Sunday, January 1, 2017

Not on My Back Table!!

Don't even think about lobbing that ovarian cystic teratoma on my back table.

Old school scrub nurses work from 2 horizontal surfaces, a Mayo stand which is positioned just South of the surgical site and a back table that sits at the patient's feet at a right angle to the patient. Every scrub nurse likes to keep an organized Mayo stand with a minimal amount of instruments. When it's time to close all I kept on the Mayo stand was a pick-ups, needle holder, suture  and straight Mayo scissors. This can lead to the back table assuming the role of a dumping ground which got me  angry as a surgeon with a non-functioning suction. Here are some things to keep away from my back table or I will pinch your keister  with a sponge ring forceps. I am experienced with doing this without breaking sterile technique, so beware! I know from personal experience that sponge ring forceps can leave one heck of  a mark and the pain can give you something to really think about.

I don't like basins of water or solutions sloshing around on my back table. This is an OR, not a trout farm. Whatever happened to ring stands for basins of water? When I see photos of contemporary ORs the ring stands have disappeared. Where does all that unused OR  equipment wind up? Probably in the same place as sponge racks and table-side light stands. Bring back the ring stands and get that aquarium sized basin of water of your back table. It's a hazard every time you move or bump the back table. A wet back table is a contaminated back table.

Another thing I hate on my back table is oversize specimens. Trying to land a huge pandus or teratoma on my back table is like landing a 747 jumbo jetliner on an aircraft carrier. Don't do it. Big hunks or globs of tissue should be handed off to the circulator. If the circulator is busy and the surgeon insists on lobbing that Big Tuna of a specimen your way, just drop it in the kick basin. The crash/splat noise it makes when it hits the target will remind everyone not to pull this trick again. Think of that sound as resembling a church bell ringing in a slaughter house as that big side of beef is placed on a cutting table. It's a  very memorable sound like a newborn's first cry or the rales and rhonchi of a patient on his death bed; an acoustic experience that really sticks with you.

Kudos to the person who invented sterile operating room light handles. Surgeons are like patients in that the more they can meet their own needs, the better for all parties concerned. Savvy scrub nurses do not keep sterile light handle adjusters on their back table. Before you set out an instrument, take a couple of seconds to thread those sterile light handles in place. Get them off the back table.  When a surgeon bellows to the circulator for a lighting adjustment you can curtly reply, "The adjustment handles for the lights are sterile, monkey around with them at your leisure." Multiple adjustments of lighting on the same surgical site can be indicative of a poor prognosis. I wrote a post about unusual signs of a bad prognosis, I think it could be located by typing "Prognosis" in the search box. In the new year, I promise to figure out links!

Anything that has the potential to dangle over the edge of the back table does not belong there. Only the very top of any table is considered sterile. Get rid of that suction tubing and potential dangler early in the game to be on the safe side.

Here is something that I have had some painful encounters with. Loaded needle holders on the back table are a real danger to hurried hands. They will stab you right through that glove.  Why do bright, young whippersnapperns wear gloves when handling needles? Gloves provide no defense when it comes to needle sticks and dull tactile sensations. It is hard for oldsters like myself to make sense of healthcare today.

Enough of my foolishness. Thanks so much for indulging in my silliness and I hope the New Year brings you peace and fulfillment in all that you do.


  1. Happy New Year, Old Fool!!!

    I never worked OR, but when I worked at a hospital that trained Family Practice docs, I always made sure to train those pups to pick out and dispose of their sharps from procedures themselves...

  2. Oh my, your descriptions are spot on. It's been decades since I first stepped into the hallowed halls of the OR, and yet reading this it seems almost like it was yesterday. We had a surgeon much like your Dr Slambow, very opinionated and difficult at times. He had a favorite circulating nurse who was from the Philippines. Despite her diminutive stature, she took no guff from anyone. One day, as she was orienting me to the ways of a big city Harvard teaching hospital, this surgeon insisted she move the lights over and over again. I noticed a twinkle in his eyes behind his loupes. Eventually, she did too. The next time he yelled at her to adjust the lights she knocked him on his noggin with it. Not hard enough to hurt but enough to get him to quit yelling. I never dared try that one on my own.

  3. Your best effort yet, IMHO. Take that for what it's worth, coming from a cop. If I'm wrong, you can pinch my keister with a sponge ring forceps, whatever that means. Without my glasses, I thought the photo was a nurse holding an odd-looking baby. Sadly, I put my glasses on just as I was taking a bite of hard-boiled egg.

  4. Debra, I received some of the best advice and technical tips from Philippine OR nurses. One day Nancy, who was one of the best took me aside after a surgeon hollered and screamed at me for an equipment failure and said "You can't let him get away with talking to you like that. You need to holler right back or your soul will be harmed." She was indeed correct and although my personality could not return the nastiness, I have always remembered her advice.

    Thanks Officer. Ovarian teratomas are really strange. I scrubbed on one case and the cyst was about the size of a softball. Having read that these cysts are a Pandora's box of different tissues containing teeth, endocrine gland tissue and even an eyeball, we begged the surgeon to open the mystery cyst in the scrub sink after the case but he declined and said that was a job for the pathologist. I have never seen a cyst anywhere near the size in the illustration.

  5. I never worked OR but I have a sister that has been doing just that for almost 30yrs. This is the post that made me call her up and insist she read your blog. The title of this post sounds just like something she would blurt out. The closest I ever got to OR was Recovery Room when the census was down in ICU. Your blog is the one I check every day for some new memory-jogging material to bore my long-suffering husband with.

  6. I have great respect for your sister for having the inner strength to work for 30 years in an OR. She must be very special. Thanks so much for taking the time to read my foolishness and commenting.