Giving Voice To Internal Dialogue In The Operating Room

Something gets lost in translation when it comes to communicating in the operating room. I am not sure if it is the pressure of doing surgery, the multitasking, the teaching of residents or something else, but once the mask, goggles, gown and gloves go on, all bets are off. 

I am sure my scrub techs have wanted to strangle me for the constant “brain lapses” that occur. One example might be: “Hand me that thing I like to use, you know, that THING!” I am also sure they want to smack me over the head with the freer I constantly forget the name for. Idiocracy and miscommunication definitely go both ways. I think all of us podiatric physicians have encountered at least one of these interactions during our time in the OR. The things we want to say are probably too inappropriate for this article, but I am confident you can relate to the following.

Circulator: [Pointing to the tray you ordered] “Doctor, do you really want this? Should we really open it?”

What I want to say: “No, I just order things for fun. I like blue wrapped things to watch me do surgery … ”

What I really say: “Yes.”

Me: [Reducing an ankle fracture and need retraction] “Retraction please.”

Scrub tech: [Hands you skin hooks]

What I want to say: “Is this a retractor for ants?”

What I really say: “Something a bit bigger … ”

Circulator: [20 minutes into a triple arthrodesis] How much longer?

What I want to say: “I will pull this surgery over if you keep complaining!”

What I really say: “Two hours.”

Me: [Doing a Chopart amputation and there is a big pumper with blood everywhere]: “2-0 silk tie please.”

Scrub Tech: [Hands you 4-0 Vicryl]

What I want to say: “Guess we’ll be back in a couple weeks for a hematoma evacuation … ”

What I really say: “2-0 silk please.”

Scrub tech: [Implant falls on the floor.], [Looks at you like a deer in headlights]

What I want to say: “Stare off … 3,2,1, GO!”

What I really say: “Let’s grab another one, please.”

[Partial first ray amputation case]

Scrub tech: “Did you want 3.0 or 4.0 cannulated screws?”

What I want to say: “For the part that is disconnected from the body?”

What I really say: “Um … ”

[I walk in nine months pregnant]

Scrub Tech: “We’re going to need an EXTRA-LARGE GOWN!”

What I want to say: “Wide load coming through!”

What I really say: silence

Me: [Scrub tech handing me size 10 gloves (I’m a size 6.5)] “Oh I’m a 7 bottom, 6.5 top”

Circulator: “Oh, that’s not on your card … ”

What I want to say: “I’ve been here for five years … ”

What I really say: “You should add that please.”

[Pre-op TIME OUT]

Anesthesia: starts reading the 10-page list of allergies

What I want to say: “Yes, I am aware I am operating on terrible protoplasm.”

What I really say: “Clindamycin, please.”

Dr. Levick-Doane is a Diplomate of the American Board of Foot and Ankle Surgery, and the American Board of Podiatric Medicine. She is a foot and ankle surgeon at Kipferl Foot and Ankle Centers in Des Plaines, Fox River Grove and Algonquin, Ill. Dr. Levick-Doane is also an affiliate attending for the RUSH podiatric residency program in Chicago.