I'll be observing Friday

[Cheisu]

I'm going to be observing surgery on the 22nd. It's a general surgeon. I'll go in from 8AM to about 5PM. He has 4 surgeries lined up for that day and I'll be there for all of them. I have never observed surgery before, but as all of you might know, I'm very interested in it.

The surgeries he has planned for that day are as follows:

-(Laparoscopic) Colon (not sure what kind of surgery)
-(Laparoscopic) Rectal (not sure on this one either)
-(Laparoscopic) Cholecystectomy
-(Classic/Open) Hernia repair

I'm kind of bummed about 3 lap surgeries, I wonder if they'll be interesting? I think just being in the OR will be interesting, but the fact that they are lap means I won't really get to see much =\

Anyway, what kind of things can I expect? How should I act, can I ask questions, how close can I get, can I ask to scrub in (just to see how to scrub in, not to do anything), etc.

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[Winged Scapula]

You'll see MORE during a laparoscopic case. The visualization is excellent and with the image projected on a screen, you'll see much more than you would just peering over a curtain and trying to see down a dark hole. Unless you are scrubbed in and standing right across from the surgeon (which it sounds like you won't be), laparoscopic is the way to go in terms of visualization for other people in the room.

In response to your questions:

1) act normal

2) you can ask questions but try and be sensitive to the timing; if the surgeon appears to be struggling or there is some untoward complication, that is not the time to ask questions. You should preface your question with, "May I ask a question?". If its a bad time, the surgeon will tell you. Since you know in advance what surgeries you are seeing, a little reading might be in order, but you won't be expected to know anything and trying to come off like you do can be annoying.

3) you cannot be touching anything sterile and the scrub techs/nurses in the room will be watching you like a hawk. You can stand behind the surgeon on the patient's left, or at the end of the table, or alternatively at the top of the table with the anesthesiologist (as long as they have given you permission). For the laparoscopic procedures, sitting on a stool in the room is sufficient to see the action.

4) I would not ask to be taught how to scrub. There is no purpose in it now since you will not be allowed to scrub and it takes time away from the techs/nurses doing their job - they will not be happy showing you since there is no reason to.

 

[-Goose-]

good advice above.

the search button is your friend:
http://forums.studentdoctor.net/showthread.php?t=201961

 

[smq123]

I'm kind of bummed about 3 lap surgeries, I wonder if they'll be interesting? I think just being in the OR will be interesting, but the fact that they are lap means I won't really get to see much =\

Oh, no. You'll get to see MUCH more!

Lap means that the entire surgery is basically broadcast over a TV screen that is easy to see from most of the room. What you see on that TV screen is exactly what the surgeons are seeing as well. So you won't have to crane your neck or position yourself in weird angles to see.

Most med students, even if they are scrubbed in, cannot see anything, even in non-laproscopic cases. So laproscopic cases are GREAT - you'll totally get to see everything that the surgeon is seeing.

Anyway, what kind of things can I expect? How should I act, can I ask questions, how close can I get, can I ask to scrub in (just to see how to scrub in, not to do anything), etc.

I think we went over this before?

* Act polite and respectful. Say hi and introduce yourself to the circulating nurses. Don't touch anything that is on a blue/green piece of cloth. If you're not sure, ask before touching/doing anything.

* Again, ask before getting too close to the sterile field. Just saying something like "This is my first time in the OR - where should I stand?" is fine.

* Ask a circulating nurse/scrub nurse if you can watch them scrub in before the case starts. Ask them to teach you if possible what they're doing.

Good luck!

 

[Cheisu]

Ok. Thank you.

What will I be required to do/wear?

I heard that surgeons like to show off when they know that high school students interested in becoming surgeons are watching, but that's just what I've heard.

For the hernia repair, will I be able to even see anything? Will I be able to see the incision being made and at least be able to see the surgeon's hands?

I'm SO, SO excited about all this I can barely sleep lol.

