Appreciating the beauty of a time out in the OR

If you’ve ever spent time in the operating room, you are already familiar with the words the circulating nurse uses to signal the time out – the few minutes before a procedure begins when the surgical and anesthesia teams review a patient’s case. If you’re a non-medical type, or a medical student whose surgical rotations are scheduled late in the 3rd year, then you’re just as clueless as I was when I stepped into the operating room for the first time.

In reality, I didn’t so much step as I did tiptoe. And actually, I probably looked more like some sort of gunslinger – with my back to the corner, trying not to be noticed, and taking in my surroundings. Dressed head-to-toe in a light blue ghillie suit; a sterile light blue ghillie suit.

I was terrified.

I heard horror stories from other students about surgeons and scrub nurses yelling at medical students who didn’t use proper aseptic technique; understandable, considering that one tiny misstep could expose the patient to bacteria and increase their risk for infection and post-operative complications. I had been oriented to the goings-on in OR the previous day; all the “do’s” and “dont’s” about the choreographed dance more commonly known as “scrubbing” – properly cleaning my hands, putting on a sterile gown and gloves, and walking around on the OR to prevent contamination – were running through my head as jumbled words and phrases while the rest of the team respectfully stood in total silence. The circulator read the time out checklist, listing the patient’s allergies and anticipated complications, and naming the antibiotics that had been given. As the time out ended, each team member set in motion, creating a sort of organized chaos where everyone goes in a different direction, each with a prescribed role.

Everyone but me.

There was no magical moment where everything suddenly came together and I saw an existential light calling me into the field of surgery. But as the rotation progressed, I became more comfortable with my role as part of the surgical team. There were understanding, patient, and helpful nurses who showed me where to stand so I could see the surgical field and whispered instructions in my ear about what I should do to assist the surgeon. Sure, once I got reprimanded for bumping into a sterile table, but I learned that I wasn’t the first or last person (medical student or otherwise) to do so. There were incredible cases, and robotic surgeries that were so amazing I can’t imagine ever describing them as less than extraordinary. Once, I was asked to place my hand into the incision. I remember being totally awestruck and thinking, “Who would let me put my hand into a living, breathing human being?”

In reality, I was retracting subcutaneous fat. Never has a medical professional ever been so excited about fat.

I began to appreciate the beauty of the time out – those short few minutes where the chaos of the operating room came to a standstill, when the entire team reflected on the life before them, and the procedure they were about to perform. With that said, I can’t perpetuate any of those horror stories that I’d heard when I started my rotation. The advice I can offer is that no matter the rotation, there will always be situations that are uncomfortable or intimidating. In those situations it is important to take a “time out,” to focus on the aspects of the rotation that you enjoy or find intriguing. These are what will make your experience worthwhile.

Allison A. Greco is a medical student who blogs at MD2B.

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  • http://arnonkrongrad.com Arnon Krongrad, MD

    A highly romanticized view of a hopeful heart. 

    Keep that heart as you take in the reality that the “time out” is but another reminder that the doctor is being shunted to the periphery as the bureaucrats take up the health care middle. Do I really need a nurse who never met my patient to yell that we’re taking out the prostate? Like I’m gonna take out the wrong one. Quit yelling and let the festivities begin.

    • Bobby Maz

      Easy to say, but the medical community is still doing wrong site surgeries.  Until your colleagues get it right 100% of the time, someone is going to be there with the checklist. 

      • http://arnonkrongrad.com Arnon Krongrad, MD

        If the community “is still doing wrong site surgeries,” then the yelling hasn’t worked.The community has never removed the wrong-side prostate. The community has habituated to the yelling and pays no attention to it; it’s not useful, it’s annoying. 

        It’s fine to let the pendulum swing back to physician responsibility. We can handle it.

    • http://twitter.com/grecoa3 Allison

      Highly romanticized and Hopeful heart? Isn’t that par for the course of a third year medstudent? Regardless, thanks for reading!

  • Dan Spinato

    Timeouts are great anywhere. But especially for a person who works in such a stressful, chaotic environment, yeah it sure is beautiful.

    • http://twitter.com/grecoa3 Allison

      Glad you agree! Thanks for reading!

  • http://www.bryantsstatisticalconsulting.com Donald Tex Bryant

    To me the timeout is not only a time to focus for those in the operating theater but also a time to make sure that the chance of errors are greatly reduced.  Others besides the surgeon are responsible for errors–the anesthesia could be incorrect for the patient.  The surgeon could be operating on the wrong eye.  Perhaps there is a new team member who needs a bit more orientation.  There are many opportunities for error in surgery.  Any reasonable method such as a timeout makes sense to eliminate the possibility of such.  In fact, the surgery will probably proceed more smoothly and all team members will be somewhat more relaxed and focused.

    • http://twitter.com/grecoa3 Allison

      Exactly. It’s sometimes hard to explain to non-medical folk, but when we talk about decreasing error and focusing, then I think it becomes a little easier to comprehend!

  • http://pulse.yahoo.com/_2LRZNHDZS6DU45WQ567LPQ7CMI ninguem

    They should get the hospital chaplain and take a time-out for a prayer.

  • Anonymous

    Thank you for caring, Allison. If you and I ever meet in an operating room, I’m sure I’ll be in good hands.

    • http://twitter.com/grecoa3 Allison

      I really appreciate that! Thanks for reading!

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