Chapter 1: The Operating Room as a Study in Cultural Anthropology

Imagine yourself dropped off on an island, or perhaps even another planet, with living beings who appear similar to humans that you know. You know little to nothing about who they are, what their lives are like, what things they do, how they do things, how they interact as a group. You may not know their language, and you definitely don’t know anything about their shared traditions. You don’t know their values and stories. All you know is that you are in a place with different sights, smells, sounds than anyplace you have ever been before, surrounded by other beings who seem very different from any you have experienced and who are doing things that appear to be a bit crazy and frightening.

You may have just “discovered” a previously unknown culture. Or you may be in the operating room.

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Are you familiar with Margaret Mead? Allow me to briefly introduce her work to you. Dr. Mead was an anthropologist largely credited with advancing the field of cultural anthropology by immersing herself with the groups she studied in Samoa and New Guinea. Cultural anthropology is distinct from other types of anthropology in that it focuses on cultural variation among humans. Because of this, cultural anthropology can provide a meaningful lens for someone new to an existing cultural environment.

Think about it … here you are, suddenly cast into a completely unfamiliar place. When you first arrive in the OR, almost everything about it is likely to feel unnatural to you and may even be a bit horrifying; at minimum it’s likely to seem weird. By coming into this space, you get the opportunity to observe firsthand the completely unique tribe of the OR on the island of surgery. Entering the OR allows you to be a participant with your presence, but you also have the opportunity to be an observer of almost everything that the tribe does while you are there. Questions you might ask include the following:

• How does the tribe work together?

• Are there any apparent rituals for the tribe?

• What patterns or symbols do you notice? Remember that language can be a symbol.

• Are there any shared myths you hear?

• How does key knowledge pass between tribe members?

• What power structures do you see among tribe members?

• What kinds of technology does the tribe have, and how do they use it?

By being in the OR, you get the chance to see firsthand how all of these things impact the island of surgery and the care of the surgical patient. What questions does being in this new place raise for you?

One of the challenges of being fully immersed in a strange culture or subculture is the possibility of projecting your own experiences and expectations onto the new culture. It’s human nature to use what we know as our “lens” for looking at the world, and this can be particularly true when one enters an intimidating environment, as the OR often is for people. As someone new to the OR, you may not have experienced or observed all of the rituals, or may not have all of the information about them (even after reading this book). When you find yourself struggling to understand what is happening and wanting to judge it, that can be an important time to ask questions to help you gain insight from the perspective of members of the OR tribe. Remember, though, that if a situation has become life threatening it is best to hold on to your questions until the situation is resolved. However, many of us in the operating room environment truly enjoy sharing our stories and perspectives with those who are new. What do you feel being in this new place as you watch what is happening?

Use your experiences observing and participating in the operating room as a time and place to stay curious and to carefully observe everything. Consider yourself an adventurer cast into a new place, and use that to learn without assumptions or prejudice. As someone new to this place, you have the ability to perceive things that have become the norm to those of us who are part of the tribe, and sometimes they are things that we could be doing better. Sometimes if we listen carefully we can learn from you as the novice.

Welcome to our island. I hope you’ll have a good stay here (Figure 1.1).