To the Himalayas!

Not everything in the Operating Room can be sterile. Anything in contact with the patient or the discontinuous surgical field (the draping over the patient, certain trays of tools, people who are scrubbed in, and almost everything inside a package) is sterile. However, masks, caps, and scrubs – all donned outside of the OR – are not and neither is anything below the waist. It is funny to think of people as “sterile” (safe?) and “not” in this environment, but it is entirely necessary; there are usually two nurses on each case, one is the scrub nurse and the other is the circulating nurse, who is not dressed in sterile garb. If you touch the circulating nurse or anything else that is not sterile, you become unsterile.
My mistake: during the laproscopic inguinal hernia surgery, I was near the foot of the bed with the monitor and controls to my right. The circulating nurse (non-sterile) had to stand on my right hand side occasionally to manipulate the controls, and on one such occasion her shoulder brushed my upper sleeve. Solution? The scrub nurse was able to get a plasticky ’sleeve’ to slide over the affected area.

To become surgically sterile in the first place is a careful craft that can only be mastered with practice and attention to detail. The ritual of “purifying oneself” isn’t all that horrible, really. If you are past the ominous red line in the OR area, you are already wearing your scrubs, cap, and ID tags. Time to scrub in. Those who had scrubbed in earlier in the day were free to substitute a simple washing and alcohol rinse for the whole procedure, but this being my first time (ever), it was key that I practice the technique all day long.

Over at the giant stainless sink, you must first don a mask, which cannot be touched at any point after the following step. You are to grab a foil-wrapped package of scrub soap and open it up. This isn’t a bar of Ivory like your mama used to use, but rather a yellow sponge impregnated with pink suds, sporting a clear plastic bristly brush on the backside. There is also a blue nailpick included in the package, which can be used if you’ve been gardening right before, but otherwise, it goes into the trash. With a swift movement of the hips, the water can be turned on. At all times, one must keep their elbows below the hands; the idea is to rinse all the yuck down to the elbows where it can drain off. Once the arms are thoroughly dripping, you can turn off the water and lather up. Take pleasure as the pink bubbles collect across your skin, because the vigorous, ‘down to the bone’ bit comes next.

My teacher abandoned me mid-scrub, but had the courtesy to direct me to the sign on the wall with the appropriate directions. There were different procedures depending on whether this was to be a “long scrub” or a “short scrub,” the former has more strokes (a stroke being one complete back-and-forth motion).  Starting with the fingernails, 20 parallel strokes. On the fingers, 15 strokes per finger times 4 planes. The back of the hand, 15 strokes times 3 planes, the same for the palm. The arm was to be completely scrubbed using small circular motions. It was hard to tell exactly how much to do (I’m sure there was a number), so I just scrubbed until my skin was turning red from the abrasion. Now comes the rinsing motion, as before [elbows down!], and a bit of shake/drip dry. If you touch any part of the sink, the corner of a paper towel, your scrubs, or whatever during this procedure, you must redo it from the start. In case you were wondering, by the end of the day, after scrubbing 4 times, my hands were not raw, they were just very clean.

There is an artful way to enter the Operating Room. With your hands in front of your chest, elbows down and to the sides, carefully use your bum to push the swing door in. Head to the far side of the room and stand around like a gimp, dripping away, until the scrub nurse has a chance to hand you a sterile towel. There is even a special way to dry your hands, as every care must be taken to dry the hands first and work downwards to the cesspools that are your elbows. Drape the towel on some piece of equipment or another, as instructed, and get ready for the dance.

Dancing is not something I’ve ever had a lesson in. I know that true dancers must execute each move with precise timing, effortless grace, and exquisite control. Those characteristics are also essential for the gowning and gloving ritual. The Scrub nurse holds up the sterile gown so that you can shove your arms in each of the sleeves, only as far as the wide, elastic fabric cuffs. Latex surgical gloves of a the appropriate size (6 1/2 [smallish] for me) are retrieved and one is held open in front of you. Reaching up with your right arm to the sky, you can get just enough tension on the gown to be able to shove most of your hand out of the sleeve, invert your hand into something resembling a diving airplane, and shove it downwards into the glove. The same basic procedure is repeated with the second glove. Some people wear vinyl liners for their gloves if they are allergic to latex or afraid of becoming so.
My mistake: While I assisted her on the cyst-removal surgery, the Resident noticed my gloves were a bit large. I thought they were fine, as they felt good, but she did have 7 more years of schooling than I, so I trusted that. As I scrubbed for the next surgery, I asked for size 6 gloves. I could not get my hands all the way in, and when trying to force it, I put my right hand straight through the glove! They managed to remove the gloves and get me a good ‘ole set of 6 1/2s. I felt stupid for making the nurses do the extra work, but now I really know my size!

Now for the ties on the gown. The circulating (non-sterile nurse) has probably already done up a little snap at the top of the back and a small inner tie at the right hip. With your hands, encapsulated in a sterile field created by the gloves such as they are, the remaining tie at the front must be undone, handed to the nurse, and then your arms are kept elevated while you spin counter-clockwise. She hands you back the tie and you do it up at your left hip. I didn’t really get the importance of this at first, but my mistake explains it.
My mistake: As I undid the tie at the front, one of the ties fell near the floor. It became non-sterile in doing so, and the circulating nurse had to use a clamp to pinch it shut at my hip (as I would not be allowed to touch the ties anymore). Everything below the waist is considered non-sterile scum.

A little bit more practice will smooth out the kinks in my technique I reckon. I was just so excited to be in the OR that whatever stupidity I got up to could not bring my mood down.