Theatre Courtesy

You’re new to theater and it’s all bright and shiny and the last time you were there, you were in med school and you stepped back accidentally and brushed against something blue (but it’s all blue…!) and then “the whole set up was contaminated…”!!!

Relax. You’ll go a long way if you have good Theatre Manners.

It’s important that you don’t let courtesy overwhelm sterility - keep the mask on, avoid shaking hands anywhere near the setup and if you really must bring your bag into theatre, make sure you set it down away in the established “doctors area” (look for cues e.g: large empty table, computer not on, chairs amassing in the corner that the table is in).

The first rule of Theatre is that there is a hierarchy. If you truly believe that the surgeon is at the top of that hierarchy, be prepared for a very cold and bumpy ride. No, the person in charge is the scrub sister (she or he is the one scrubbed) and in general, it’s best you address them first and introduce yourself - name (drop the “doctor” stuff, you’re not the surgeon) and your role (assistant / medical student/trainee coming in to watch - though hopefully by then, you know this!!). Be polite and wait for her attention - her clock is set by when the surgeon wants to start and she doesn’t want to keep him or her waiting!

Be courteous to the new scout team too, introduce yourself to them next. They don’t know your style but will be quickly sizing you up. Ensure that the team has your glove size and your preferences. If you’re particularly junior or new, introduce yourself to everyone. No one expects - or would tolerate - your arrogance in a theater. Check with them, or the anesthetist if the patient is due to have a catheter (or other preparatory activities) pre-operatively - particularly if it’s due to be done by you!

Ensure the patient knows who you are. Patient interaction will be covered in another post. Suffice to say, morally, ethically and legally, a patient should know who has been in or near their body.

In the theater before surgery, ensure that you’re helpfully present but out of the way when things look like they’re ticking along fine. A good example is willing to do things that get the theater going - eg roll the patient (if you’ve had the correct training), check the consent (pending hospital regulations). Respect the fact that this team has probably worked together for longer with the surgeon than you have, so let them lead. Make sure you know the name of the anesthetist and theater tech so if you or the surgeon need assistance on the repositioning of equipment it sounds more like a request, than a rude command.

It’s important that you be proactive but not demanding. If you need a wet pack, calmly hold out your hand and clearly ask, “may I have a wet pack please” or “wet pack please” - if there’s any question as to why you need it, indicate or gesticulate as to why it’s important at that stage of the operation for you to have access to the instrument or support tool you’re asking for (eg Kerrison punch -> wet pack in the hand of the assistant on the same side as the punch).

Never grab!!! Yes, it makes more sense for you to take the instrument from the surgeon and the scrub team to find the next instrument the surgeon has asked for - but some scrub teams have been trained to take everything and give everything to ensure the count is correct. Be mindful of how your cleaning or placing of the instruments feels to the other party - some don’t realize their exuberant grabbing midair throws the surgeon off her aim and she has to recalibrate to target the same area again. This is easy, but after a while, exhausting. Best you just don’t do it.

Be kinesthetically aware - that is, assess your relative body position - are you blocking the flow between a surgeon and scrub nurse (there should be a clear path - lest there be scalpels in hands or arms)? Leave enough time if it a new specialty in order for you to do things as part of the team and to register yourself to the new hospital. Enjoy and see this is a new opportunity to get your name out there and you’re experiencing something new and interesting, it may lead to a new specialty opening up for you for greater appreciation to the existing one.

Don’t lean on the patient. It’s a sad fact that patients (and medical staff, to be honest :)) are becoming laterally-challenged, but a great amount of what we do surgically is about relative anatomy. Any force you onto the patient, or worse, onto the struts or supports holding the patient endangers the safety of the patient. There are terrible stories of Neurosurgical residents leaning on the headframe or the Mayo table believing it to be secure, only to have loosened the supports - doing great harm to the patients as a result.

If you’re tired, stretch when possible (keep sterile) and review your position. More tips in a future post.

At the end of the case, thank the team. Help them to take the patient off the table (see above re: training) and if they have lost an item of their count, stay til it’s found. It’s also good form but not necessary for you to wait till the patient is awake. However, if the surgeon says it’s ok to go - head on off!

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