How Not To Teach Surgery
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Loading ...One of the things that intrigued me about my program is that we actually had a surgery class our second year, well before our official clinical rotation 3rd year. I assumed this was because by teaching us basic skills, we could do our clerkship being of at least minimal usefulness right away (at least in theory). In addition, the Mexican medical degree is literally titled “Physician-Surgeon” (Medico-Cirujano), so surgery is integral to the program. I was looking forward to class, mainly because surgery interests me to no end, but also because it’s a break from the auditorium lectures, which we’re all bored of at this point.
On our first day, we began by being subjected to a video of proper handwashing technique. Sounds reasonable to watch before we do, but trust me: watching a scrub brush pass laboriously over every finger surface, hand surfaces, forearm, elbow, etc. you get bored really fast. Then it was time for the other hand/arm, following proper technique to rinse the brush, even. Just when I thought it was over, it was time to repeat again, only this time to the forearm only. Change hands again, 3rd time’s the charm.
The room where we practiced (and will be graded) is obviously a teaching trough for hand scrubbing. It’s a stainless steel “L” with about 12 stations or so. There was a foot pedal for water, but no pedal or self-mechanism for soap because you are supposed to yell “jabón!” so some lackey (currently our classmates) can douse the area with soap from a squeeze bottle. I kid you not. But before we could get there, we had to pass “inspection,” where our nails were inspected for shortness (fingers = fleshy nubs), cleanliness (um, aren’t we about to scrub for crying out loud?), and for the attire being appropriate (the ever-hated “whites” which must be pressed (because as we all know, wrinkled scrubs are the harbingers of disease, with microbes hiding in those wrinkles)).
Throughout, the instructor was basically barking orders from the center of the room, pacing like a drill sergeant, yelling at no one in particular: “external surface, ring finger…internal surface….dorsal surface…palmar surface….soap!…external surface middle finger….” as we scrubbed in perfect synchrony to the barked commands. By the time we were at the end of the 2nd repeat of each hand, I was looking at the bristles for bits of my flesh. Neither the brush nor the soap was from Aveda, let me tell you. (no I’m not metro/gay, I just know things 
)
Louis Gossett Jr. behind me was only part of the experience–one professor per two students hovered over shoulders to examine in miniscule detail what was being done. Any little thing was scrutinized, made to do over, etc. The irony is that the female professor looking over my shoulder, critizing this and that, had nails that I hadn’t seen since Big Trouble in Little China. There’s no way this chick does any surgery these days.
I understand if I let my arms drop that’s bad technique and should be pointed out (upper arms are parallel to the ground and forearms are pointed upwards at all times), but does it really matter if I forget to make circular motions instead of linear ones or that I involuntarily began move my hand/finger being scrubbed instead of my brush (still with correct position) because my right arm is getting tired? C’mon. I felt like a total wuss after my arms started burning with strain towards the end until I talked to some of the other guys and everyone felt the same. I know I need to up my conditioning, but I was quite unprepared for this. Last I checked, I was in Guadalajara, not Guantanamo.
Finally, the ordeal of scrubbing done, I looked forward to getting the holy hell out of there and waiting to see what I was subjected to next. What was in store for me? More drill seargent barking, of course! Normally, after you’re done scrubbing, you enter the OR proper, only for us, it was a flapping door that led to the next phase of torture: the toweling off.
First, we had to go through the door properly: stand with back to the door, push back three steps, turn and you’re done, all with arms in the correct position. Easy, peasy. Except when yours truly approached facing the door and turned to place my back to it, I rotated counterclockwise instead of clockwise.
“No, again!” came the admonishment, pointing to the curved arrow under my feet indicating my infraction. Turning the “right” way this time, I executed the simple maneuver, took three confident steps backwards, whipped at the end like a professional dancer, ready to take the sterile towel (dangled by another lackey with a pair of forceps) as a trophy.
