If you’ve never walked into an OR, it can be intimidating. There’s a bunch of people (mostly staring at you or actively ignoring you) who know what they are doing and clearly you do not.
You know that if you mess something up even inadvertently, you’ll be crucified. It’s a little nerve-wracking. So, I thought today I’d take you on a quick tour.
For me, the scariest part was always identifying the surgeon.
I remember my preceptors saying, “There is a vascular case at 10:30 with Dr. K Rotid. He won’t mind having you, but hurry down and ask him if you can scrub on his case.” I’d just sort of mull it over. Should I just run for my car now? Maybe head to lunch and just say I saw the case? They don’t care about me. They probably won’t check to see if I was there. In the end, I’d drag myself to the OR admissions and begin my search.
There are gaggles of people you don’t know. There are clues as to who the surgeon is, but they can be subtle and easily misread. I compare it to asking a woman if she is pregnant or when her due date is. There are clues, but you if you’re wrong it’s a little uncomfortable. There is one fail-proof way to discover the identity of the surgeon, and it’s so simple William of Ockham would be proud. Here it is in one word.
Ask.
“Hi, I’m Brian a PA student, and I’m looking for Dr. Neeskope. Can you help me?”
Simple and straight to it. You can’t look foolish using this technique. You can look foolish lurking in the corner trying to guess and keeping to yourself. People will say yes or no, but usually, they will point you toward an answer even if they can’t help you.
“Hi, Dr. Neeskope. I’m a PA student, and Jennifer sent me to observe your case today if that’s all right?”
“Yes, of course.”
“Would you mind if scrub? They want me to get as much experience as possible.”
“You’ll probably see just as much just watching the screen, but if you want you can scrub.”
“Thanks that would be great.”
Always take any opportunity to scrub. Scrubbing and standing there is learning. You may not feel like it, but you’re getting experience scrubbing and being sterile. It isn’t just about the surgery. It’s about your entire experience.
How to glove and gown is important even if you’ve done it a million times. On top of that, if a chance to do something does come up you’re ready. If you’re sitting in the corner watching a monitor, no one is going to ask you to hold the camera. No one is going to ask you to sew.
Scrub so at the least you LOOK like you’re interested
Let’s talk for second about the rest of the people in the room. Once you get in, who is everyone? I was in a C-section the other day, and we had TEN people in the room. TEN, and that didn’t count mommy and daddy. Crazy.
Surgery is a team sport, so let me run through the positions for you.
1. Anesthesiologist
a. CRNA – certified nurse anesthetist who works with the doc, kind of like a PA for anesthesia. They are in the room the whole time, and this lets the anesthesiologist manage 2 or 3 rooms at a time.
2.Surgeon – we covered that
3.First Assist
a. PA
b. Resident
c. RNFA – Registered Nurse First Assistant
d. A second surgeon
e. You
4. Circulating nurse
a. This is the nurse who runs the room. He has a million jobs. He gets the room ready. He documents what goes on during the case, and he is the non-sterile person in the room. Meaning if we need something at the field that we don’t have, the circulating gets it and puts it on the field. They are also in charge of making sure all of the counts are correct.
5.Surgical Technologist (scrub tech) / Scrub Nurse
a. This may either be a tech or a nurse. This is the person in charge of sterility and equipment. This is the person who HATES you because you are a threat to sterility. This is the person you most need to demonstrate your good upbringing and your competence to. Pleases and thank yous go a long way.
There are more positions as things get more complicated.
-X-ray tech
-2nd scrub
-Nursery Nurse
-Neonatologist
-Equipment rep (Please don’t blow these guys off. They are integral to the surgery and can be your best resource for learning in the room. They will typically love to talk with you about the surgery. They will have the best images and models to help you understand what’s going on. All you have to do is be nice and ask.)
The easiest way to get comfortable in the OR with all of these people is back to the simple plan your grandmother would tell you to use. Introduce yourself. Now, your preceptor should get the ball rolling, but really it’s up to you.
Again, this is simple. “Hi, my name is Brian. I’m a PA student, and I’m going to be scrubbing on Dr. Neeskope’s cases today. Is there anything I can do to help you?”
Who’s going to be grumpy with you if you lead with that? That is much different from slinking into the room and hiding in the corner until someone speaks to you. You can use that line on anyone in the room even if you have no idea what position they play. Is it a problem to say that to the anesthesiologist? Of course not. Is it a problem to say that to the scrub tech? Of course not.
It can only help.
The OR is a team sport, and so is PA school. If you’ve been thinking of getting yourself a copy of The Final Step, consider helping out YOUR entire team. I offer drastic discounts for group order. Shipping is my biggest expense, and, if I can ship 10 books to one place, I can pass that savings along to you. If you reach out to me and we set up the group order, your book is on me. Yup, 100% free. That helps cover the little bit of work it takes on your end.
So by helping your team, I mean selfishly help yourself get a free book. I always help with turnover between cases. The nurses think I’m such a nice guy. Now, I am a nice guy, but the real motivation is that I go home faster if we get through the day faster. It is a 100% selfish act that has the added benefit of winning the affection of my coworkers and this is no different.
You get a free book AND the love and admiration of your peers.
I’m in the middle of two group orders now for different schools, and it’s a great way to get TFS at a huge discount. Just hit reply, and I’ll shoot you the easy steps to get it done.
Thanks.
Brian Wallace