All Dressed Up, Nowhere to Go

Are you essential to the running of the OR? Will your skills be of any value?

Of course not.

On the other hand, just because you don’t know your ass from a hole in the ground when it comes to surgery does not mean that the team does not want you there. On the contrary, because everyone likes to show off to an appreciative audience your attendings and residents will be happy to have you there even if they will occasionally poke fun at you.

You would have to be a hoary old misanthrope not to appreciate the opportunity to demonstrate what you do well to someone who has not seen essentially the same resection of the colon fifty times. There is a certain thrill in impressing the new guy and, believe me, you will be impressed.

While it is true that many surgeons have personalities that would make Ghengis Khan wince in shame, there is no denying that over the course of their training they learn amazing skills. Be appreciative but do so silently because, as I have said elsewhere on this blog, nobody likes a tool.

Don’t be a tool.

So there you are. Scrubbed in. Ready to go. At this time if no one has told you, you should ask your resident or attending where she wants you to stand. Usually you will stand to the right of the attending. The resident will stand across the patient from the attending. This is not written in stone as sometimes it might just be you and an upper level resident loosely superivised by an attending who may or may not think it necessary to scrub in.

Your job now is to keep you mouth shut, your eyes and ears open, and to above all not do anything stupid. Leave your ego at the door. Being silent and respectful neither makes you a suck-up nor a tool. Do not take any good natured ribbing personally. Hell, don’t take anything personally.

I have a friend who’s attending threw him out of the OR after cursing at him and then throwing a few (non-sharp) surgical tools at him. He had forgotten to take off his ring and the attending could see it under his glove.

In a situation like this, do you go to your school’s office of cultural sensitivity and file a complaint? Of course not. He’s a surgeon. His personality, failed marriage, and long hours are more than enough punishment. All you will do is establish a reputation as a cry-baby and somebody who can’t take the heat. At the very least my friend always remembered to take of his ring so we can probably file the whole incident under “learning experiences.”

I keep coming back to not being a tool. For your surgery rotation more than any other you wil have to grow a thick skin as this is the rotation which cares the least for your hopefully non-fragile ego.

If you are asked to hold something hold it. In fact, your primary job will very likely be to hold retraction which usually involves holding body cavities open. Either that or to hold up limbs during orthopaedic procedures. Not too much else, if even that, will be expected of you until you show a little bit of interest and a little bit of the ability not to crush important organs.

Sounds easy but occasionally you will hold retractors for what seems like and often is hours. Pick up a light book and hold it out at arms length. See how long you can do it. That’s what holding retraction can feel like.

No doubt your school will have a suture lab during the end of second year at which time you will learn the mysteries of both suturing and knot tying. Pay attention and practice on your own. It is unlikely that you will be asked, on your first day, to close an incision but you might be asked to tie a few knots and nothing says “loser” quite like not being able to tie a simple sugeon’s knot. If you can do it, on the other hand, don’t expect any accolades. It is a basic skill, after all.

You might also be asked to use the suction catheter to keep the surgical field clear of blood and fluid. Watch what the resident does and imitate him. Do not poke and prod randomly and when in doubt, ask.

Invariably as the hours creep by your legs will get tired, you will itch all over, and you will regret skipping breakfast. Or nature will call with increasing urgency. Tough luck. You will just have to gut it out.

A few pieces of random advice:

1. Don’t lock your knees.

2. Do not doze off and fall into the surgical field. It can happen. Some operations are long and boring especially if you are not actually doing anything but watching.

3. Eschew the extra cup of coffee in the morning.

4. Turn off you pager. Residents and attendings typically put theirs on the board in the OR so the circulating nurse can answer their pages but you are just not that important.

5. Study the relevant anatomy before the operation. Typically you will look at the OR posting sheet the night before to determine where you will be. At the very least have a copy of Netter’s in your locker so you can quickly brush up on the arteries supplying the colon or anything else you might be asked by way of pimping.

6. Be scrubbed in and ready to go before the attending. This is not always possible but you should do it if possible.

7. Try to relax. Remember, as a medical student you have no real responsibility. Whatever happens you will be done with the rotation in a matter of weeks. If you don’t like it, tough it out.

8. If you really don’t like it surgery more than any other rotation offers you abundant opportunities to “hide and slide.” There are a thousand reasons, some of them actually quite good, not to scrub in on cases. In the end nobody will really keep that close track of you and you are only depriving yourself.

With that being said I had a friend who knew that he wanted to do psychiatry and nothing else so he saw absolutely no reason to to get jiggy on his surgery rotation.

let your conscience be your guide.