Time Out

When the time out was called, I stood at the side of the room, far from all sterile equipment–anything covered in blue–prepared to witness my first surgery as a medical student. In surgery, a Time Out happens before anything is begun on the patient. The team–everyone in the operating room–stops all activity and listens to a review of the patient before them, and of the procedure about to be performed. This is the final confirmation that the right patient is on the bed, that the right surgery is about to be completed, and that the surgery is about to be completed on the right body part.

It had taken some very careful orchestration to get this shadowing experience underway; I’d needed a day that would work with my schedule–a day with recorded lectures which I could review at a later date–and one on which the surgeons were willing and available for medical students to come in. I’m generally loath to miss lectures so I needed a lighter day, and even so, I struggled with the concept before conceding to the greater allure of an incredible experience. My medical school Surgery Club coordinated the process once I’d signed up, serving as the liaison between myself and the vascular surgeon I would end up shadowing.

I arrived at the Vascular Surgical Suite far too early. Then I ended up running back to my apartment to retrieve my stethoscope–I’d been told to bring it along, but I did not end up actually using it. I was still early when I returned to the hospital, but the surgeon was already in. I introduced myself with all the confidence of a first year medical student–not that much–and then stood beside her while she waited for a call back from someone in another department. “I want to make sure they call back and it’s done right,” she’d said, and I’d nodded in agreement; even though I was missing the context, I understood the concept. I liked her already.

“We have one procedure scheduled for noon today, if you can stay for that,” she’d said. I hadn’t expected to stay for the afternoon, but nodded eagerly. Of course I could stay; in the moment, nothing was more important. It was a little after eight in the morning, and I would be shadowing her in the clinic for the next few hours before she would start to prep for the surgery. It was two hours of internal conflict later that I confessed that I had a lecture at one that afternoon (it wasn’t being recorded), and wondered if I could come back afterward. She seemed to debate for a moment before saying, “Sure, you can absolutely run out for class and come back.” I skipped internally, literally counting the minutes until we would go down to the surgical floor.

It was to be a femoral-distal arterial bypass on an elderly but very active patient. The procedure involved removing the great saphenous vein – a superficial vein that is the longest in the body – and using it in a graft to both the femoral artery at the head of the femur and the dorsalis pedis artery at the foot. The procedure was meant to increase blood flow distally in cases of ischemia–reduced blood flow.

“She’s great, you have to meet the family too. So supportive,” the surgeon added. It was a continuation of a theme I’d noted with some surprise that morning. In the clinic aspect of surgery there was without doubt a certain level of continuity in care. For some reason, in my exploration of medicine as a pre-med I had been given the impression that in surgery, you needed to give up some aspects of the patient relationship. You might forget your patient’s names, their families, their stories, and you couldn’t expect to have patients to whom you were “their doctor,” the way the attendings in other specialties did.

But this vascular surgeon knew her patients well, and they knew her. She gave me a review of each person before she went into the room, in as much detail as I’d gotten while shadowing in Medical Oncology. She knew their families, the sports they played, the places they’d been to and a host of other miscellaneous details that made each patient unique to her. And so when she went in to prepare her patient for surgery, I had no doubt that to her she was meeting someone who she had taken the time to know, not simply another medical record number. It seemed that somehow, I had accepted what now seemed the fallacy of surgery: a required sacrifice of the physician-patient relationship.

I will also confess another fallacy, which I succumbed to, even before I went in to shadow. I remembered reading the email that confirmed my shadowing schedule, and reminded me to email “the surgeon,” to confirm that I would be there. In my mind, before I looked up the vascular surgeon’s email I had assumed I would be shadowing a man. As a future female doctor, this was somewhat appalling to me; I considered how easily it had been to assume that, and how pervasive the stereotype of the male surgeon is that I – who had considered the specialty– could have been so swayed by it.

It reminded me of the famous riddle that goes: “A father and son are in a horrible car crash that kills the dad. The son is rushed to the hospital; just as he’s about to go under the knife, the surgeon says, ‘I can’t operate—that boy is my son!’ Explain.” When I first heard the story in college, embarrassingly, not one of us in the room had been able to explain. And how simple it was, that the surgeon was his mother. The first answer suggested had actually been that the surgeon was his second dad. Years later, we still fall prey to the bias, and female surgeons still needed to prove that they exist and that they are just as competent as their male colleagues.

It seemed incredible that this surgeon before me could ever have had her abilities questioned – to me she was nothing short of awe-inspiring – but every other month, an article appears in which a female doctor shares her experience of having to prove herself in the medical world: to patients, to colleagues and even to herself. The reflection was certainly sobering.

I was present for the beginning of the surgery and then slipped out to my lecture about an hour in. My mind raced during my time out of the operating room, as I considered the unique experience I had just had. Although my heart was still tied to oncology, I could not help but reflect on the possibility of surgery as a future specialty. It is – of course – the reason why we as medical students are often admonished for pre-selecting a field before we know more about all the others. I practically ran back to the surgical suite after my class, checking in with the circulating nurse–who, among other things, documented everyone present in the room–and resuming my vantage point far from the sterile equipment. The surgeon was just taking out the great saphenous vein, which would be used for the graft during the bypass. She had a remix of a classic Adele song playing in the background. Even though she had her back to me, she noted my return.

“Welcome back,” she said. It was almost like I’d never left, and it actually felt like I belonged.