Thursday, July 19, 2012

Scrubbed in for the first time!

This post conforms to the blog rules.
I'm shadowing Dr. D, a gynecologist, as part of the IBPCA preceptorship. I've worked with her for three days so far and I'm really enjoying her company. One of those days was her "surgery day" and I watched a BSO, a myomectomy, and part of an adhesiolysis. She did all three with the da Vinci robot. (That machine is pure 'wow.')

As a pre-medical student and a first-year medical student, I wore a cap and mask (you are not allowed into ORs without these). But I had to stand at least three feet away from everything blue when I watched surgeries.

If you've every seen an operating room, you know that most of the interesting stuff either is or is near something blue. So, I watched the screens and waited for the day when I could "scrub in." Scrubbing in is something third-year students learn to do at my school. I had heard there were prescribed methods of (literally) scrubbing each finger. Scrubbing in was apparently a ritual cleansing that would rival Deuteronomy. The caste of the scrubbed in wears gowns and gloves and are free to touch everything sterile (and nothing else).

Last week I was allowed to scrub in. The scrub sinks are deep, stainless-steel things that have foot pedals or other hooks and knobs so that personnel don't have to contaminate their hands by turning off the water or dispensing the soap.

Brush with nail pick.
Above the sinks are shelves of masks, face shields, beard covers (...), and individually-packaged scrub brushes. Mimicking everything Dr. D did, I tore one open and covered it liberally with soap that I dispensed with my foot. I turned on the water with my leg and dutifully scrubbed each finger and fingernail, and my arms up to the elbows. A rinse and *poof,* I was sterile. I backed my way through the OR door and a scrub tech tossed me a sterile towel. Then, she helped me gown and glove. The first thing I did with my hands was touch something blue. (I touched my own gown, because that's actually what you're supposed to do to help yourself avoid contamination.)

During the first procedure, I watched and "mmhm'd" a lot. Dr. D. quizzed me about the origins of the ovarian vessels. My anatomy professor would be agonized to hear that I forgot that the left ovarian vein (not the right, just the left) empties into the left renal vein. DARN IT!
During the second procedure, however, I got to hold the camera! It was a difficult myomectomy and Dr. D needed two assistants, not just the one who was scheduled. As a result, I got promoted from "observer" to "menial task assistant" and held the camera, moving it as best I could to follow the tips of everyone's instruments and keeping the operative area in view. It was surprisingly hard, especially because the da Vinci camera, unlike other laparoscopy cameras, is a chunky piece of equipment. (The picture at right cuts off the top few inches of it.)

The experience was a mixture of cool and weird, like many first-things in my budding medical career. It was cool to be helping in a surgery; cool to be advancing; and cool to be "driving" the image on the laparoscopy screens. It was weird to be pivoting a camera on a stick in someone's abdominal wall.

However, since that action isn't morally wrong, I have no problem with getting over the weirdness and dwelling on the coolness of taking another step toward being a surgeon.

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