A Look from the Other(?) Side

A contribution from MS4 Beth Carpenter:
It doesn’t happen every day, but every so often you have a day that is for lack of a better word, a joy.  And our first day of Week 3 with general and pediatric surgery was just that.  Just look at this adorable video of MS4 Corinne and one of her patients today who is post-op from an inguinal hernia repair…

Life can be tough as a medical student on the usual clerkships back at home.  You meet and work with new people every day and just when you get comfortable (and maybe even helpful) on a service you inevitably have to switch to learn something new.  And every role in the hospital has its own niche who seem to rarely interact with one another—the nurses are with nurses, attendings with attendings, residents with residents (+/- a tag-along student), and the scrub techs with scrub techs.  Sometimes when the going gets tough with a late night or a difficult case, tensions can flare and relationships amongst different roles in the operating room and the wards can seem strained.   Sometimes it doesn’t feel like you’re all on the same team.
 
This brings me to one of my favorite things about our annual trip to Haiti—we are hands-down a team here.  And it’s amazing how eating dinner together and debriefing every night about our days, and actually getting to know one another and understanding where everyone is coming from can make the difference for a great day in the hospital! 

​Getting our patients to the operating room anywhere is a team sport, but it feels especially intimate in Haiti because you know everyone who played a role along the way.  Our workflow goes a little like this: a medical student and one of our wonderful translators see a patient in clinic and perform a history and physical.  We then staff the patient with resident or attending surgeons and anesthesiologists and coordinate with the local hospital OR staff and administration to get labs, medical clearance, logistics, and finances arranged.  On the day of surgery, the medical student works on consenting the patient, gaining IV access, ensuring our Emory charting and local Haitian charting is in order, and helping the patient back to the operating room.  Nurse circulators, scrub techs, medical students, and our anesthesiology and surgery teams all assist in pre-op and during the case!  The patient is taken to the recovery room after the operation with monitoring by the medical students and nurses and either discharged same-day or admitted to the hospital for further care. 

Every single one of these roles is equally important when it comes to taking care of our patients and getting them home and healthy.  And I think the mantra “it takes a village” has real meaning in Haiti where I see every one of our teammates play a part in the above process. 
 
Today I had the privilege of seeing the operation from an entirely new perspective—as a scrub tech!  Running two rooms today (a pediatric surgery and general surgery room) with only one official scrub tech—the incomparable Saiying!—one of the M4s was needed to help in the general surgery room.  (Heavily supervised and assisted by Dr. Haack and Saiying, I should mention.)

Learning to anticipate is a huge tenant of surgery, where as a first assistant you try to be one step ahead of the surgeon you’re operating with.  When they pick up the needle driver to start suturing, you get your scissors ready.  If there is blood obscuring the field, you get a lap sponge to clear it for better visualization.  If they shift their retractor, you shift yours for appropriate counter-traction. Anticipating has an entirely different meaning as a scrub tech where you have to think fifty steps ahead of the surgeon and have an intimate understanding of the operation to have everything in the room before the surgery even begins!  From orienting the table perfectly to protecting the sterile field (let's be honest, usually from the gangly med student) to handing instruments so that the surgeon doesn’t even have to look up to have it properly in his or her hand... the list goes on. 

And a scrub tech’s job doesn’t even end at the completion of the case, because our scrub techs in Haiti are also responsible for the washing and sterilization of all of our instruments between cases!  I have such respect for all of our scrub techs on our team in Haiti who make due with the limited supplies we bring when their job usually centers on having the perfect supplies for a case.
 
To all of our amazing scrub techs so far on the trip: Curtis, Donny, Lauren, Manny, Greg, Toni, Saiying, thank you for teaching me just a little bit each week about an essential part of surgery I wouldn’t learn anywhere else!  As I found out today, your job is REALLY hard.