Tuesday, August 23, 2011

Scrubbing


Third year can be exhausting. When I was on my obstetrics and gynecology rotation, my car rolled into the hospital’s dim parking structure anywhere from 4:45 to 5:30 in the morning and I rolled out sometime between 5:00 and 8:00 at night. The time stretched between those two poles was like a slingshot propelling me from room to room, task to task—a frenetic scramble to stay on top of what my team was doing. But perpetual motion is good. Because pause gives sleep an idle target upon which to pounce. I remember one day in particular, when my knees buckled halfway through a 4-hour laparoscopic cystectomy. I could barely believe it myself, but after staring at a screen in the dark for 2 hours, sleep was upon me before I could sidestep its claws. I ended up catching myself with a startled yelp before I did something really embarrassing like wake up on the OR floor. My resident asked if I was alright, probably assuming I had tripped, because honestly that’s what it looked like. I quickly chimed “yeah, I’m okay.” The surgery went on. I was wide awake for the remainder.

Being in the operating room, or OR, can be tricky. Of course, staying awake during surgery is an obvious tip every student should keep high on their list of priorities. But there are a number of more delicate rules, most of which become habit over time. And this is precisely the problem. For surgeons who have scrubbed into thousands of surgeries, OR etiquette simply becomes nature. This means that trying to explain to fresh 3rd year students how to scrub into a surgery is like trying to explain to an alien how to order drinks and have fun at a bar. Even if you could verbalize all the proper steps, your alien is bound to forget something. And the results are always awkward and frustrating. So I decided to piece together some advice for anyone having to scrub into surgery for the first time. I present to you my very own medical triad:
  1. First—and most important—is come to peace with the fact that you will look like a complete buffoon the first half dozen times you scrub in. In every operating room, there is a field of items, including the patient, which are draped in blue. This is the “sterile field” in which the surgeons and scrub techs work. You will violate this sterile field multiple times in your first few surgeries, and people will scream things like “NO! Don’t do that!” but it will be too late. You will have touched the untouchable. Sterile will rendezvous with non-sterile. And the result will be great shame and condemnation. But 99.99% of the time, the patient will not die. So unless you are in the unlucky 0.01%, the best advice I can give is to be fully resigned to the fact that for your first few times scrubbing into the OR, you enter as an alien buffoon. So be okay with laughing at yourself. It’s a healthy defense mechanism.
  2. The only other real key advice is to make sure to wear your facemask ANYTIME you enter the OR.  Even if you are not scrubbed in—even if you are just peaking in for a millisecond to say “bye” to your gorgeous resident—put a facemask over your mouth. Your kisser is synonymous with a filthy oracle of doom that spews forth death and plague. If you remember this, you might avoid the lament of nurses and scrub techs everywhere. But you won’t remember this. And even if you do, the only difference is that you will be an alien buffoon wearing a facemask. 
  3. Tie your mask tight but evenly. But not too tight. Okay, there is really no way around the fact that your mask will slip into an awkward, uncomfortable position early into your first surgery, and you will stand for over an hour trying to adjust your mask using only the muscles in your nose and lips. Important Note: you CANNOT touch your mask with your hands after you have scrubbed in. Such actions will call forth hellfire and gnashing of teeth. I spent my second surgery, a vaginal hysterectomy, with my mask slicing upward into my eyeballs for what seemed like 2 hours. After the first hour, I began to embrace the possibility that I might go blind, but at least I was preserving the sterile field.
So really, what it boils down to is if you can successfully play the role of surgical buffoon for your first few scrub-ins without getting too down on yourself, you will get over the hump and the OR might even be fun. You will screw up, get yelled at, have to scrub and re-scrub until your hands are raw, and sometimes want to stick your tail between your legs. But if you are lucky, you will not gouge out your eyeballs via facemask. Then perhaps you’ll retain just enough of your vision to witness future buffoons walk in through the OR doors.

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