Initially, I was thought maybe I would be allowed to scrub in just to get a little closer, I thought maybe the surgeon would let me touch inside the cavity he was working in! o.o ...lol, guess that won't be happening now though, lol.

I heard that the first time can be kind of nerve-wracking. Like, are there odd smells the whole time, or large amounts of blood?

What will the rectal surgery be like?

I'm just very excited about all this.

BTW, I have two pairs of scrubs. I have green ones and the "hospital blue" ones, but the green ones are more comfortable, should I wear those?

 

[smq123]

What will I be required to do/wear?

BTW, I have two pairs of scrubs. I have green ones and the "hospital blue" ones, but the green ones are more comfortable, should I wear those?

No.

Show up to the hospital in your street clothes. Ask one of the nursing coordinators to get you some hospital-issued scrubs. If the OR staff usually wears blue scrubs, and you show up in green scrubs, they may not let you inside the OR. So play it safe and ask them to give you "visitor" scrubs.

 

[nlax30]

All good advice here.

I'd show up in some sort of "professional" dress. When you get there in the morning you'll probably go to some locker room where you can change into the hospital issued scrubs.

Just go in with your eyes and ears open and ready to listen/watch. They should tell you where to stand and how close to get but if not don't be afraid to ask. Kind of depends on what the doctor is like. Back in high school I shadowed an ortho surgeon for a couple hip replacements and he kept have me get closer and closer to the table.....he really enjoyed teaching and having students watch.

There will be strange smells, blood, and all of that so be prepared. If you feel lightheaded at any point PLEASE back away and stand/sit against a wall or in the corner until you feel better. It happens, you just don't want to fall, or fall into any equipment or the patient.

 

[Winged Scapula]

Get to the hospital early so as not to get lost.

Come in a nice shirt, tie and trousers in case you need to see patients with the surgeon between cases.

Do not bring your own scrubs. "Outside scrubs" are not allowed.

If the surgeon doesn't take you into the locker room, find the OR front desk, introduce yourself as a student with Dr. X today and could someone help you get some scrubs, etc.

Bear in mind that most cases start at 0720 or 0730 so if you show up right then, there will be some chaos. It might not be a bad idea to come the day before, mid afternoon to get the lay of the land, some scrubs, etc.

As for showing off, we all like to help those interested in our career, but frankly, only a tool would "show off" for a student.

Ask where you should stand; the surgeon or the scrub tech/nurse will tell you. Depending on how close you are allowed to be, you may or may not be able to see the hernia incision or what the surgeon is doing. Depends on the hernia - if its an inguinal or umbilical, the incision may be small; if its a ventral/incisional hernia you may be able to see more.

Again, you will likely see more with the lap cases...bear in mind that a lap colon and lap rectal cases are pretty advanced skills, so be pretty impressed that a general surgeon is doing these. If the rectal case is all laparoscopic, you probably won't notice a lot of difference frm the colon, as the anatomy will be strange to you, but the surgeon should point out some obvious differences.

I suggest you read the threads here and in the Clinical Rotations forum about going into the OR for the first time. Most of them have good advice about how to avoid feeling faint, etc. Make sure you eat a good breakfast, don't fluid overload (although not being scrubbed in, you can leave to pee if you need to), and yes, there will be smells you are not used to. You will NOT see a lot of blood unless there is some major disaster...none of the cases you've listed are particularly bloody. Interestingly enough though, the blood doesn't bother most people, btu rather the heat, the smell, or sometimes just standing for long periods of time. Anyway, read through those threads and I think you'll do fine.

Make sure you post and let us know how it went.

 

[Cheisu]

Thank you!

And will do!

 

[Blade28]

Well-played, sir.

 

[Winged Scapula]

You forgot a few:

Make sure to frequently comment, "That's not the way Dr. Shepherd does it on tv."

Ask the general surgeon if he feels like he should have done a fellowship because all he gets are the leftover cases no one wants.

Frequently refer to the Anesthesiologist as an Anesthetist and act suprised when he/she informs you that they are an MD/DO.

