Possible

It’s hard to know how to set up for every procedure you come across. You might know the basics or be able to make an educated guess (or an uneducated guess like how I function half the time), but the particulars are highly dependent on surgeon preference. Teachers tell you “as long as you know what anatomy you’re working on, you should be able to critically think your way through a set up.” That’s fabulous, but then there are those times when you look at a procedure and your first thought is “What the hell?”

A few weeks ago, I looked at my room assignment and there wasn’t one recognizable word in the procedure name. Seriously. It looked like the alphabet had randomly vomited a bunch of letters onto the schedule board. I met my circulator in the room and whispered as covertly as possible, “I have no clue what this procedure is.” “Me neither,” she whispered back. I’m a little embarrassed to say, we spent the next 5 minutes Googling the procedure before we started opening stuff just so we didn’t look like complete idiots when the surgeon showed up. Thank GOD for the Internet.

So there are times when you know what you’re doing, and there are times when you definitely do NOT know what you’re doing, but that’s not what I’m here to talk about today. Today, I want to talk about those times when you think you know, but the surgeon pulls the rug out from under you because they don’t really know.

Let’s talk about “possible” procedures.

You can tell without even looking at surgeon names, which procedures belong to Dr. Waffle.

• Arthroscopy with possible ACL repair, possible osteotomy, possible tendonesis

• ORIF of tibia with possible osteotomy, possible external fixation, possible IM nailing

I have yet to see Dr. Waffle schedule a procedure without the word “possible” written in it less than 3 times. Part of me thinks Dr. Waffle was a Boy Scout as a kid and took the whole “Be prepared” motto just a little too far into adulthood. I mean… I’m all for being prepared, but really? His case carts are always loaded to the gills with instruments for every potential situation you could possibly run into, and yet somehow we never seem to have the instruments he wants in the room once the case is underway. How is that even possible??

I’ve devised a mathematical equation to help the surgery control desk decide how many circulators they’ll need to help with Dr. Waffle’s cases.

Number of “possibles” listed in the procedure name X 5 = the number of times a circulator will have to run to SPD to get something

In the above mentioned cases that would mean approximately 15 trips to SPD per case. Good thing most of my circulators wear sneakers cause they’re gonna get a workout.

From a tech perspective, the constant streaming question of “Do you have ______?” is just a nuisance. I pride myself on anticipating what my surgeon needs and having it open and ready before we start. Dr. Waffle makes this impossible. I’ve learned to use a HUGE back table for every case he does because (I guarantee) it will be totally piled full of instrument pans by the end of the case.

I suppose it’s a little rude of me to speak ill of my surgeon. He’s a wonderful person and a good surgeon. I just feel like you should kind of have a better idea of what you want to do before you’re knee-deep into a procedure. If things get hairy and you need different stuff that’s totally cool, but every case shouldn’t feel like Christmas morning with a constant stream of unwrapping things to add to the field.

In the end, all you can do is prepare as best you can and remember: the only thing that’s constant is change.

Until next time, stay sterile.