Friday, January 22, 2021

Not on My Mayo Stand!

 One of my most popular posts from the  past was about items I never, ever want to see on my OR back table. Scrub nurses work  at ( or least  they did 50 years ago) from two horizontal surfaces. A large  back table at the foot of the patient which is loaded with just about anything and everything  needed for the surgery and the Mayo stand placed over the patient just below site of the surgery. This stand  is solely for the instruments in immediate use. I've seen some illustrations of Mayo stands that really flustercate my fragile foolish faculties, so here are some thoughts about the care and feeding of Mayo stands from a perspective of many moons ago. (I had to put that disclaimer in because some folks compare my ramblings to contemporary standards and I get harshly critical emails.)

Side hanging  instruments as shown in this illustration desecrate one of the most basic of  OR commandments - Thou shall not let any instrument dangle over the edges of your Mayo stand. The outer ridge of the stand acts like a fulcrum sending your instrument flying if you inadvertently drop an elbow during a critical moment. Flying instruments, depending on where they land, are never a good thing in an OR. A nasty surgeon once lobbed  a Haney clamp at me and then in a Karma driven moment, dropped a weighted speculum on his foot. Yes...there is a flying instrument god in every OR.

I started this post out thinking that maybe I should do the ten commandments of Mayo stands, but that sounds cliched and besides, what happens if I can't think of ten? Maybe it's better if I just ramble  on in in my typical foolish manner.

When in use, Mayo stands should always be at the scrub nurse's waist. A uniform height helps establish muscle memory so that when you go to grab something, your hand goes to the intended spot without thinking. Many nurses need some altitude enhancement to reach the correct height and I went out of my way to construct elaborate altitude enhancing arrangements.  oldfoolrn: Scrub Nurses Flying High

Yikes! When it comes to just about any sort of tubing or cable, be it suction line or Bovie, it's much neater to keep them on the back table until needed. Think of your Mayo stand as fly-over country and pass the long  tubing or wiring directly from the back table to the surgeon. This Mayo also has a towel clip and a Metz scissors hanging over the edge of the Mayo waiting to be dropped or take flight. I do like the way the scrub nurse lined the top of the Mayo stand with a couple of honest to goodness cloth towels. Disposable paper Mayo stand covers and towels generate that raucous rustling noise that really grated on my nerves. It reminded me of opening presents on Christmas morning when I was often stuck in the OR.

Old scrub nurses were real sticklers when it came to keeping all your instruments on one level while they were reposing on your Mayo stand. The only high-rise object tolerated was a stack of 4X4 sponges because when it comes to anything bleeding you can't be too careful. I vividly recall the dressing down a new resident received from Dr. Slambow when he took a loaded sponge stick and  swiped instead of a dabbed at a small bleeder. "You meathead!@#&, you are wiping the clots away." The good surgeon did not tolerate fools well, except for me. 
This Mayo stand illustration should be captioned double trouble. A scrub nurse is like a mama bear protecting her cubs when it comes to guarding and maintaining the sanctity of her Mayo stand. Here we see more than one set of lunch  hooks...oops I mean mitts on a Mayo stand. Fifty years ago a stunt like that would merit a knuckle smack with the business end of a scrub stick, especially if my nemesis, Alice, was standing behind that Mayo stand. Alice was an equal opportunity knuckle buster, surgeon or nurse, it didn't much matter. The other faux pas  here involved a specimen jar filled with a likely toxic solution like formalin. Mayo stands are restricted from any liquid that could be toxic. Methylene blue and lidocaine are just fine, but biopsy fixatives are a big 

Noah was right, everything is better in pairs. When bringing up ratcheted instruments from the back table always grab two at a time. There should be an even number of hemostats, needle drivers, kochers, mixters and babcocks. I never did like the way grabbing a babcock. registered in my ear  when spoken.  Picking up a pair of babcocks always sounded more civil, so don't grab a babcock, pick up a pair. Avoiding odd numbers of instruments on your Mayo stand  helps avert that dreaded foreign body mishap. Thank heaven  this never happened to me (I pray.) .Avoiding some mishaps is  a matter of luck as much as skill. Surgery is a high wire act with lots of distractions and bad things do happen. It was well known that any nurse involved in a foreign body incident would be fired on the spot. We were scared straight.

Some nurses delighted in adding artsy fartsy touches to their Mayo stands and I'm not sure if this is a good thing or not. I'm not very artistic so maybe I have a dog in the manger attitude when it comes to fanciful touches to Mayo stands, especially when the artist is a much more accomplished scrub nurse than me. My friend, Janess, liked to craft lovely designs in her  wax paper sharps bag by cutting designs along the top border of the container. She was an artist with a straight Mayo scissors and I think her flower designs were the very best.

Elite scrub nurses were a very special breed that certainly excluded me with my size 9, hubcap sized hands. Fleet of foot with nimble fingers and a fast firing central nervous system, always totally relaxed, but ready to strike at a moments notice. Probably the ultimate paradox was their narcissism coupled with unyielding selflessness. You have to love yourself if you are going to  do just about anything for another with such blatant disregard of your own needs. 

I'll always remember my favorite scrub nurse mentor, Alice, harping about some Mayo stand minutiae and when it came time for self-evaluation her only fault was having to deal with low motivated sloppy dolts like me. Old OR nurses like Alice were different from the rest of us.

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