Locked out of a Locker and Stuck in Scrubs: an OB-GYN farce

[nightengalesknd]

I have had worse days than yesterday - far far worse. No one was mean to me. No one was hurt, not even me, unless you count not getting lunch or dinner hurt, which I don't. No one really even did anything wrong. But what a day! This farce is intended for general audiences. However, since I spent much of yesterday in an Operating Room, I have placed some of the details under a cut for anyone whose sensibilities might be affected.

The day began around 6 AM, when I showed up at the scrubs-issue counter in search of Small scrubs. (actually the day started a little before six when I ate a bowl of Cheerios, but whatever.) I had some Mediums on loan from the department - at least I think they were Mediums. I couldn't find a size written on them. The waist was OK but the pants were too long. So I went to the scrubs-issue window (in the basement near the morgue) and asked for Smalls. I held the proffered pair up to the presumptive Mediums, and tried to hand them back. "They're the same length." The answer: "they're all the same length." Oh. Enter safety-pins. I've been told most people merely roll them up, but I don't need something else in my life over which to trip, especially in an Operating Room.

Next on the agenda is Morning Report. In Family Med, these had been loads of fun: a resident presents a case a little at a time, inviting questions from the audience, especially other residents, but also the collected med students and a few attending Attendings. Sometimes the Attendings or more senior residents would give advice and opinions, often solicited. That was Family Med. This was OB. Same ostensible set-up of a resident presenting a case to an audience of residents, students and attendings. The students spoke not a word. Other residents asked procedural questions. Attendings pounced. It wasn't clear who had made the-buck-stops-here final decisions about the patient in question, but neither attending thought very much about most of how her case had been managed. And the Attendings peppered the rather hapless-appearing resident for information. It wasn't cruel, but it wasn't. . . kind, either. A classmate said later, "In your face," and I think that sums it up nicely.

This brings us up to the whopping late hour of 8 AM. We were supposed to get a tour, learn to scrub, and then after my tour, I was to report to the OR, page my resident du jour, and scrub. We were also even promised the tour would include directions for us to get to wherever else we had to go. Well, we had our tour, all right, but it didn't include scrubbing instructions, and began and ended on L+D. The nurse was short on time, and chose to skip scrubbing, in favor of what turned out to be my fifth or sixth demonstration of starting an IV on a plastic arm. Right. We didn't even get a chance to practice ourselves. Now 9 AM, I stood unscrubbed, lost and lonely, and decided to page my resident and ask for revised instructions.

So I looked skeptically at my pager, and tried to follow the garbled "how to page" instructions I had been given. First, I had to turn the pager on. A nearby resident helped with that. Then it said, in LED (yes, I speak LED), Lo Cell. "Lo Cell?" said I. "It needs a new battery," said a passing intern. "O-k," said I. She rummaged around in a closet (and I'm still not sure where that closet was) and extracted a battery. In retrospect, I'm not even sure why I was trying to resurrect my pager, when in fact what I wanted to do was contact someone else's pager, but I suppose I thought maybe they would page each other in LED and then apprise me of their progress. Oh, come on, it could happen. So with someone else's help, I approached a phone, and was shown how to type in my resident's pager number and give the number of the correct line of the random wall phone we had selected. So I paged him, and got called back by a woman. That's how I learned people take their pagers off in Surgery and the circulating nurse answers them. It turns out there is a lot I didn't know about how Surgery worked. I received further instructions to come on down to the OR, put on a cap and mask, and enter. Right. Then I asked for directions to a cap-and-mask provisioning area.

So I found my way down to the surgical locker room, and there I stashed everything non-valuable I had on my person, like a sweater and my inhalers. (Valuables were locked in a locker up on L+D. Valuables included my purse and PDA.) I ate a granola bar. I had been told to bring to the OR only myself in scrubs and a pager. I grabbed a passing person in scrubs and asked if I should/could also bring my nametag and received an affirmative answer. Me, my scrubs and pager and ID tag, and I presented ourselves to the cap and mask provisioning station.

