I have a question about surgery tools and the OR room, can any med students help?

Jun 5, 2020
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Hi everyone. I am new here, nice to see you! I am a student aspiring to be in medicine.

I had a few questions and am wondering if medical students with clinical experience could shed some light.

I unfortunately have a bad sensory issue when it comes to metal things clanking against one another. (Such as metal utensils touching each other, metal spoons touching metal bowls, etc).
Would that be an issue in surgery? As I am very interested in surgery. I don't have a problem holding stainless steel objects or the sound of drills going into areas such as bones, etc. I just don't like when the metal objects touch each other. This has been an issue all my life.


My second question is, how sensory intensive is the OR, would you say? As I am prone to sensory overstimulation but am not sure if the OR would be a good or bad place for me. I have never been in the OR before, so it is hard for me to gauge.

Thank you very much
 

Cawolf

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There are lots of good videos of actual surgery on YouTube - that might be a good place to start to see what you think. There is quite a bit of stapling and cautery in general surgery which can be loud. As far as general sensory, I think the OR can be controlled and quiet, or the extreme opposite in some emergent cases when things are not going well. To generalize, I think that all of the major senses are stimulated (except hopefully taste) during most surgical procedures.
 
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operaman

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Hmmmm I think metal on metal would be fairly uncommon. Most containers are disposable and most metal surfaces are covered with sterile towels and drapes. I’ve actually had a hard time finding old fashioned metal bowls when I’ve wanted to hear the clang of a bullet or metal foreign body after removal!

There will surely be occasional metal on metal sounds but probably not that often. Definitely worth some shadowing in the OR to see if the sensory levels are tolerable.
 
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the negative 1

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I agree with shadowing someone in the OR. Every case is different, but you'll get a general sense of your tolerance for certain sounds.

I feel I'm pretty hyperaware of sounds around me and like a quieter OR when I'm operating. With time, I've learned to tune out the environment around me and am much less bothered these days by extraneous sounds.

My bigger pet peeve these days is having cords near my feet.
 

nlax30

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Definitely agree with trying to watch some actual OR videos and do some shadowing.

General noise environment can vary widely depending on the case and staff/culture. Ultimately as an attending you could set the tone though until then you’d have to put up with wherever you end up for training.

IF you are truly interested in surgery and if this is a big issue then maybe seeking professional help to see if some sort of therapy, (? Desensitization, cognitive) would help reduce the reaction.
 
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longhaul3

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You will definitely hear metal on metal. Almost any surgical instrument that clamps has a simple ratcheting mechanism that I imagine would bother you pretty badly based on what you explained. The tables are also metal, and, even though they're covered in drapes and towels, setting down a metal instrument on them will make that sound.

The trays that instruments are sterilized in are metal, and the 20+ instruments in any given tray will all clang against one another any time the tray is moved. On top of that, the sterile tray itself is inside of a nonsterile metal tray for transport to the OR. Furthermore, these trays are transported to and from the OR in large metal trolleys.

Any sort of implantable surgical hardware (e.g. spinal instrumentation) will come in a sterilizable metal cage with an assortment of tools and loose parts. These will also be metal and will clang around cacophonously whenever they are moved. When they are implanted, especially into bone, they will often be hammered or screwed in using metal tools (though many mallets are plastic).

Retractors are also usually metal and frequently come into contact with the instruments in the operative field. Many retractor systems are also designed to be used hands-free by attaching to other large pieces of metal that are anchored to the table.

All that said, ORs can range anywhere from absolute mayhem to blissful serenity. I agree with everyone else that you should shadow and see how it goes. I would advise you not to tell anyone in the OR about your issue because as a new med student you will be judged for it. If it's unbearable, just excuse yourself politely or leave without saying anything. Unfortunately, even if you hate it, you will still have to live with this issue for a few weeks at minimum for your surgery clerkship unless your school provides some sort of accommodation. If you hate it and you still want to do surgery, you should seek professional help for it.
 
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kb1900

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Metal on metal happens all the time. Maybe if you’re the attending you have some control over it but other than that, I don’t think it’s reasonable to avoid it
 
Jun 5, 2020
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Thanks, everyone!! Seems like a mix!
I generally wouldn't have an issue with the tables being metal or the tools coming in packages together. I have seen a few videos and it doesn't seem like surgeons use tools against tools, but I did want to make sure.

I do have an opportunity to shadow but I was thinking I should do it when Covid 19 calms down a bit more.

Thanks everyone! I'm going to watch more surgery videos. Great idea.
 

efle

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Metal on metal was frequent in every OR I was in. Especially in fast paced cases like C-sections where it can get loud. There is also a ton of other stimulation you might not be aware of - the smell of sizzling human while cauterizing, sweating like a pig because the OR is warm and you're under a gown, MSK aches from retracting in weird ways for long periods (looking at you, uterine manipulation), music you might hate being the attending's favorite and on for the whole case, and some pretty gruesome sights and sounds depending on the types of cases (I'll never forget watching spleen and fibroids be morcellated).

Definitely try to shadow in an OR or at least watch some youtube!
 
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kb1900

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Metal on metal was frequent in every OR I was in. Especially in fast paced cases like C-sections where it can get loud. There is also a ton of other stimulation you might not be aware of - the smell of sizzling human while cauterizing, sweating like a pig because the OR is warm and you're under a gown, MSK aches from retracting in weird ways for long periods (looking at you, uterine manipulation), music you might hate being the attending's favorite and on for the whole case, and some pretty gruesome sights and sounds depending on the types of cases (I'll never forget watching spleen and fibroids be morcellated).

Definitely try to shadow in an OR or at least watch some youtube!
My last case on general surg was a palliative mucinous ca resection....we removed ~15 total lbs of slimey caked mucin....Handful by handful
 
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NeedACar

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Very surprised at some people saying it isn't common in their experience. I would say just about every OR I've been in has that sound. Specifically metal retractors always hitting and scraping over each other.
Less common in some ORs (lap surgeries were ok), but lots in ortho and non-lap gen surg at the 3 hospitals associated with my institution!
 
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curbsideconsult

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Such as metal utensils touching each other
Tons of metal utensils touching each other with lots of clinking when the tech/nurse has more than one instrument in hand ready to hand over to the surgeon or when they're looking for a particular instrument on the table or when they have to open an entirely new tray and have to dig through ferociously to find what the impatient surgeon is asking for. To me, it sounds like those old shows and movies where an inmate is running a metal cup along the cell bars.
how sensory intensive is the OR
It can get VERY loud. I distinctly remember during one procedure where there were two extra nurses, a device rep, a nursing student, some other type of student, and me (a med student) on top of the attending, intern, CRNA, tech, and circulator. Everyone was talking and the two extra nurses were cackling about something at the top of their lungs AND the attending had something like the AC/DC station blasting away through the OR sound system. I'm not particularly sensitive to noise the way you are, but I was kinda stressed out during that case.
 
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May 21, 2020
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There is always clinking in the OR. Videos won’t show it, but scrub techs need to move tools and set up. Retractors are noisy. There is constant beeping, buzzing, talking. It’s never silent.

I would recommend getting professional help/practicing desensitization no matter what you go into. Running a code (especially a code in the OR) is incredibly loud and hectic and as the physician you need to stay focused even with the sensory overload.
 
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