Surgery Voodoo

There is some kind of cosmic force in the OR between myself and our various attending physicians. With some attendings, I operate confidently and (somewhat) gracefully. I am happy with my suturing and knot tying, I am able to deliver the baby’s head from the uterus, and can keep up with the pace set forth by the attending. With others, I operate like it’s my first c-section ever. I am clumsy, can’t seem to throw the suture in the right place, and work at a snail’s pace. I’ve noticed that this pattern is set forth by the success or failure of my first OR experience with an attending. If it’s a good case, then I am forever blessed with decent OR skills with that particular surgeon. If it’s not, I am doomed to a lifetime of surgical ineptitude in future cases with that attending.

Yesterday, I scrubbed in with Dr. B for the very first time. She is young, smart, and lovely to work with. Unfortunately, the case was a postpartum tubal ligation (a.k.a. PPTL, a.k.a. The Most Annoying Surgery Ever). Let me remind you that I have not done a PPTL since my first round of OB back in August. That’s right, it had been 6 months. Needless to say, I had forgotten the steps, which instruments to ask for, where to tie, where to cut. The scrub nurse, taking pity on me, periodically whispered hints in my ear. The more flustered I got, the worse my technique got. The worse my technique got, the more critiques I got. The more critiques I got, the more flustered I got. See the cycle? Wash, rinse, repeat.

Today, I scrubbed in with Dr. B again for a primary C-section. I thought to myself, “Great! A surgery I know well! It’s my chance to redeem myself!” You see, in that brief moment, I had forgotten about my OR voodoo. The relationship had already been set! Because of the disastrous PPTL the day before, I was doomed for the case today. First, I didn’t cut my incision big enough. Then, I bovied (used an electrosurgical tool) right through a blood vessel. Moving right along, we arrive at the uterus and I made my incision. I see little baby face staring back at me. I thought to myself “I got this!” I reach inside, wrap my hand around the baby’s head and lift. But the head doesn’t budge. I try reaching around, orienting myself, flexing the her head – all to no avail. I can’t deliver this baby’s gosh-darn head. Then I hear the words every intern dreads hearing. “Why don’t you let me do this part.” Read: you are failing at the task at hand and I am taking over. I sigh. Now, baby’s out and we move onto repairing the uterus. Now I am flustered. As I suture, I am reunited with my old friend: Intern Tremor! My hand shakes as I throw each stitch and suddenly I am taken back in time to my first couple of OR experiences. Oh intern tremor, I thought I had left you behind long ago… Finally the god awful task of repairing the uterus with med-student hands is done. I tie off my suture. I think the worst is over but then as I throw down my third tie, I notice it. The dreaded Air Knot (a.k.a. a knot that is too loose to stop bleeding or hold your tissue tightly together.) I had sewn all across the length of the uterus only to finish the job with a knot that made my suture obsolete. Ouch. The rest of the case was a blur. As we finished, we shook hands across the patient in usual end-of-the-surgery fashion. She smiled. “Thanks for your help! That was…uh…good…”

About 12 hours later, I still sit here cringing at that OR performance. I swear one of these days, I’ll break this curse. Right?