Except I also had my new cane with me. It had a nice non-porous handle and was still in its plastic sleeve. It also had all sorts of tags and do-hickies attached, so with it I had also a pair of scissors, because I've learned the hard way over time to Bring My Own Scissors. The people at the desk (nurses? clerks? some of each?) were rather skeptical of the whole thing. I kept having to explain that the person who was supposed to teach us how to scrub couldn't do it, and they promised me someone else would appear to do it instead. Finally someone brought me a cap and mask and she and I agreed the priority was to get me to the OR sooner, rather than my cane to the OR later, and she brought me to the OR. I mean, IN to the OR. Me. In an OR. Awake.

Here are some things I learned about the OR. It's smaller than they look on TV shows. There is stuff everywhere. You are allowed to be in the OR without being sterile, so long as you don't touch anything sterile. You don't even need gloves for this, although you do need a mask and cap. You might want to wear purple gloves, which are also not sterile, in case you want to touch other non-sterile things like clamps which have fallen onto the floor, or the patient after the operation. You are allowed to bring all sorts of non-sterile things into the OR with you. Like pens, paper, PDAs. As pens, papers and PDAs, things of which I am inordinately fond and from which I hate being separated, are neither myself, scrubs or a pager, I had none of those things on me. This matters later.

They sat me on a stool, and I sat there and watched what I could see. Who I could see was the attending, the resident, and a fourth year medical student around the patient. Just next to them was the scrub nurse, who hands them stuff on cue. These people are all sterile. Farther away is the circulating nurse, who is not sterile. He or she answers phones, gets supplies (opens the packages which are sterile on the inside but not on the outside) and can even run errands to the great Outside. People I couldn't really see were the anesthesiology team, which the best I could tell involved a med student and a doctor or two and maybe a nurse. It was hard to tell, because they were partitioned off by a sheet hanging up across the patient. From what little I've been able to see, they aren't sterile either.

At one point, someone came into the OR and she and I had a heart-to-heart about my cane and sterile. We finally decided I would try not using it for now, pending some inspiration. Fine with me.

Suddenly the surgery was over. The sheet came down, and people started waking the patient up. I had no idea they did that still in the operating room. Then I was following the resident at a trot hither and yon, and the next thing I knew, we were talking to the next patient. It turns out that about 20 minutes before surgery, someone is supposed to ask the patient what operation she is having and why, as well as a bunch of other medical history questions. If I am ever having surgery and someone who claims to be working with or for my surgeon comes and asks me what operation I am having and how my condition was diagnosed, that close to operation time, I hope to goodness I am able to get off the bed by my own steam and leave AMA ASAP. It is lunchtime. There is no time for lunch. There is no time to get a pen, which turns out to be useful here to write down the answers to the questions we ask the patient.

I am taught to scrub. It's pretty much what Carter was taught on ER, as far as technique. My hands are raw and I think there isn't enough lotion in the world to make them all right again. One of the rules of the OR is that if you (you being anyone who is not The Attending) are scrubbing with an Attending, you need to scrub longer than the Attending does. Unless the Attending tells you to stop scrubbing to go do something. Right. Having no attending handy (the one we had had barely spoken to me during the first operation) I scrubbed longer than my resident.

Into the OR. The initiate enters the ritual chamber. I am inserted into a blue gown, and gloves are placed upon my hands, right, then left. I later learn it is an institutional tradition to glove the left hand first, but clearly no one ever told the glove-er, and it is not my place as glove-ee to argue. The gown is blue. The drapes around the patient are blue. Blue things are sterile. I am allowed to touch anything blue, except my cap, of course. I spend this operation standing at the foot of the patient, asking questions sotto voce to the fourth year med student who is my savior a hundred times over.

My pager goes off. Who has my pager number, and why would they want to talk to me? I am shown how to read the phone number from whoever is paging me. I call them back on the wall phone, full of importance. "Have you been trying to reach us," they ask. I've never heard of them. My pager is a wrong number. And the time on it is wrong.

It is lunchtime. It is well past lunchtime. I am still standing. We get word that our next patient has a fever. It is decided that she should not have elective surgery today, and they call for the subsequent patient. The operation ends, and I am sent to ask her my inane question list. I am granted a moments reprieve to grab a pen and paper. Inane though the list may be, the human interaction seems to do us both good. It is nice to have a name and face and voice to a patient while she is still awake and herself. I ask if she has any questions or concerns, knowing full well that I wouldn't know the answers to any she might ask. This turns out to be the only contact with an awake patient I have all day. The fourth year helps me write up my note into proper format. We enter the OR, unscrubbed, to position the patient. I am putting special stockings on her feet. One moment I am telling her what I'm doing; the next I realize she has been anesthetized in the short moment it took me to work the stocking velcro. We leave the OR, scrub, and re-enter.

