Thursday, March 31, 2016

Left Handed Surgeons

This illustration shows a neurosurgeon dissecting with his presumed dominant left hand, with a  suction ready to go in his right hand. I spent many happy hours with our internationally known neurosurgeon, Dr. Oddo and was always impressed with his ambidextrous abilities. He was equally adept with either hand. Whenever I asked about his versatile handedness he always replied, "It's best not to think too much about things like that. I just use whatever hand feels best. Just shut up,fool, and keep that suture coming." (I always waited until the end of cases to pose philosophical questions figuring that a combination of fatigue and relief that the critical segment of surgery was over would reduce inhibitions and produce answers to my foolish inquiries. Sometimes this strategy worked yielding valuable insights.

After spending many lengthy sojourns underneath the OR table adjusting the foot pedal of the Mallis bipolar cautery, I noticed Dr. Oddo always used his left foot to actuate the pedal. From this, I concluded Dr. Oddo was left footed. I extrapolated this finding to figure that Dr. Oddo was probably a natural southpaw who had been converted to using his right hand by societal pressure or his lengthy medical training. His left laterality preference was revealed by his left footedness.

Unlike some of my colleagues, I actually enjoyed crawling under the OR table to adjust the Mallis bipolar foot pedal. It was kind of like a mini-vacation from all the noise and mayhem going on above the table at the operative site.  No flying bone chips to dodge and no putrid Bovie smoke to inhale.The drapes made the area under the OR table feel like a  cozy tent pitched in the middle of the wilderness. It was a nice quiet place to pause for some refreshment until the surgeon hollered to adjust the lighting or the scrub nurse pestered me to open more suture. It was a nice respite while it lasted.

Now I knew why Dr. Oddo  insisted upon having a left handed set of Raney clip appliers available at all times. He was a closet lefty.  The ratchet mechanism of the left handed Raney clip applier released in the opposite direction as a right hander.  ( Those purple things around the scalp margins in the above picture are Raney clips and they prevent blood from oozing all over the operative field.)  One of my claims to fame as a scrub nurse was the ability to load 2 Raney clips at a time, even Dr. Oddo was impressed. This was the only left hand specific instrument he ever requested which was a testament to his ambidextrous abilities.

Sometimes Dr. Oddo's  ambidextrousness befuddled me. Instrument trafficking (thanks to whippersnapperns for coining that term, it fits like a glove) involves several elements; timing, correct hand placement, and with enough oomph that the surgeon can feel the instrument slapped into his hand. Whippersnappers sometimes are shy about instrument slapping, but it's called slapping for a reason. I've never had a surgeon complain about the slap being too hard, although one did call me "old school" for aggressive instrument slapping. I think it was a compliment.

My signature instrument trafficking trick was to smack a needle driver loaded and ready to go into the surgeon's right hand while simultaneously sliding a pickup forceps into his left hand. This always happened at the close of a case when everyone was in a relaxed state of relief that the critical portion of the surgery was over. Surgeons just loved receiving two instruments in one motion or maybe they were just ecstatic that they were almost done. Anyhow, I never had any complaints about my trafficking technique until I scrubbed with Dr. Oddo.

Sometimes he would work with the instruments as trafficked (needle holder driver in the right hand and pickups in the left) Other times he would give me a nasty look, I could easily read a scowl even with a mask on, and switch hands so that he was suturing with his left hand. Of course, I had instinctively placed the needle holder in his right hand.   Out of the blue, I'm thinking.. pick a hand Dr. Oddo...Pick a hand and stick with it...  and it inadvertently  capers across my tongue.  Dr. Oddo screams at me, "Mind your own business fool and keep that 3-0 coming." After the case, Dr. Oddo approached me and actually apologizes and explains that when he was a resident, the attendings  would always implore him to "pick a hand." This caused handedness to become a hot button issue with Dr. Oddo. I never again just slapped an instrument into a specific hand, but always tried to be aware of which hand he was using.

I once worked with a neuro fellow that had done his residency at the famed Mayo Clinic and was accustomed to gloving up with his left hand first even though he was a right hander. It seems that the two Mayo Brothers were left handed and as a tribute to them all surgeons gloved left hand first. I was just getting used to the practice when Dr. Oddo took note of it and started asking pointed questions of the fellow. I was shocked when he dressed the resident down saying, "This is not the Mayo Clinic and that old fool scrub nurse has enough to worry about at the beginning of a case. I want everyone gloving the same way, right hand first." The humiliated fellow readily concurred. I thought maybe Dr. Oddo was taking out some of the frustration he received as a left handed resident on the poor fellow.

There was a left handed general surgeon that had a complete major set of left handed instruments. The needle holders, clamps, and scissors were left hand specific. I could never get used to releasing the ratchet in left handed instruments and was constantly fumbling around. Luckily there were a couple of left handed nurses available to work that room. We had a left-handed specific general surgery room where even the anesthetist was left handed. It worked out well. I was a committed right handed person and could never feel comfortable releasing ratcheted instruments in my left hand.

I then tried using the left handed ratcheted instruments in my right hand, but somehow the thumb is not designed to slide the ratcheted side of the instrument upwards. Somehow left hand specific instruments just were not my thing.

I did some research on the internet about left handed surgeons and the terminology and tone was overly complex and full of bafflegab and bolderdash. Scalpels, sponges, and pick-ups are not hand specific. The only difference is with ratcheting instruments opening and closing in the opposite direction. If the left handed surgeon simply operates from the left side of the table, I would think everything should go well. As a right hander, I don't think I could ever be comfortable with clamps ratcheting the "wrong" way or working from the left side of the table. I was lucky that there were left handed nurses to work with left handed surgeons.

1 comment:

  1. Reason # 8273 why I never wanted to work OR ~ "putrid Bovie smoke"