Learn to tie knots really well.

Admittedly, I’m a slow learner, but I was a couple of months into the year before I really grasped the meaning of a square knot, and I’m still working on how to pick up the threads so that they naturally fall into a square when I tie them. Privately with bare hands, and under observation in the OR with bloody gloves on, are two different things.

The nature of surgery is that the senior person is guiding what happens, and the junior is left doing a lot of the mechanical work: tying off vessels that the other surgeon has clamped, for instance. And believe me, they notice what you’re doing, especially the first few times you work with that attending. They notice how easily you tie, and how smoothly the knot falls, even if they don’t say anything.

One of the attendings interrogated me once: “Alice: can you tie knots well?” “Umm, I hope so, maybe.” “No. If you can’t tie, you’re no good to me. Can you tie knots well?” “Oh yes sir, absolutely.” “Okay, fine.” Later he told me, “If you can tie well, attendings will be willing to give you more to do. And if you can’t tie, they won’t trust you enough to let you do anything.” I’m pretty sure he noticed, because a few days later was one of my best days this year, during a liver transplant. I showed up just to watch, figuring that between multiple attendings and senior residents there would be no place for me, but they needed another pair of hands, and had noticed me hanging around their service whenever there was the slightest thing going on, and told me to scrub in. (I don’t think I want to do a transplant fellowship, but I’m fascinated by the surgery: the potential, the dramatic implications of taking organs from a dead person and using them to make another person stay alive, and the technical demands of the procedures.) So I got to help with the back-table dissection, and spent an hour tying dozens of tiny knots all over the specimen. That was one day, maybe because I knew it was vitally important, where my knots worked well.

If you’re in to surgery, you know how to get the clean left over sutures from the scrub techs at the end of a case (preferably the ones where you don’t conclude with blood and guts sprayed all over every inch of the instrument tables) and practice all over your scrubs and coats and pens and drawer handles. (The nurses like you better if you clean these off when you’re done.) I think it would be a great idea, though I haven’t managed it yet, to get some gloves to practice in.