a London Air Ambulance crew used a new method (Reboa) of preventing blood loss on a patient involved in a large RTI. The method involves open heart surgery, and the patient survived.
- In 2016, an Australian doctor took a wrong turn and discovered a catastrophic truck collision in the middle of nowhere, and called for emergency services. When they arrived, they asked the doctor to stay in case they needed help and firefighters freed the truck drivers. A paramedic attempted to decompress the chest, without luck, and called the doctor over. He then cut open the man's chest cavity, called his attending, and continued surgery to relieve it. The doctor says that, really, anyone with the same skill in the same circumstances would have done the same.
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