Here’s where you stand: out of my way, that’s where. If I hear you breathe, if I see you twitch, you’re out of my OR. Can’t see anything? Well, that’s too bad for you. Suction there. NO, there. NO, THERE!! Can’t you see where the blood is?!? Remember before when I said speak when spoken to? Well, that is especially true right now. No I won’t let you throw a stitch this case, but here is a retractor for you to hold for the next 6 hours. And no, I don’t care how much your arm hurts. That pain is what learning feels like.
By now, you should know that you are a valuable member of the OR team. As such, you are not expected to just cower in the corner now that the drapes are on. This is important to know from the very beginning of the case, known as the “time-out,” when the surgeon or nurse reads through a checklist to ensure that all steps have been completed so the procedure can start safely. During this time, every member of the OR team should feel empowered to speak up if anything seems amiss. This means YOU. As always, this is done to ensure that we are doing the right thing to the correct patient. If you are intimidated, give the resident standing next to you a quick nudge. However, please make sure we are aware of any issues before we start. Will we be a little ashamed that a med student caught something we didn’t? Perhaps. But if it leads to better care of our patient, BELIEVE US, we will be thankful.
Once the operation has begun, this should be the fun part. Yes, it’s true, we might need you to hold a retractor for a bit or suction some blood away from the operative field. We are, in fact, very appreciative for this thankless work. However, you are the one paying good money to be here, and as such you should be getting something out of it, too. If you can’t see what is happening in the case, let us know. We may be able to reposition you elsewhere around the patient. Perhaps the circulating nurse can get you a step stool. Advocate for yourself, and we’ll try to help the best we can.
We appreciate students who are proactive in helping during the case but it can be tricky to find a happy medium. Try to pick up on our cues to the best of your ability and always think of patient and team safety when making your moves. You may have been told to never touch the scrub tech’s instrument stand. This is true. He or she has this set up in a very particular way, with sharp objects that could injure you if you try to grab at things. Always ask permission if you feel like it would help the case for you to take an instrument off the tray—for your safety and the scrub tech’s sanity.
After you’ve toiled away, hopefully seen amazing anatomy that is a true privilege to behold, all the while taking in skillful surgical technique, it’s your time to shine. It’s closing time. This is a part of the case where residents are typically most comfortable and happy to give up the reins. This is where you can get your first experience practicing surgical skills on a real live human being. So, when the skin suture comes onto the field, if it looks like you are getting passed over you should speak up. There might be a rush to finish up the case and you might get accidentally (or purposefully) ignored, so make your goal of participating in the closure known; also, make sure that you’ve been practicing your suturing outside the OR because some attendings will only let you “play” if you have been practicing via simulation. Participating in the wound closure in the OR is how you get to hone the skills that you can’t develop anywhere else. This is why the OR is so great.