Tweet This: 

Tweet
This

Fellow Ramin Lalezari takes us inside the operating room http://bit.ly/2vpFEqL 

2017

Portrait of the Operating Room from the Hand of the Medical Student

I kick the sink and the warm water pours over my hands as I start the now familiar ritual. I scrub my hands intensely, from my fingertips to where my scrub sleeves end. The process takes a few minutes, before I gently rinse the soap off, again, from fingertips to the ends of my sleeves. My elbow bumps the faucet. “Dammit.” I have to start over. The resident scrubbing next to me finished a few minutes ago and is already inside the operating room where the action is. I finally finish scrubbing my hands and head inside.

 The resident and attending have already finished draping the patient in blue, everywhere other than a small rectangle from which his arm protrudes. I awkwardly maneuver through the sterile obstacle course, making sure I don’t touch anything blue as I make my way towards the scrub nurse. She holds out my gown as I put it on, and opens a glove for my hand. I force my hand in and four fingers lock in position, but my thumb gets caught. I’m embarrassed, and it causes me to miss three fingers on the left glove. The scrub nurse can see my distress and tells me, “It’s okay, you don’t need to rush!” as she waits for me to adjust before opening the second set of gloves. I smile at her but realize I’m wearing a mask so she can’t tell. She’s wearing a mask too but her eyes squint and I can see the crow’s feet around her eyes proclaiming a smile back.

 I make it to the table and wedge a spot between the resident and the scrub nurse, just able to see the operative field and in time to hear the attending call “incision.” The moment the sharp scalpel pierces skin the pace of the operating room triples. Instruments pass like strikes of lightning from scrub nurse to attending and to resident and back. Everyone’s hands are moving swiftly but deliberately as if rehearsing a graceful ballet. The familiar smell of burnt flesh follows the humming of the Bovie knife. “Hold,” I hear, mesmerized at the dance before me, and a Rich retracting the wound falls onto the patient’s skin. “Crap, that was a direction to me,” I realize. “HOLD THERE!” I grab the end of the retractor and try my best to hold the exact position it was in when it entered my hand. Another Rich pulls the other end of the wound and my other arm is already there this time.

 I try in vain to follow the posterior approach to the elbow as I had watched online the night before. My own elbows are bent in gawky positions as I hold the two retractors in a way to leave space for two attending hands, two resident hands and one scrub nurse hand over the operative field. My hands begin to quiver, but before I can take a breath the attending turns and asks me what nerve she is protecting with the vessel loop in her hand. Thank god she called it a nerve or I’d never have guessed. “The ulnar?” I timidly answer. “Are you asking the questions or am I?” she bites back. I tense up. “The ulnar,” I reply with confidence. “Mallet to Ramin,” she rewards me. The scrub nurse smacks a large mallet into my hand and I see an osteotome in front of me, ready to split the olecranon to give us access to the distal humerus fracture that we’re all here for. The steel is cold in my hand and I feel its powerful weight.

 I strike the osteotome several times before the bone breaks and the pathology that hides in textbooks and diagrams sits directly before us. The OR is supernatural in that way. It’s like watching a movie after reading the book – all the characters you tried to conceive pictures of in your mind are personified. The distal humerus was shattered, five pieces of bone, unrecognizable from its Netter counterpart. “Rongeur,” the attending calls out, and within seconds the scrub nurse’s hand waltzes to her with the large tool. I feel something soft in my own hand and look down. A laparotomy pad. I’m confused for a minute, before I hear a crunch and see the Rongeur moving away from the field, filled with bits of soft tissue and bone. Instinctively, I wipe the tool clean. “Thanks,” the attending acknowledges, “you know, Rongeur is French for ‘get a ****ing lap.’” We chuckle and I turn to smile at the scrub nurse for watching out for me. I see crow’s feet around her eyes.

Metal hardware surrounds the bone as screws work to put the pieces of the puzzle back together. Slowly, the humerus starts to resemble, well, a humerus, and I feel like I’m recognizing a face. When all the pieces are where they should be, and the olecranon has too been reduced, we begin to close the incision. Sharp needles are passed and suture snakes through the soft tissues. Another cold smack hits my palm and I look to find scissors. I cut the suture as knots are tied before me faster than I can follow. I consistently cut the tails of the knots too long or too short, and both resident and attending are eager to let me know.

The attending retires, leaving monocryl sutures for the resident and I to finish closing the skin. Nervous, I go through the motions I’ve been practicing for months. With my hands covered in blood and latex, it feels nothing like it did at home, and my work mires the pace of the room. I wonder how many times the resident has thrown these knots and how many it took before he achieved the swiftness with which he works now. We dress the elbow and tear off our gowns, running to prepare for it to begin again on the next case, and I’m left with but a few minutes to process the magic I just walked out of.

 

 American Resident Project fellows receive compensation from Anthem for sharing their perspectives on this blog. Fellows views are their own and do not necessarily reflect the views of Anthem, Inc.