When the above happens, make sure to tell them that you think they wasted their education when they could have done it faster as a nurse and made almost as good money with less hours. Anesthesiologists think that's a funny comment.

Make sure to step on the Foley catheter tubing. Its fun to watch the anesthesiologist get upset about the low urine output.

Leave the nurses your phone number and email. Lord knows, they all wanna marry rich doctors, so they can get a head start with you.

 

[Luv2Cut]

Man, you guys are hilarious.

Also, a week before your observation get you a bag of balloons and practice blowing them up. So, when you get in the OR and the Foley is placed, THEN offer to blow up the balloon. You'll be a hit.

 

[Castro Viejo]

When the surgeon asks for an instrument, YOU take it off the Mayo stand and hand it to him. This makes you seem knowledgeable.

If you don't beat the scrub tech to the instrument when the surgeon asks for it, intercept it during the handoff and then YOU hand it to the surgeon. This makes you seem aggressive.

If you don't beat the scrub tech to the instrument and you miss the interception and the surgeon already has the instrument in his hand, knock it out of his grip and onto the floor. Then YOU go back to the Mayo stand and pick up a replacement to hand to the surgeon. Make you sure cough loudly as you swat his hand, though, to make it appear as if you did it accidentally. This makes you seem in control.

Continuously reprimand the Anesthesiologists with phrases like:

"No, the OTHER Reverse T-burg damn it."

"No, the OTHER patient's right damn it."

"No, the OTHER table up damn it."

"Hey Gas, this patient's got good insurance. There's no reason to go light on the anesthesia."

If the Anesthesiologists introduce themselves to you, "Hi, I'm Dr. So-and-So," just put your hand in their face and reply, "I will simply refer to you as 'Gas' or 'Nurse.' You choose." This makes you seem hard core.

If you hear any of the nurses in the room start a sentence with "Well, I thought..." Promptly cut them off and snap back with "The only thinking you did today was to decide whether or not you were coming into work. Since then it's just been following the surgeon's orders." This makes you seem authoritative and in complete understanding with how modern healthcare works.

And make PLENTY of jokes about different minority ethnic groups, the surgical resident's penis/breasts/vagina, and how utterly ridiculous it is that Anesthesiologists train for four years to learn how to turn a few knobs and read the Wall Street Journal during a case.

Good luck buddy! You're on your way!

 

[smq123]

You guys are just mean.

Cheisu - remember, if you're scrubbed in, you can't touch yourself. At all. So if you have an itch or a runny nose, tell the circulating nurse to take care of it for you. Particularly if you have an itch - they're always very helpful and willing to scratch for you.

 

[sestamibi]

Don't forget the cardinal rule of the OR: take your pants off before entering. Underwear is optional.

 

[nonesuchgirl]

tired.

blade

WS

Castro

I want to be y'all when I grow up.

 

[Winged Scapula]

You guys are just mean.

Cheisu - remember, if you're scrubbed in, you can't touch yourself. At all. So if you have an itch or a runny nose, tell the circulating nurse to take care of it for you. Particularly if you have an itch - they're always very helpful and willing to scratch for you.

Don't forget the cardinal rule of the OR: take your pants off before entering. Underwear is optional.

Taken together, these two posts are excellent advice. Circulators also love it if you wear your pager and/or phone on your waist. Make sure its on the front of your pants, preferably the center rather than your hip and that you ask her to reach under your gown to turn it off.

"There, no just a little more to the left...yeah, right there."

 

[Castro Viejo]

You guys are just mean.

Cheisu - remember, if you're scrubbed in, you can't touch yourself. At all. So if you have an itch or a runny nose, tell the circulating nurse to take care of it for you. Particularly if you have an itch - they're always very helpful and willing to scratch for you.

Especially if you end the request to scratch said nose by addressing them as "Mah Beeahtches."

 

[redbeans]

- Bring in your own ipod to play in the OR, make sure you include songs about blood, death, and enough booty rap to keep the scrub techs dancing. Then sing along and dance wildly.

