Waiting is a part of surgery, and how a surgeon perceives time

People like us, who believe in physics, know that the distinction between past, present, and future is only a stubbornly persistent illusion.
– Albert Einstein

The surgical case is delayed for ten minutes and I am getting restless. I anticipate a very difficult dissection. The cancer has returned after extensive prior treatment with surgery, chemotherapy and radiation. I have enlisted additional help to make certain that everything goes as smoothly as possible. Now we wait as the final preparations take place. Time passes very slowly.

Waiting is a part of surgery. Patients wait to see the physician. Surgeons wait until a day is available on the operating schedule. Families wait in the family center during the operation. Everyone waits while the patient recovers from the procedure.

As a medical student and intern, I remember scrubbing in on surgical cases for the first time. There were clocks by the scrub sinks that reminded us to vigorously wash our hands and forearms for ten minutes. The first days in the OR were scary. We did not know what we could and could not touch. I am tall, so I was constantly bumping my head into — and contaminating — the overhead sterile light handles as I looked around at the unfamiliar sights. Being in the operating room was such an unusual experience that time always seemed to stand still. I soaked up every little detail.

A few months later, after I had grown accustomed to the privilege of being in the operating room, the passage of time changed. I remember one day when my resident referred to me as “a hook.” “Here, Campbell,” he said. “Your entire purpose for the next two hours is to think of yourself as being a hook that was screwed into the wall as an anchor for this retractor. Hold it like this. Don’t move.” I did not do a very good job at standing still, and he reminded me of that several times. I could see nothing of what was happening. Those were the longest two hours of my life and I remember them like yesterday.

Back to the present. The delay is eventually resolved, and we begin the operation. The dissection is, indeed, challenging, and my colleagues and I call on all of our prior experience and training to remove the large cancer. We stop to discuss the best way to proceed. We trade places for a while to get different perspectives. We quiz the trainees about the anatomy and their reading. We overcome several obstacles, changing course as needed. The cancer finally yields and is removed from the field. Soon, we are closing the wound.

I look up at the clock. It seems like only a few minutes have passed since I had anxiously waited to begin the case. Five hours have disappeared like an instant.

I realize that time spent truly engaged in a challenging experience follows no rules. For the residents, maybe the case might seemed like an all-day event. For the nursing staff, the clock likely slowed as the end of their shift approached. For the family, I imagine the day seemed like an absolute eternity.

Einstein famously said that “reality is merely an illusion, albeit a very persistent one.” I do not pretend to understand the mathematical or existential implications of his statement. I do know, however, that the mysterious slowing and speeding of time really does occur, and I sense the shift most intensely while working in the operating room.

Bruce Campbell is an otolaryngologist who blogs at Reflections in a Head Mirror.

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