Resident Evil
It’s the most wonderful time of the year…
Not really. Actually, it’s that time of the year when new surgical residents flood the halls of operating rooms everywhere. RUN FOR YOUR LIVES!! I am fortunate that my hospital is small and we only get a handful of residents per year. Most of them work with podiatrists doing relatively minor procedures. This makes me feel better about their odds of doing any major harm to anyone (including me), but other surgical techs aren’t so lucky.
At one of my prior hospitals, residents ran rampant. Summer was like “March of the Surgical Penguins” with a new clutch of residents filing aimlessly down the hall to the Doctors’ Lounge, their white coats still stiff with starch from the manufacturer. While some were great, a number of them were so bad that I was this close to grabbing instruments out of their hand and doing the surgery myself. (Damn you, scope of practice…) The one that stands out most in my mind was an orthopedic resident I had the misfortune of dealing with (whom I’ll refer to as Dr. Percival).
Dr. Percival showed up to a total knee arthroplasty with one of my favorite surgeons, Dr. Gawain: a soft-spoken, endlessly patient, and agreeable man whose capacity for forgiveness was well-tested working with me (being a new graduate). Dr. Gawain also carried the added bonus of his PA, Terence. Terence was a surg tech-turned-PA who took extra pains to make sure things went smoothly. I loved them both and took their acceptance of Dr. Percival as a good sign that he’d be one of the competent residents on the floor. This was the day I learned that doctors don’t always get to choose their residents-sometimes they’re assigned.
Dr. Gawain started the initial dissection into the knee and Dr. Percival launched into a recitation of his illustrious surgical pedigree. “When I was down at Mayo… At Johns Hopkins…. I can’t believe you guys don’t use the same system we had at UCLA… Blah, blah, blah.” The commentary was irritating and I saw a microscopic crack appear in Dr. Gawain’s peaceful veneer. I don’t know if he thought it would shut him up, scare him off, or what, but Dr. Gawain unexpectedly handed over the case to Percival.
Terence and I looked at each other like, “Is this shit happening for real right now?” Percival asked for a rake and I reluctantly handed it over. He hooked it over the tissue on the lateral side of the knee letting it dangle as he grabbed for the cautery. With each millimeter of tissue he exposed, the rake prongs began to slowly dislodge. “Um, you’re going to lose your rake,” I pointed out. “It’s fine,” he replied just seconds before the last two prongs of the rake released sending it clattering onto the OR floor. “Give me another rake,” he demanded. I looked over at Dr. Gawain, my eyes saying “Do I really have to?” He nodded and apprehensively, I surrendered my remaining rake. I sighed as I watched him hang it off the exact same spot where the previous rake had just committed instrument suicide and not a minute later: CLANG! Rake #2 was on the floor. With no more rakes to ruin, Percival was forced to let Terence do his freaking job and retract with a few right-angled hohmanns.
Then came the scary part. Dr. Percival wanted to drill and cut the femur. Before I could start hyperventilating, Dr. Gawain stepped back in and began the process of prepping the femur. He got as far as pounding on the femoral cutting block before the running commentary got the better of him and he stepped back before he could no longer hold back his urge to bitch-slap Percival.
“Give me the saw,” Percival barked. Oh no, no, no, this isn’t happening. I picked up the saw and stared at Dr. Gawain. “PLEASE don’t let him do this. Don’t make me hand him a power tool. GOOD LORD MAN! HE CAN’T EVEN HANDLE A RETRACTOR PROPERLY!” But my pleas were ignored and he nodded for me to surrender the saw to the resident. Percival took the saw, made two cuts and tossed it onto the drapes! I snatched up the saw, whisked it back to my table then turned back to inspect the drapes and the patient for signs of damage (Hey idiot! There’s a second leg on the table remember?). Miraculously, everything was unharmed.
I looked up from the drapes only to find Percival watching me. His hand was extended expectantly for the return of the power saw to finish the femoral cuts. Not breaking eye contact, I reached back and covered the handle of the saw protectively. After what I would consider the surgical version of a good ol’ Wild Western Stare Down, Percival looked to Gawain for backup. Luckily, the good doctor had sensibly recognized that I had reached my limit of dealing with safety-negligent blowhards for the day and stepped in to complete the procedure. Fortunately for him (but unfortunately for me), Percival made a hasty get-away with Dr. Gawain when it came time to close so I wasn’t able to discuss my "concerns with his technique” (which may or may not have included a swift smack to the back of his head).
That was the first and last time I worked with Dr. Percival. I often wonder (and worry) if he went on to graduate. Did anyone pull him aside and explain the concept of patient safety? Did he transfer into a specialty that wouldn’t afford him the opportunity to throw power tools at people? (I hear OB/GYN is hiring.) I guess I will never know. But to all of you fabulous techs out there please remember: Resident Season is coming! While I realize that everyone is the newbie at some point, safety shouldn’t be something we have to teach at the field. I don’t know about you, but that lesson was Day One through Graduation Day at my school. Patient safety is our top priority! So even if it means standing your ground or having an uncomfortable stare down to get your point across, do what you have to do.
Until next time, stay sterile!