- Bring a snack in your scrub shirt pocket, you'll really appreciate that chocolate later. (p.s. also see how long you can go before someone gets the guts to ask you what that brown lactation stain is)

- Wear your favorite shoes, don't worry about sole support, style is more important to plastic surgeons anyway

- Ask the anesthesiologist a question during intubation. That's their favorite time to chat.

- Make sure you have a catchy top 40 hit for your ring tone (so new that you don't know it's yours) and leave your phone on in your scrub pants.

- If you've got an itch that the circulating nurse can't scratch, just rub against your fellow surgeon - they're sterile!

 

[sestamibi]

- Bring in your own ipod to play in the OR, make sure you include songs about blood, death, and enough booty rap to keep the scrub techs dancing. Then sing along and dance wildly.

I find it pretty reprehensible that you would lead a high schooler astray for your personal amusement.

Especially after having been in an OR and knowing what kind of music is typically accepted.

To the original poster, load your iPod with songs similar to the one below. INSTANT respect. I will agree with redbeans that you do need to sing along and dance wildly to stand out from the pack. Surgery is jammed with passive onlookers. Dare to be different.

[youtube]IggwnFoUO30[/youtube]

"You are......my fiiiiire!"

 

[Luv2Cut]

Oh yea remember the OR is a very family oriented atmosphere.

-Always refer to the surgeon as "Bro", "Dude" or "Babe" accordingly. High fives and slaps on the butt should be a major part of your OR repertoire.

-Circs, scrub nurses and techs should be referred to as "Hon" or if male "Bro" will do just fine. Lots of hugging and playful backrubs are in order as well. And for the guys, you can't go wrong with a well placed nipple twist or a wedgie.

-Feel free to make your self at home. Prop your feet up, scratch, burp, flatulate etc. This is acceptable and encouraged. In fact it is rude if you don't.

-Don't forget to bring a sack lunch in case you get hungry.

-Most surgeons love animals. So if you have a kitty or a pup. Bring him along. You'll be a hit. In fact they will call you a gunner.

-Remember to follow your surgeon EVERYWHERE. They love that. In fact, they want you practically in their hip pocket. If he/she goes to get a drink, your getting a drink too. If they go to the bathroom, your helping.

 

[redbeans]

I find it pretty reprehensible that you would lead a high schooler astray for your personal amusement.

Especially after having been in an OR and knowing what kind of music is typically accepted.

I think the point of a lot of these reply posts is that Cheisu needs to just relax and go with the flow with whatever happens in the OR, and not believe everything that's on the internet. Most of the boundaries are pretty intuitive, and in my experience as long as you're polite and attentive, you should be fine.

 

[Sunfire]

Just hope that the patient has followed proper procedure and that there's no BM spillage out onto the table...that happened during one of my observations and did so not smell good...(don't think he had eaten a high-fiber diet in a while by the looks of things)

 

[sestamibi]

I think the point of a lot of these reply posts is that Cheisu needs to just relax and go with the flow with whatever happens in the OR, and not believe everything that's on the internet. Most of the boundaries are pretty intuitive, and in my experience as long as you're polite and attentive, you should be fine.

I was joking.

Hence, my suggestion of blaring Backstreet Boys tunes in the OR

 

[smq123]

- Bring a snack in your scrub shirt pocket, you'll really appreciate that chocolate later. (p.s. also see how long you can go before someone gets the guts to ask you what that brown lactation stain is)

No, no. Don't put the chocolate bar in your shirt pocket. Some hungry resident may just pull it right out of there and eat it.

Be sure to put that chocolate bar in your scrub pants pocket. MUCH safer.

 

[EM_Rebuilder]

LOL, these cracked me up.

I love the 'If its on blue, its for you' and to fart right when they start mucking with the bowel.

 

[-Goose-]

How'd it go?

 

[beastmaster]

Poor kid was probably bored half to death.

Like every other high schooler I've seen in the OR.