The operating room with its bright lights, sharp steel and demanding scrub nurses is a land of mystery for most medical students. I have discovered there is an awful lot of anxiety about where to stand, what to do and generally how to act in the OR. Let me calm some fears with my simple tips on how to survive your first trip to the OR as a medical student.
1. Don’t Piss off the Scrub Nurse
It’s a common misconception that all scrub nurses are evil and that their sole purpose in life is to make life miserable for medical students. They actually have two purposes, making life miserable for medical students AND handing the surgeons instruments. In all honesty, the scrub nurse, just like everyone else, just wants to get through the case as efficiently and safely as possible. You, of course, are an obstacle to this and being the lowest one on the totem pole are liable to get some shit. Most of them are actually cool people and will help you out as long as you display a basic level of competency. Do this by:
- Knowing how to scrub and dry your hands. If your school doesn’t teach you how to do this a) that’s pathetic and b) YouTube it. When entering the OR make sure you keep your hands up/elbows down so that the water drips downward. Reach OUT for the towel. No fast moves brotha’! If in doubt, watch a resident/attending do it.
- Know your glove size. Remember, if you want to double glove then typically your innermost glove is a half-size LARGER than you would typically wear and your outermost glove is the proper size.
- Help them, help you. When preparing to gown hold your hands out straight at nipple level. As they present the gown to you SLOWLY push forward to help. With your left hand inside the arm of the gown pull the right arm of the gown up so that your right hand is partially exposed. The scrub nurse will present the right hand glove to you and you will slide your hand slowly in. You can use your, now sterile, right hand to pull up the left arm of your gown and partially exposed your left hand. The scrub nurse will present the left glove to you and you will slowly insert your hand. Someone will tie up the back of the gown, you will spin to secure the belt and you’re good to go. Now don’t touch anything! Again, sounds confusing, watch someone do it and it will become obvious.
2. Read Before the Case
In our program we provide the students with a list of cases for the next day and encourage them to split the cases up so that they can prepare for them the next time. I am AMAZED at how many of them do NOT take advantage of this and do not know even the most BASIC shit about the case when asked. Everyone is worried about being pimped in the OR. Prepare and you will do fine. There are two basic forms of questions:
- The “what song is this?/who invented this?” question that no one really expects you to know but thinks it’s cool when you get it right
- The basic question about the case including indications for the procedure, simple technical details and potential complications. These you should be nailing!
I seldomly hear a med student get asked a question that cannot be answer by a review of Surgical Recall and a quick look at the relevant anatomy. Take the time the night before and you will be well ahead of your (often lazy) peers.
3. Know When to Speak
This one sounds a little drastic, after all, this is ‘Merica right! There is a time and place for everything. If the surgeon is working expeditiously to control an arterial bleed it is not the proper time to ask what that muscle is over there. Additionally, if you come into the OR mid-case to tell the resident something, you generally want to wait quietly until they make eye contact with you (we know you’re there don’t worry) unless it is something that is urgent (when a chief walked quickly into the OR last week and interrupted the case I KNEW it was important).
4. Knot Too Long, Knot Too Short
See what I did there? It’s a running joke that no one can ever cut the knots the right length but there is some truth to it. In general BRAIDED sutures (vicryl) can be cut at or close to the knot. Simply slide the TIPS of your scissors down to the knot, turn them to a 45 degree angle and cut. Monofilament sutures (monocryl, PDS), which look and are slippery, should be left a bit longer, 2-3 cm. When in doubt, ask!
5. Get Comfortable
In my short tenure as a surgical resident I have learned a few things about operating, foremost, the OR never runs on time and cases always take longer than they are scheduled for. Like anything, preparation is half the battle. Eat and pee before the case. Wear comfortable shoes. I just got a pair of Sanitas (the original and still hand made Danskos) and they are like heaven for my knees and back during a “2-hour” fem-pop that turns into an 8-hour case. Proper footwear in the OR is important enough that I dedicated a whole article to it! When you are at the OR table stand comfortably, don’t lock your knees and don’t be afraid to rest your upper body on the patient (IF they are asleep!). Finally, IF you feel like you are going to faint step away from the table and sit down. There is no shame in taking proper preventative action. There IS shame in doing a face-plant into an open abdomen!
A few final words of advice. If it’s blue don’t touch it unless you’re blue! If you have questions, ASK! And seriously, don’t piss off the scrub nurse!