Breaks during an operation

[adoggie]

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Does anybody know if surgeons are allowed to take bathroom breaks or anything like that while operating? I suppose it would depend on your role, and the immediate condition of the patient, but in general... are breaks permitted?

 

[smq123]

Does anybody know if surgeons are allowed to take bathroom breaks or anything like that while operating? I suppose it would depend on your role, and the immediate condition of the patient, but in general... are breaks permitted?

If you're a medical student and you're not scrubbed in - technically you could come and go as you "chose." That obviously depends on how upset your resident is going to get if you decide to waltz out of the OR just because you're thirsty.

If you're scrubbed in on a case - you really don't take breaks to pee, drink, or eat. And you don't scratch yourself or blow your nose either, because you'll contaminate yourself.

 

[Pir8DeacDoc]

Sort of depends on what field you're in and what the case is that's going on. It always seemed to be a badge of honor not to ever take a break in General Surgery cases. Where I am now in ENT, people will scrub out during really long cases if the case lends itself to a natural break. Taking a leak and getting a quick bite isn't a sign of being weak. Clears the mind and refreshes the body, probably makes the case go quicker and more smoothly.

 

[smq123]

Sort of depends on what field you're in and what the case is that's going on. It always seemed to be a badge of honor not to ever take a break in General Surgery cases. Where I am now in ENT, people will scrub out during really long cases if the case lends itself to a natural break. Taking a leak and getting a quick bite isn't a sign of being weak. Clears the mind and refreshes the body, probably makes the case go quicker and more smoothly.

I guess it's surgeon dependent too - my friend said that, on his ENT rotation, one of the surgeons gave one of the residents a hard time for having to break scrub and get some juice. When the resident came back into the OR, the surgeon said very sarcastically, "Well, hopefully, you'll be able to concentrate and actually be useful now." Yeesh.

 

[THP]

I have been scrubbed when general surgery attendings had to go take a pee break. He made me and the resident stay. When he got back he sent the resident to go pee. When the resident got back the case resumed. Guess who nobody thought about might need to pee. . .

 

[Pir8DeacDoc]

there is never an indication for a medical student to break scrub. 😀


It's sort of silly how we have so many rituals in surgery, but such as the territory I guess.

 

[maxheadroom]

In Plastics it's pretty common to take a break or two during a free flap. Usually I'll take a break after I raise the flap (before I divide the pedicle) and let it perfuse for a few minutes. We also typically will take a break after the micro is done and let the flap perfuse for a few minutes before doing the final inset.

 

[BlackSails]

While watching a private practice CABG, the attending scrubbed out to get a bite to eat while the PA was harvesting the saphenous vein.

 

[Blade28]

Like others have said, it depends on the attending/fellow/resident.

There have been times the attending will break scrub to check on another room, go to the bathroom, get a snack, etc. But this has only happened a handful of times during the cases I've scrubbed, and only for the longer (6+ hours) ones.

The longest case I've ever scrubbed into was a 19-hour redo-redo-AVR 😱 - and after around 13 hours we took a break to drink some juice. The attending went to the bathroom and ate a sandwich. That's it.

 

[johnny_blaze]

The longest case I've ever scrubbed into was a 19-hour redo-redo-AVR 😱 -

19 hours to do a redo AVR! how the hell did it take 19-hours to do that? 😕 I've seen the paed cardiac guys remake the entrire outflow tract in much much less time then that. Even the big thoracoabdominal aneurysms dont take that long to do.

 

[ExtraCrispy]

You'll find that when you're actually doing the case, as opposed to standing around watching or retracting as as a student, the time passes much more quickly. You're so focused on the next step that the little things like aching calves & bladder urgency just don't present themselves as problems.

Of course, if you're talking a 12-hour Whipple, after hour 7 or so those little annoyances resurface. 🙂

 

[Blade28]

19 hours to do a redo AVR! how the hell did it take 19-hours to do that? 😕 I've seen the paed cardiac guys remake the entrire outflow tract in much much less time then that. Even the big thoracoabdominal aneurysms dont take that long to do.