There are fewer doctors in on this one, and I get a somewhat better view at the outset. The fourth year offers to let me have the closer spot, but I decline. Her jobs are running the suction thingie, and cutting the ends off the knots. Then I am invited to the other side of the table. I watch her carefully. She occasionally holds a retractor. The attending steps away for a moment. The resident takes up his role, and the fourth year takes over what he had been doing, and like the cookies in the hat and the fish in the frying pan, I hear myself offering to take up the suction. At the end of the surgery, the fourth year is putting in stitches, and I am cutting the little ends of her knots. This is enough of a thrill to last me donkey's years. I am told that this patient is My Patient, and I should follow her and write a progress note on her tomorrow morning.

I have class at 6, a mandatory miss-it-and-you-flunk-the-rotation class. Around 5, I mention this to the resident. I start asking him about tomorrow, what I'm supposed to write for a progress note, what surgery is going to be. He tells me we'll cover that later. Around 5:30, I start reminding him again, I can't miss this class (the fourth year says she was 3 minutes late last year due to a hurricane and was roundly scolded) and finally, quarter of, and sans helpful instructions for the morrow besides to do the best I can, I am permitted to break scrub.

I have been standing for most of the past 6 hours. I have had nothing to eat or drink in more like 8. Miraculously, my legs still work. I grab my non-valuables from the surgical locker room, and take the elevator upstairs to the L+D locker room, wherein lies my locker. I spill a resident's cup of coffee. Sorry. Sorry, sorry, sorry. I beat myself up as I run the locker combination. Once, twice. Once, turning in the other direction. Maybe I have the wrong locker. I know I don't have the wrong combination, because I wrote it on a piece of paper, but I'm not sure about the locker number because I put that on my PDA and locked it in the locker. Of course. Time's a wasting, so I decide to just come back later for my PDA, purse, keys, wallet. . .

Class was fine. I learned how women think. I grab a little of the juice I had brought with me and a bite of beef jerky. After class, one of my classmates went back to that pesky locker with me and we did battle with it. The locker was correct. The locker combination was correct. The locker had just been stuck. I decide while I'm in the hospital I should find out what tomorrow's surgery is, and figure out where my patient is, so I'm not doing those things at pre-dawn. I find a resident who tells me the surgery is on the intranet (never heard of it) and the patient rooms are on LastWord, and wasn't I trained on LastWord? Well, I was and I wasn't. The LastWord people didn't do any formal training. They just gave us a password in a Confidential envelope and waved. I did use LastWord on Family Med, but all it does for an outpatient is display lab tests and radiology tests. Nothing else is highlighted/clickable. So I had no idea that LastWord also contained an inpatient med list, vital signs and the patient's room number. I found out how to use Last Word. I found out my patient's room number. It appeared to be on the 7th floor of one building or another - the hospital is about 5 interconnected buildings and I had no idea how to tell which one. I was on the 7th floor of one building, and wandered through the pathway across to the next building, at which time I also, thankfully, found myself on the 7th floor. This is not intuitive - one building has no 6th floor, and has ramped instead of horizontal passages to access the 5th and 6th floors of the adjacent building. Miraculously, I stumble onto the right wing of the right floor of the right building, find my patient, read her chart, and head for home.

Home again, home again, jiggedy jig. I come home, virtually NPO since 9 AM, and plan to wriggle out of my scrubs and crash on the sofa. Scrubs are stuck. I reassess. The bow came untied but the knot is still fastened. And ever tightening. The knot is stuck behind the fabric tubing of the waistband. It takes me 20 minutes to extricate myself.

It seems I studied the wrong things my first two years of medical school. Here I had been memorizing medications and perusing the pathophysiology of disease. Here I had been learning to communicate with patients. Nope, I should have been learning the floor plan of the hospital, how to scrub, how Sterile works, and how to use a pager. They won't kick me out of medical school if I never learn to page someone, will they?