A shocking change has occurred in the world of surgery. No, it’s not operating robots, which have been hanging around for a couple years. Nor is it “flesh-eating bacteria,” which now bores even the tabloids. We’re still struggling, of course, with the restriction of resident work hours (only 80 hours a week – imagine), but that happened a decade ago, and we’ve more or less adjusted. Instead, what has rocked my world is a change in the process of scrubbing, the washing up that we do before every operation.
Almost certainly you’ve seen surgeons scrub, either in real life or on TV. There’s water and sudsy disinfectant soap and some person in a hat and a mask who’s standing in front of the sink, vigorously scrubbing hands and arms with a disposable plastic brush. Remember that? Of course you do. It’s iconic.
But now there’s an alternative scrub, and I can hardly believe it.
Wet or slimy?
Strictly speaking, the alternative “scrub” doesn’t actually involve any real scrubbing – no brushes, no water, no standing at the sink. The new “scrub” and the old scrub both use disinfectants, and they’re equally successful at cleaning our hands. The new version is quicker, though, because it’s more or less a lotion, dispensed at the scrub sink like bathroom soap. We dip our fingers in it as we rush by the dispenser and into the operating room. Then we slather it over our hands and forearms. For a second, it’s sort of sticky. Then it dries, and we’re done.
“Wet or slimy?” asks one of our nurses when we enter the OR. If you’re wet from washing, you get a towel. If you’re slimy, you just get dressed.
Now I’m an old dog, I admit it, but not so old that I didn’t bother to give the new “scrub” a chance. I wasn’t wowed, though. As far as I’m concerned, its main selling point is speed, so if someone is bleeding to death RIGHT NOW, I’ll get clean by getting gooey, but otherwise, I’ve decided that I’ll continue to wash with water.
And here’s why.
My hospital world is pretty speedy as it is. If you looked at me through a microscope, I’m a reactive little paramecium, darting around the hospital, bumping into a target, and then ricocheting off in another direction. One minute I’m in the Surgical ICU, helping the ICU resident drain blood out of the chest of a guy with a stab wound. Then I bop down to the ER to see a woman with appendicitis, and from there up to the Rehab unit where one of our brain-injured patients is having a seizure. And when I’m done with that, my senior resident wants to talk about a feeding tube. It worked after we put it into a stroke patient last week, but it’s not working now. What are we going to do about it?
5 minutes to slow down
Busy days like this, with fewer residents and more patients, have made me hyper vigilant, acutely attentive to everything that’s going on around me. These days, from my perspective, any call, any beep, any overhead page could be the canary in the coal mine, the early warning signal of some disaster that is about to become my business.
The OR, it turns out, is a relative refuge. Sure, it’s challenging sometimes. More patients weigh 400 pounds, which makes their operations more difficult, and we’re a safety-net teaching hospital, which means many of the patients were sick as snot before they developed whatever surgical problem they now have. Still, in the OR I have the privilege – the luxury, really – of concentrating, of being able to focus completely on the one patient in front of me.
Moving from my hyper vigilant outside-the-OR self to the laser focus of my inside-the-OR self is hard. My brain is bristling with things it wants me to do, and it takes a while for it to power down and transition to its next mission.
Which is why I like the scrub sink. It’s soothing. For five minutes before I enter the OR, I’ve got nothing to do but count the brush strokes back and forth over my fingertips, hands and arms. The warmth of the water is comforting, and counting brush strokes while I scrub is the rosary of surgery. While I wash, I slow down. I stop scanning the horizon for the next darn thing and immerse myself in details of the operation we’re about to do.
It’s at the sink, too, that I actually have time to teach. I ask the resident at my side what she wants to learn from this operation. I ask the student about the anatomy that we’ll be focusing on during the case. It’s team-building time, which is another reason why I like it. Because if there’s one thing I’ve learned from a life in practice, it’s that surgery is a team sport.