Wednesday, May 02, 2007
Suds and Buttons
Without question, the best way to sanitize an operative field before making an incision is with a mixture of iodine and alcohol. (Barring allergy, dose related burns, stains, etc.) I have my reasons. It's fast. Easy to see where it is and isn't on the skin. Kills on contact, no scrubbing required. One layer is fine (although most OR folk can't seem to be convinced of that.) All of the preceding points are true, but unimportant. It's about drama and belly-buttons, in that order.
Ritual is comforting. It grounds us, connects us; going through certain motions consolidates attention, funnels us toward a specific task, strips away the extraneous as it sharpens our focus on the moment. Unlike ritual, which also suggests creaky and forgotten reasoning, what we do at the start of an operation has obvious purpose. Still, it's a literal (and perhaps a figurative?) cleansing ritual.
Hands upward as if blessing, we enter the operating theater. (There's a reason: if held downward while dripping from the scrub, the hands would be contaminated by water running downhill from the unwashed elbows.) In the days of powdered (to facilitate sliding them on) gloves, we often dipped, after donning, into a bowl of water. Ablution. And then, always where I trained and often in my practice (usually when there was enough other stuff the nurses needed to do), came the ritual annointing.
Grasping a perfectly folded sponge in a ring forceps, I approach the sleeping patient whose undraped and exposed belly awaits, vulnerable. Starting with the place for incision, I draw the sponge -- soaked with ruddy-brown liquid -- across the skin. I am gowned and masked like a higher priest, and my arm is unnaturally extended as I lean toward the patient in such a way as to keep my robes from touching her. I brush the skin, changing it to a color of my choosing, taking ownership and admitting responsibility, placing my mark. In a literal sense, I make that body my canvas, declaring my willingness to commit and to be judged by my work. Mundane and otherwise forgettable, prepping in this way is, for me, preamble and overture, the assumption of intimacy. I much prefer it to watching a nurse soap the area for a few minutes. Rub-a-don't-dub.
And if you find all that a bit improbable (I'm serious, though: I really relished doing the prep-painting myself), there's this: nurses love picking around in belly-buttons. Come into surgery with stuff in there, they're gonna find it and get it out. Poking it with Q-tips, dragging the gunk across the belly. Drives me crazy. Unless I'm planning to be working on the button, I fill it up with iodine and drown whatever is in there. Keep it where it belongs. When I have the brush in my hands, it's my rules.