New attending with a super-fellow (was in the 3rd year of his 3rd fellowship...PGY-16!!!). Lots of conflict there, #1.

#2, case started at around 8 am, originally finished at around 4 pm. Then we spent the next 3 hours following large chest tube outputs while Anesthesia struggled to keep up with blood, FFP, platelets, cryo, Factor VIII.

By around 7 pm we made the decision to reopen the chest.

Got into lots of bleeding, shredded aortic root, etc. Had to use the paddles a couple of times (luckily the patient was a relatively healthy young man).

Didn't bring the patient up to the SICU until around 3:30 am. 😱

 

[NDESTRUKT]

3 fellowships? in what?!

 

[johankriek]

19 hours to do a redo AVR! how the hell did it take 19-hours to do that? 😕 I've seen the paed cardiac guys remake the entrire outflow tract in much much less time then that. Even the big thoracoabdominal aneurysms dont take that long to do.

They ****ing suck dude.. have you ever heard of that.. someone taking twice as long to do anything.. they ****ing sucked.. there are ****ty surgeons who ****ing work in slow motion you know..

 

[johankriek]

New attending with a super-fellow (was in the 3rd year of his 3rd fellowship...PGY-16!!!). :

Im sure at the begiinning of his progress note he put down PGY 16 admit note.. LMAO.. By the time he finishes his fellowship he will have to retire.. because there will be no cardiac jobs.. LOL
and nobody will hire him because he will have BPH and will have to go to the bathroom all the time LOL

 

[Blade28]

3 fellowships? in what?!

2 adult CT Surg fellowships, 1 peds CT Surg fellowship.

 

[johnny_blaze]

New attending with a super-fellow (was in the 3rd year of his 3rd fellowship...PGY-16!!!). Lots of conflict there, #1.

#2, case started at around 8 am, originally finished at around 4 pm. Then we spent the next 3 hours following large chest tube outputs while Anesthesia struggled to keep up with blood, FFP, platelets, cryo, Factor VIII.

By around 7 pm we made the decision to reopen the chest.

Got into lots of bleeding, shredded aortic root, etc. Had to use the paddles a couple of times (luckily the patient was a relatively healthy young man).

Didn't bring the patient up to the SICU until around 3:30 am. 😱

ouch... that must of hurt. aortic root revisions can take a hell of a long time, especially following surgical error.

 

[johnny_blaze]

They ****ing suck dude.. have you ever heard of that.. someone taking twice as long to do anything.. they ****ing sucked.. there are ****ty surgeons who ****ing work in slow motion you know..

Where I’m from you don’t make it into CT surgery by being a bad/slow surgeon. And for someone who claims to be an attending, you speak very obscenely

 

[Blade28]

ouch... that must of hurt. aortic root revisions can take a hell of a long time, especially following surgical error.

Yes, it did hurt. Strangely, my feet/legs/back were fine (maybe from excitement?). Didn't have to go to the bathroom. Wasn't sleepy. Wasn't even really hungry or thirsty. Just restless and ready to take the patient to the SICU already! 🙂

In the end, it makes for a good story.

 

[johankriek]

Where I’m from you don’t make it into CT surgery by being a bad/slow surgeon. And for someone who claims to be an attending, you speak very obscenely

i dont know where you are from .. but ive seen plenty of marginal CT surgeons and they really piss me off.. Because if you are gonna do something make ****ing sure you are damn good at what you do.. please for petes sake..

 

[Misterioso]

I was scrubbed in on a case with the attending and resident. The attending broke scrub and told the resident "Don't f#@k anything up while I'm gone". Those were like the only words he spoke to the anyone during the entire case except when he yelled at the resident for moving too slow. It was great.

