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.

13 comments:

oshee said...

That explains so much about belly button condition after past surgeries. Thank you. :-)

Greg P said...

Ah, but what about the fur, Dr. Sid?
I know when I was going to medical school there developed this big thing about shaving the hairy patient in the OR or just before, rather than the traditional night before -- something about bacteria growing around the hair shafts. Then there was the question of whether shaving is needed at all.
I remember in my OB rotation there was an associate clinical professor (ie a guy in private practice we rotated with). He made what might have been termed a restrained yet impassioned speech as we began our rotation, talking about the dehumanizing effect of shaving the vulva at the time of childbirth. His approach was that of what we might call a genital barber (harking back to the barber-surgeons perhaps?), lathering up the pubic hair, then ever so carefully trimming with scissors only the hair which might otherwise find its way into an episiotomy incision.
Such are the things medical school is made of, even for those who end up being neurologists.

Sid Schwab said...

Good point, Greg: I was a minimalist shaver. A little shaver, you might say. I particularly avoid shaving pubic hair in adolescents, who'd just gotten used to it.

Someonetc said...

i love the ritual. most surgeons have some sort of ritual. and we all have our separate rationale. i refer to my own as "an emotional issue" or "the feel better" (because it makes me feel better)

in ortho, we have the same problem you have with belly buttons with finger and toe nails. for some reason nurses love to pick. :)

Emily T said...

Dr. S., your patients are indeed lucky to have you. Reading the thoughts of a surgeon through the steps of an operation would certainly lessen the anxiety of an overwhelmed patient who has no idea what happens in the operating room. It would be great if you could chapterize (is that a word?) thru to the conclusion of the operation.

emily t said...

Meant to ask this: As I only know the operating room through TV or the movies, is there always music playing in the background? Do the doctors argue politics and discuss their weekend plans, etc. while they're operating on you? The shows supposedly have medical advisors.

My only reference is the show "Nip n Tuck" ;-)

Magpie N. said...

Sid, I love hearing of your reverence for your work. I get the feeling that reverence really sustained you, and I hope to develop a similar attitude when my time comes. (I'm a second-career, pre-nursing student, eager to avoid burn-out.)

Sid Schwab said...

Emily: I've actually been planning to do a very detailed (sort of a Nicholson Baker thing without the nail clippings?) description of an operation; the sounds, the relationships, the methods. Now, I think I will, sometime not to far away...

Ms-Ellisa said...

I'm in awe of "the ritual"... as I read it made me feel that everything is so... organised I guess...! :-)
Why so much fuss over the belly button? I mean in particular if you don't operate near that area...

FetchingGal said...

Are you going to put that descrption of a surgery from your POV on the blog, or into a new book? ;)

FG

Sid Schwab said...

FG: I'm working on a series of posts on the subject, for the blog. Stay tuned.

FetchingGal said...

Eagerly awaiting :)

SeaSpray said...

Interesting post.