Today was my worst ever experience in an OR. The other interns must have had some sixth sense, because they all bowed out and offered to let me be the primary resident on the case. The trouble started when we walked into the OR (larger than most I’ve been in this year.) (And if some of the details sound stiff here, it’s because I’ve adapted the day’s mishaps to another common surgical procedure.)
“There are way too many of you in here,” the circulator, Cathy, snapped. “You’re going to contaminate everything. Get out.” (The sterile tables being safely against the far wall, some yards from we were standing.) The medical students got out. We interns acted as though we hadn’t heard, and started moving the patient onto the table (which required several people to accomplish safely).
“Ok, folks,” the attending said. “Straightforward lap chole here; in and out, one hour.” Which was making allowance for me being all thumbs. “By the way, Cathy, I’ll need opsites for the final dressing today. Knife, please.” No response. “Could I have a knife please?” No response. I turned around to the back table, where all the instruments still were, and handed him the blade. “Lap, please.” No response. The scrub tech and her student were both busy with something on the far end of the table, not really related to the current proceedings. I handed him a lap pad.
A few minutes later: “All right, let’s hook up the gas.” Hooked up, but no whoosh of air. “Is there a problem with the pump?” The circulator ambled over from her seat by the door and pokes the pump. At length, she discovered the ‘on’ switch. We’re in business.
“Grasper, please.” No answer. The scrub tech and her student were discussing whether it was time for the student to scrub out for lunch. (If it were the tech, I might remotely care; the student’s lunch opportunities are completely uninteresting, especially as, for some reason, she’s been standing stock-still the whole time, not even helping with obvious things like lap pads and 4x4s.)
Some time later, we needed a specific instrument, the plastic retriever, which is used routinely in most lap gallbladder cases. “This one’s got something wrong with it,” the attending announced. “It won’t close properly.” We examined it under the lights, but whatever was wrong with it was not amenable to being fixed right here. “Ok, let’s get another one.” Cathy left the room. A few minutes later, the phone rang. One of the students answered it. “She wants to know whether you want the plastic retriever.” We were a little at a loss for words. I’ve actually seen another instrument used in medical school, but in this city, this is the only instrument that could possibly be wanted for the case. In fact, the hospital doesn’t possess any other kind. We wondered what other type of retriever she was proposing, and where she would find it.
Finally, the last stitch in, it was time for the dressing. “Here you go,” the scrub tech announced brightly, convinced that she’s got something right. “Mastosol and steri strips.” “No, no, we need opsites today,” the attending answered. “Opsites?” You’d think neither the tech nor the circulator have ever heard of these commonly used wound coverings. “We don’t have any in here; let me go look.” Cathy came back with one tiny one. “Will this work?” “Not really, because we need to cover all these incisions!” the attending answered. “Oh, you mean you want them for wound dressings! You should have said so at the beginning of the case.” “I did,” the attending replies, through gritted teeth.
I’d give him more credit for his remarkable hold on his temper during this ordeal, except that the OR staff were clearly so apathetic, getting angry wouldn’t have bothered them at all. You can’t stimulate people who take no pride in their work. We got out of the OR three long, painful hours after starting, which was already three hours after the scheduled start time. I’m glad I don’t have to work at this hospital much. I can’t imagine how they get surgeons to voluntarily keep working here.
(Looking this over, I’m not sure whether it will make sense to nonsurgeons. The basic idea is that, without being egotistical, surgeons still expect the ancillary staff to have the same general goal as them, to wit, completing the case as efficiently as possible in order to minimize the patient’s time under anesthesia. In a well-run OR, the equipment is regularly maintained and usually works, the scrub techs try to anticipate what you need, or at least listen when you ask, and the circulator has at least a vague idea of what equipment she’s looking for. Having staff whose priority is discussing their lunch break schedules, instead of helping with the case, is a problem for the patient, not just for the surgeon’s preferences.)
Other than that, I’ve decided I need to learn to pick my moments, and join in the perennial feud between medicine and surgery. I walk away from my patient for a few hours, after carefully deciding that he’s stable, and really doesn’t need a central line, much as I would love to put one in – and come back to find a medicine resident putting in a central line. Without so much as a hello, let alone, “your patient has x y and z problems which will necessitate a central line.” What have I and my predecessors done to make the nurses not tell me about these problems? (And of course when my attending saw the patient in the morning, he was disgusted with medicine’s treatment plan and completely reversed it, thus making the central line completely unnecessary.) So I am going to start hovering over my patients, and standing up to the ICU team more. They put my patient at risk unnecessarily, and stole my procedure.