 

[THP]

I was scrubbed in on a case with the attending and resident. The attending broke scrub and told the resident "Don't f#@k anything up while I'm gone". Those were like the only words he spoke to the anyone during the entire case except when he yelled at the resident for moving too slow. It was great.

Sounds like a real barrel of laughs.

 

[Misterioso]

i dont know where you are from .. but ive seen plenty of marginal CT surgeons and they really piss me off.. Because if you are gonna do something make ****ing sure you are damn good at what you do.. please for petes sake..

It's because most CT fellowships go unfilled these days and they'll take anybody they can get. Before they used to take only the best graduating general surgery residents so you had top quality guys going in. But now that those top-notch residents realize there probably won't be a CT job waiting for them (or one that'll pay more than a family practicioner) they don't bother with CT fellowships and go into something else.

 

[Misterioso]

Sounds like a real barrel of laughs.

It was great dude. This is the same surgeon I was telling you guys about who doesn't acknowledge anybody. So it was funny hearing him finally acknowledge the resident, but it was to tell him not to screw it up. The other funny time was when there was another med student scrubbed in and she thought she'd be slick and ask him a question during the case to show her "interest". He completely and utterly ignored her and her question as if she didn't even exist.

 

[NDESTRUKT]

It was great dude. This is the same surgeon I was telling you guys about who doesn't acknowledge anybody. So it was funny hearing him finally acknowledge the resident, but it was to tell him not to screw it up. The other funny time was when there was another med student scrubbed in and she thought she'd be slick and ask him a question during the case to show her "interest". He completely and utterly ignored her and her question as if she didn't even exist.

sweet...kind of like how he doesn't know you exist either eh? at least you're marginally intelligent enough to not piss him off by talking...even fools show their wisdom when they keep their mouth shut!

 

[BullsOnParade]

It was great dude. This is the same surgeon I was telling you guys about who doesn't acknowledge anybody. So it was funny hearing him finally acknowledge the resident, but it was to tell him not to screw it up. The other funny time was when there was another med student scrubbed in and she thought she'd be slick and ask him a question during the case to show her "interest". He completely and utterly ignored her and her question as if she didn't even exist.

Sounds like medical education has served you well. What utility is there in being placed with a surgeon who doesn't give a damn about teaching? Are you content just to bask in his presence for hours? That's pathetic. You're better off watching OR-live.

 

[johnny_blaze]

i dont know where you are from .. but ive seen plenty of marginal CT surgeons and they really piss me off.. Because if you are gonna do something make ****ing sure you are damn good at what you do.. please for petes sake..

I’m based in England and over here CT surgery is still very very competitive and you definitely have to be a member of the old boys club to get in. no room for ****ty surgeons I’m afraid. So the CT surgeons here are very good at what they do... especially since their mortality results are available for the public to view!

 

[johnny_blaze]

Yes, it did hurt. Strangely, my feet/legs/back were fine (maybe from excitement?). Didn't have to go to the bathroom. Wasn't sleepy. Wasn't even really hungry or thirsty. Just restless and ready to take the patient to the SICU already! 🙂

In the end, it makes for a good story.

I was once involved in a long cardiac case. It was a supra-annular type a dissection. The echo showed a normally functioning aortic valve so a yacoub remodelling procedure was done. The patient had to be re-explored later that night due to output insufficiency and another echo showed aortic insufficiency and bleeding from the distal suture lines! A modified bentell then had to be done with an AVR. In total it must have taken about 11 hours but we did have a bit of a break in between.

 

[Winged Scapula]

Breaks are one of the benefits of intraop frozen sections!😀

 

[PediBoneDoc]

i do about 2-4 cases a month that take 8-10 hours. at the noon mark, i usually tell the resident to go to the restroom, grab something to eat and drink and come back. after they return, i will go. i have found that this helps with speed of the operation. when you are dehydrated and have to go to the bathroom, the case does not flow smoothly. these breaks help you to refocus.