“No, come back!” came the bark, shattering my victory. I was told I stepped backwards with my left foot instead of my right. Obviously, I just cursed the surgical procedure and doomed my patient, stepping off with my sinister foot like that. Thankfully the mask was hiding my sneer.
Repeating for the final time, correctly, I grabbed my towel. About to towel off and relax my burning deltoids, we were instructed to 1) grab and hold towel in front of us at shoulder height, as if praying, and 2) wait for everyone else to finish. I’ll get myself into a lotus position at this point, just let me drop my friggin’ arms already! We were then instructed to drop the folded towel holding it by one corner, towel each finger off methodically, then fold towel backwards, exposing the virgin surface underneath to towel off the other hand (in the proper order of digits and arm segments, of course).
The gowning was the next phase of the ordeal, but it was not nearly as degrading. Perhaps by this time, they’d have spotted the ones that started crying or had a breakdown and there was no need to continue the high-pressure. Oddly enough, this is where I started faltering. I understand it’s helpful to know how to glove properly in case there is no assistant present at that moment, but trying to get gloves on through a heavy OR gown using the cloth ends as blunt mitts (we use reusable cotton gowns, not disposable ones, and since your fingers can’t poke through the opening, it’s like having your hands inside your sweater sleeves) is an exercise in frustration. While it did take some getting used to, I was about to consider myself an absolute retard until it was discovered by my now-frustrated instructor that some jackhole sterilized two left gloves and put it in my packet. I swear, they could have used the whole thing as a comic reel. Placing hands into gloves held open by an assistant was like entering Paradise by comparison.
Anyway, that’s the scoop. I don’t think we start vivisecting Thumper (yes, we train on rabbits) for another 2-3 weeks, after learning various stitching and instrument techniques. I’m positive I’ll have more stories to tell along the way.
Medical School | enrico | 
July 28, 2006 10:01 pm
By Jess, July 30, 2006 @ 9:24 am
Hilarious…glad to know I wasn’t the only who had bleeding stumps for fingers, burning arms, etc and I felt like a puppet being directed where to go except they indirectly cut the strings when you did something wrong. The next time I’m in the OR back home I’m going to yell at the vascular surgeon that he’s not scrubbing properly. Yeah, that ought to go over like a fart in church.
By Jenna, July 30, 2006 @ 4:08 pm
Beautifully portrayed down to the very last detail!! I think we all felt belittled at the end of the scrubbing. Afterall you had first hand experience of my idiotic technique, “arm once in the water, and then out, etc” But I do have to admit that our ‘instructor’ had the longest, gaudiest, glitziest nails I’ve yet to see for a ’surgeon.’ All it took for her was to just show me once the proper technique and ‘gasp’ get her hands wet, after the skin was peeling off of ours. Lets see whats in store for tomorrrow….
By Sid Schwab, July 31, 2006 @ 10:18 pm
Wow. Guess they have enough surgical interns and don’t feel the need to encourage students…. In theory, in order to avoid the repeated humiliations during an actual operation, the idea of pre-op “wet-run” makes some sense. But, as surgeon are wont to do, sounds like they turned it into some sort of perverse S and M orgy. Present company excepted, surgeons can be a$$holes. It’s in the genes.
By Alice, August 10, 2006 @ 7:37 am
Wow. And I thought the surgery orientation we got in the US was rough. What I want to know is, do the real surgeons in Mexico do things this precisely, or is it, as usual, the more senior you get the less the rules matter? It sounds like surgery run by the army, or even the Nazis.
Although, as far as that closed-gloving technique, I thought it was a pain to learn, even in paper gowns, but it turns out to be really useful. For one thing, on OB, there are lots of times when there’s no time or extra person to help with gowning, and you better know how. But also, in surgery, I’ve had it happen a lot that the attending was ready to go, and the scrub nurse was helping him, while the resident(s) and student(s) were still just drying off; so at least one of us would have to self-glove, and then help the others. You feel a lot less idiotic, being able to get “dressed” on your own when you have to.