Oct 27, 2011


As a first year medical student who spends lots of time in neurosurgical operating theatres, I’ve become very good at standing around. I don’t even mean that in a self-deprecating way, because standing around can be a complicated business. To understand the hostile standing environment that is the operating theatre, one must first understand the species present in this surgery safari.

The most dangerous species in the OT is the scout nurse. The scout nurse is responsible for the sterile area containing the instrument trolleys. These she guards like a lioness her cubs. Woe betide the unfortunate medical student who leans over a trolley, they will receive a snarl or mauling at the hands of the scout nurse.  The scout nurse has a less aggressive variety in the scrub nurse, who is too busy handing weird and wonderful instruments from the sterile area to the surgeon to have the time to protect her den.

The surgeon is a more complicated beast, sometimes grumpy and controlling of his theatre space, sometimes willing to dispense pearls of wisdom and opportunities to participate. It can also be disconcerting when a neurosurgeon wants to discuss the rugby world cup or the Tory policy on gay marriage while his instruments are deep inside some poor sod’s brain.

The most benign beast in the theatre is the anaesthetist. Anaesthetists are responsible for keeping the patient unconscious or otherwise unobjectionable and monitoring the patients vital signs. As such, anaesthetics as a profession resembles that old proverb on war, that it is long periods of boredom punctuated by brief moments of sheer terror. Fortunately the inactive times allow the enterprising medical student to pick their brains, which is usually a goldmine operation because of their excellent knowledge of physiology, pharmacology, and nearly every type of surgery you can imagine.

Cognisant of the many and varied surgery species and their behaviour, standing strategy must address the competing goals of:

a)      not pissing anyone off 
b)      getting a good view of the surgery
c)      conversing with various staff who can clarify different aspects of the procedure
d)      occasionally winning a minor participating role

Combining these is obviously difficult. Immediately after entering the room the med student must have assessed the lay of the land and selected multiple potential standing positions. They must be far enough from sterile areas and the operating table to guarantee a, while close enough and on the correct angles to achieve b.  Next to the anaesthetics equipment and seating (yes, they sit, often reading the paper) will always be useful territory for fulfilling c, but not always b and d. Securing d) is the most difficult and capricious task, by standing behind the surgeon you may sometimes be tasked with moving the gigantic telescopic light apparatus, but more exciting opportunities are rarer and must be seized by the brave student.

All this is complicated by the ever-changing arrangement of the landscape and constant transit through the theatre. The patient must be moved in and out (duh), nurses rearrange with perfect choreography, and occasionally the mammoth surgical microscope is swung into action like a narcoleptic transformer. A previously optimal standing position can be rendered uninhabitable and the med student must scurry.

I feel I can say I have become somewhat a master at this surgery squaredance. I say this without pride, as it would be far more impressive if I was actually doing something. I’m also sure this applies to many fields other than medicine, and I look forward to my law student friends regaling me with the difficulties of standing around barristers. I think Newton was close, but not quite, when he reiterated his standing on the shoulders of giants as the source of his incredible scientific vision. To truly excel one must stand over the shoulders of giants. But one must also watch out for their elbows.

NB: I just realised I’ve used very much non-gender-inclusive language in this essay. I won’t amend but instead note that women do comprise at least 90% of nurses and men do comprise about 90% of surgeons. The former will change slowly with cultural shift. The latter is more of a puzzle. While around 55% of med students are female (in Aus), they tend not to filter through to the surgical specialties, as it is a herculean task to simultaneously train for surgery and raise children. While I don’t believe that raising children is compulsory for women, the fact remains that most want to. Those who do manage the juggle are invariably very impressive individuals, and I had the good fortune to observe a female neurosurgeon yesterday operate on a tumour, steel-nerved, for 10 hours straight. 

No comments:

Post a Comment