About a week after the events in my previous post, we had another big case to do at that hospital. I quickly discovered the reason that the surgeons at this hospital, more than at many others, dread having to schedule a case on the weekend. From the look on his face, Jim, the weekend circulating nurse, regarded the mere existence of our patient and us as a personal affront – let alone our insane desire to perform surgery in the OR which he was trying to keep neat, clean, and organized.

I consider myself rather tidy in the OR. I don’t drop blue towels (sterile, used to dry your hands after scrubbing) on the floor unless there’s absolutely no container within a sterile-arm’s reach. I try to put paper trash into the bins, unless we’re in too much of a hurry, it would compromise the sterile field to do so, or the only bin is heaped full and on the other side of the room. In which cases I will let things go on the floor. After all, the whole place is going to be covered in a mixture of blood and dripped chlorhexidine (disinfectant used to prep the patient) by the end of the case, as well as the inevitable bits of tissue and cloths which slipped off the table. Moreover, the whole place will have to be cleaned in detail before the next case. Jim gave me a personal glare every time anyone dropped something on the floor. Apparently I was more accessible than my attending to be glared at.

Another point on which Jim and the surgical team (of which he could by no stretch of the imagination be called a member) disagreed was the relative priority to be assigned to filling in paperwork. Jim clearly felt that checking off all his boxes was number one on the list of things to be done that morning. I, on the other hand, tended to share my attending’s belief that handing in pro-coagulant supplies was more important for a patient who was bleeding copiously, and for whom blood loss was one of the two riskiest aspects of the case. We also tended to feel that bringing in clean instruments (eg, when a scalpel had been contaminated) was perhaps of higher importance than picking up every scrap of plastic which had made its way to the floor. As for getting the suction actually hooked up and working, Jim maintained such a scowl whenever the subject was mentioned (and was always so far behind on other important tasks) that we were obliged to proceed through almost the entire case without one. When Jim was finally relieved for lunch, his replacement gave the machine one quick push, and voila, working suction. Thanks, Jim.

At one point, as Jim walked slowly out of the room to look for supplies, trailing a string of obscenities, I murmured a question to the scrub tech, why the three of us (including the attending, nominally more powerful than a circulating nurse) put up with such filthy language and obstructive behavior. The answer was obvious. He held us hostage, inside the sterile field. Unless we were willing to bet that the five minutes involved in re-scrubbing would be less than the time wasted by his nattering, there was simply nothing we could do about his behavior. (As for complaining to the supervisor, I believe it’s been done; but this is a union hospital.)

When it got to the point where Jim was standing in the corner answering work-related inquiries on a portable phone, rather than walking to look for some objects which were absolutely essential to taking even one more step in the case, our scrub tech finally gave up, broke scrub, and ran out, to return with the items before Jim had finished his phone conversation. This was after the attending had repeatedly, politely but firmly, suggested that our immediate needs (sterile supplies, etc) were more important than his paperwork, to be met with a literal cold shoulder: Jim simply turned his back and kept on with whatever he had been doing.

The only thing that made the day bearable was the scrub tech, who was a miracle of cheerfulness, enthusiasm, and determination to get the job done, in glaring contrast to Jim. She didn’t complain about me and the attending asking for several things at once, as we tried to move as fast as possible through a major surgery on a patient whose precarious condition was further imperilled by extra time in the OR. In spite of being near the end of an incredibly long shift, she remained alert and helpful. There were literally no words good enough to thank her in without sounding melodramatic; but I tried.

(The patient did well, despite the obstacles. Enough strong team members can balance out the rotten apples, but at some cost in energy and cheerfulness.)