Saturday, October 1, 2011

Looking Cool

When I was in medical school, during my surgical clerkship, I was introduced to a large number of surgeons from a variety of different specialties. I always found the actual surgery to be fascinating, which is one reason I decided to specialize in this area. But, I also was fascinated by the surgeons. They all seemed so confident and comfortable in the operating room, like they were born to be there. In those early years, I also noticed that there were certain things that the surgeons did that looked “cool”. I distinctly remember being impressed by one surgeon’s ability to orient a needle exactly how he wanted it by manipulating it with only the needle holder. To my neophyte eyes this was the ultimate cool; recently I started thinking, again, about what it takes to look “cool” in the OR.

The cool OR fa├žade begins with appearance; properly styled, slightly form fitting scrubs, preferably monogrammed or inscribed with the individual’s logo, are a must. Designer scrubs are most cool for women. Scrubs that are too tight or too loose are a no-no. Scrub bottoms that are pulled too high or hang too low are definitely uncool. Even slightly different colored tops and bottoms disqualify the wearer from membership in the cool surgeon fraternity. Men should sport surgical caps jauntily worn slightly to the side. Bouffant style head covering is not acceptable for male surgeons, which leaves me among the uncool. Women may wear the bouffant style, but custom designed ones are required. There are no requisite shoes to be amongst the cool, although clogs tend towards being cool.

The real test of coolness comes during the operation. The aforementioned ability to manipulate a needle without holding it is still way cool. Holding multiple instruments on one hand is also considered essential cool. This skill involves putting your ring finger through ringed handle of scissors and/or clamps and flipping them back out of the way while operating with a different instrument. One instrument on the ring ringer qualifies for mild coolness, two brings the surgeon to the intermediate level, three raises him or her to expert and four means membership in the exclusive “superstar” club. Of course, any fumbling at any time, no matter how many instruments are involved, demotes the surgeon to complete uncool status. Similarly, attempting to manipulate the needle sans hands, being unsuccessful and then having to use fingers to adjust it also is very uncool. As a resident, one particular attending repeatedly tried to teach me to hold instruments on my ring finger instead of putting them down, which was my preference. He wasn’t really trying to teach me to be cool, he ws trying to teach me to avoid wasted motion. I never really mastered this skill; I still put the instruments down when I’m not using them and exchange them as necessary. I guess I’m still making unnecessary wasted movements. I don’t think my patients have suffered because of this deficiency.

Music played in the OR also can be a major contributor to achieving the proper state of coolness. Heavy Metal Rock and Roll played at over 100 decibels is supposed to be cool, while country western is not far behind. Listening to Swiss yodeling, classical music (my preference) or no music is not cool and also relegates me to the uncool category.

Being cool in the OR has the potential for all sorts of benefits. Having one’s choice of surgical techs and nurses is one perk. Being forgiven rude or ill tempered behavior also seems to be the province of the “cool” surgeon. Charming the OR scheduler to get a favorable start time for surgery also comes much easier to the coolest surgeons.

After thinking about all this coolness I realize that nothing I do fits into the aforementioned cool category. But, there are some things that surgeons do that are really, really, really cool. Treating the surgical staff with the greatest respect, being attentive to the worries and needs of the patient before, during and after surgery and making their families fully aware of what has or may transpire throughout the course of surgery; all these are the true epitome of coolness.

Throwing instruments, belittling and berating staff, ignoring patients and their family’s questions and concerns are definitely uncool. The coolest surgeons put patient first, do what’s right whether it’s the middle of the day or 2:00 am. Doing the right operation, at the right time and staying on top of any bumps in the surgical journey is what’s truly cool. All the rest is empty window dressing.


However, being able to flip the needle around with just the needle holder still looks pretty cool.