The 5 inch gaping abdominal surgeons incision that is.
Welcome, ladies and gentlemen to life as a junior doctor in an operating theatre.
Life within theatre is a bizzare melting pot of sterile, protocol-driven activites, James Blunt music and discussion over whether I should shave off my Movemeber beard. As someone who is a self-confessed NON-SURGEON, I must admit, I have kind of enjoyed this week. You see in a rare twist of events I was taken off the wards (not for something I had done!) and placed in theatre, as they were short of more senior doctors, to assist the Consultant Surgeon.
Consultants Surgeons by the way are the most feared and reveared people in the NHS. After their medical secretaries that is.
So there I am standing in my ill-fitting scrubs feeling as though my buttocks and thighs have been cling-film wrapped by the blue scrub material (they only had small mens scrub trousers left). I only realised the stupidity of the ankle swinger look later that day on the post-op ward round. Anyway, there I am 8.55am in theatre surrounded by 4 or 5 (I couldnt tell as they all run around so quickly) theatre staff laying out sterile operating equipment and preparing the patient who lay anaethetised with cool drugs that sadly they don’t let you play with as a junior doctor.
This is the thought that came to mind as the Consutlant Surgeon bellows “Well then Knight – get scrubbed”.
Getting scrubbed is a very formulaic procees of making yourself sterile.
No, not in that sense…
In the sense that I have to wash my hands and arms for 5 minutes in a set pattern that allows the water and bugs that may be living on my skin to run away from my hands. I then pat them dry from the hand to the elbow (you don’t want to take dirt from you elbow to your hand but we move any remaining dirt away from the hands). Then I stare at the opened scrub pack (by helpful theatre staff) which contains my scrub gown and gloves. I should add at this point that I am in a mask and scrub hat to avoid coughing over anyone. You slide into the gown and gloves (without touching the outside of anything!) and there you go – you are scrubbed and ready to operate.
That process takes me 10 minutes. A senior surgeon does it in 3 minutes (and makes you feel a bit slow and clumbsy in the process). The seriousness in being scrubbed is this. If I brush my gown on something NOT sterile i.e. a table or an non-scrubbed person….you DE-SCRUB i.e. remove everything and repeat the process. This is how we cut down on peri-operative infections.
Fast forward 30 minutes, and I leaning over the first patient with my Consultant Surgeon on the opposite side of the table. We are both closely examining this man’s groin area which we have happily cut open with a 5 cm slice thanks to an exsquisetley sharp surgeons scalpel. The consutlant comments that the transversalis fascia has a weakness causing the direct hernia to the medial aspect of the inferior epigastric artery. Now yes, I know what this means and undertsand the process and required actions to correct it (a mesh inserted into the inguinal canal sutured in place). However, staring down at this open cavity, I may as well have gotten out a magic eye as it all looked the same – gunk. A trained, experience surgeons eye is beyond impressive. As such I just noded and said a few words that suggest I agree and support his opinion. HA! As if he needs my validation!!
Fast forward another 30 minutes during which time I have been holding two langenberg retractors constantly. My shoulders are really burning at this point, my back killing owing to the 6 inch height difference between myself and my Consultant Surgeon and hence the operating table being well, basically on the ground, and then he says “Ok – you can close.”
The moment I have been waiting for. Time to shine!
“3/0 Vicyl, straight needle” I command with confidence to the scrub nurse who hands the surgeons their operating equipment. I stare at the surgeon-inflicted gaping hole. I pause – not in a dramatic, season finale of Friends way, but in a way that makes me consider myself very lucky I was able to do something so cool. Post non-dramatic pause, I put in the first stitch.
I breathe a sigh of relief – the stitch didnt kill the patient. Result.
Many stitches later, I have “closed the patient” (well, plus a few steri-strips as I left a bit of a gap in one part of the wound..).
I step away from the patient and look at the consultant. I feel proud of my achievement. A sense of anticipation in me builds up with the eye-contact developing between my consultant and I. Is he going to tell me that I did a good job?! I wait. The silence and locking eyes makes me begin to feel a little awkward..
“Go and consent the next patient”. Ah. Not quite the reaction I was hoping for.
As I leave and walk into the main hospital in my scrubs off to consent the next patient, I catch the eye of a few hospital visitors. I can’t help but smile for today my job felt pretty cool….
I’ll catch up with you all next week.