Sunday, December 17, 2006
Boxers, or Briefs?
Early in my training, I noticed that some attendings would strip raw before putting on their scrubs and heading to the OR. Given who some of them were, I found it sort of creepy, as if at some point they'd lean over to the scrub nurse and whisper, "I'm not wearing any underwear." I never liked seeing my dad naked, for that matter, and I certainly didn't want to watch those old guys parade around. But, it turns out, there's a good reason. Sometimes, surgery is really messy.
When I started in this game, AIDS was unknown. We took certain precautions, of course, but getting drenched was just part of the deal, especially at the county hospital, where we treated every instance of trauma that occurred in San Francisco. Neither the cloth gowns we used at first, nor the paper ones that came along later were particularly water-proof. Operate on a guy bleeding out from a few stabs or gunshots, and you'd finish the case soaked in blood; literally, it could fill your shoes. Remove the gown, and the scrubs were wet with sweat and blood. Remove the scrubs, and your front side might look spray-painted. Pink pubic hair: not a good look, at least on me. The smell and stickiness of blood: not pleasant. Showering after looked like the scene from "Psycho," only in color.
My friend Bill Schecter, now Chief of Surgery at San Francisco General Hospital (he was one of my junior residents when I was chief resident), tells his residents if they want to see their grandchildren, they need to wear rubber gowns, full facemasks, and tall boots. At SFGH, it's assumed that everyone they operate on has HIV. In my practice, it was rare indeed. On the occasions when I knew in advance I was operating on someone with AIDS, I wore a rubberized gown, and it didn't work for doodly. I was still gooey at the end. And for some reason, I never made it purely habitual to remove my shorts before operating. Decorum? Shyness? Don't know. But more often than not, at the end of a thrash of a case, I'd be washing out my underwear in the sink, wrapping them in a hospital towel, and taking them home. I've got a nice stash of towels embroidered with "Central Supply." They make perfect bath mats.
One of the old surgeons where I live used to like to speak to his patients' families still fully gloved and gowned, particularly if bloody. I assume he thought it made him look like a knight in dripping armor. Made him look like an ego-addled jerk, was my opinion. And it would never be allowed today.