Playing surgeon? Eat your Wheaties!

Because it really sucks to be 2 hours into surgery and start getting woozy and feel like you're about to black out.

(Lesson learned.)

All throughout this year as we've been learning about surgery (and even in the past two years, when we've had surgical principles lectures and labs), they have emphasized to us that it takes some practice to get used to being in surgery.

"Every year," they repeat, "some students pass out. Don't be the student that passes out! Tell us right away if you start overheating or getting dizzy or feeling funny! Nobody will catch you and we don't like picking up vet students off the floor!"

Okay, I figured. Apparently there are students in the class who haven't had the opportunity to be in a surgery environment or observe surgeries before. Too bad for them. After all, I have spent years as a technician monitoring surgeries.

Well, I'm here to tell you that being in a surgical suite monitoring anesthesia for a surgery performed in a private practice setting does NOT mean you know how to be in a vet school teaching hospital surgical environment.

And I sort of knew that. So even with my past experiences, I've tried to be extra careful this year when I knew I'd be scrubbing in for surgery. During my community practice week, for example, I paid extra attention to what I ate for breakfast, made sure to drink lots of water, and ate a quick granola bar right before scrubbing in. I was conscious of my body position during surgery, made sure I wasn't locking my knees, etc. And all was well.

This past Friday, however, I had the opportunity to scrub in with last week's Junior Surgery Lab since one of my classmates was out sick with a self-described "dysentery." (Sounds thrilling.)

I'll be having JSL ("pig lab") at the end of October, so you'll hear about it in much greater detail then, but here's a brief overview: There are 22 students in the lab at a time, divided into pairs, and working on 11 anesthetized pigs. The first day of the lab is suturing skin incisions. Days 2-4 include intestinal resection and anastomosis, nephrectomy, splenectomy, cystotomy, gastrotomy, enterotomy, etc. Day 5 (Friday) is an abdominal exploratory -- meaning the instructors have already cut open the pigs before you get there, and created problems -- marbles hidden in the abdomen, superglue injected into the bladder, an intussusception, etc.

So it was on a Friday that I jumped into the lab.

But before I got to lab, I woke up at 6:15, had my usual piece of toast and OJ for breakfast at 6:30, had a doctor appointment at 7:45, got to the VTH at 8:20 and found that the JSL students were about to start scrubbing. The sick student hadn't arrived but there was still a chance she would make it. So I ran up to my locker to put my stuff away, then hurried down to the soft tissue rounds room to make sure it was okay for me to ditch SD and go to JSL, and make sure the other junior on the SD rotation didn't mind me leaving, then headed back up to the locker room to change into surgical scrubs, and finally made it back to JSL as they were finished scrubbing. Needless to say, I didn't have quite enough notice or time to get my brain in order and mentally prepare for the upcoming 3.5 hours of surgery.

Everything was okay for the first 2 hours or so. Since I hadn't done the first 4 days of the lab yet, my role in the surgery was basically holding intestines out of the way for my partner -- which was fine. After a couple hours, though, it was getting boring. And I was getting hot.

(Let me take a minute to tell you about our surgical attire. First, in private practice settings, vets often perform routine, non-complicated surgeries wearing scrubs or even their everyday doctor clothes. They sometimes wear a cap or bouffant [like a hairnet] over their hair; sometimes not. They sometimes wear a surgical mask over their face; sometimes not. In a vet school setting, however, they want to teach us the higher standard -- which means we wear booties over our shoes, caps or bouffants over our hair, a mask covering our face, AND a full cloth surgical gown, that ties multiple places in the back, goes down to at least your knees, is tight around your neck, and has long sleeves with thick 3-inch-long cuffs on the end. You pull your sterile gloves over the cuffs of your gown sleeves so that none of your un-sterile skin can get out. End result: Your wrists rapidly become soaked with sweat; your back and neck sweat; if you have a ponytail, it sits on your already overheated neck; and every breath you inhale and exhale through the mask blows hot air onto your face.)

It was a combination of multiple factors that culminated in my wooziness: (1) Overheating due to surgical attire, (2) boredom leading me to focus intently on how I was starting to feel weird, (3) eating breakfast earlier than usual due to my doctor appt, (4) not grabbing a quick bite to eat right before heading into surgery, and (5) a morning dose of an antibiotic that has been giving me some GI upset for the last week.

Here's another lesson I learned: If you want to get the instructor's full attention during a surgery lab, tell them that you feel funny and need to sit down. Let me tell you, you can get waited on hand and foot.

So I started feeling a little dizzy, vision going in and out of focus. I've experienced that feeling only once before -- during my first year or two of college when I was shadowing at a vet clinic back home, and the doctor invited me to watch surgery (the first declaw I'd ever seen) -- and that first time, I did nearly pass out. So I was eager to quietly sit down and get my nerves back while I was only feeling a little funny, rather than making a huge scene in front of 21 of my peers by collapsing to the floor.

I called over one of the 3 instructors helping in the lab and said, "I'm starting to feel a little funny. Can I sit down for a few minutes?"

He immediately looked totally alarmed and grabbed me by the shoulders, presumably to make sure I wasn't going to drop to the floor then and there. He said, "I'm going to bring you that chair. Can you stand here for a few seconds?"

I was like, "Heck yes. I don't feel that bad." The chair was literally only 8 feet or so away.

So the chair was delivered to me and I sat. The instructor advised me to take off my mask and I did, which helped a ton. He also turned on a box fan right next to my surgery station. (Oddly enough, each of the 11 surgery stations has its own box fan to cool off the student surgeons. Guess with 22 student surgeons, 3 instructors, and 11 pigs all in one room, it often gets warm in there.)

They left me alone for a couple minutes, and really I felt 90% better after sitting for about 30 seconds with my mask off. When the instructor came back to check on me, I told him I felt a lot better and thought I was ready to start again. But he said, "You still have no blood in your face. Can I get you some food? A granola bar? Some orange juice or coffee or a soda?" I said no, I felt better, but he persisted with, "Okay, but do you mind if I kick you out of lab and send you upstairs to have a snack?" Which was nice of him. Especially since my surgery partner later confirmed that I was apparently white as a sheet even though I felt fine again.

So I dutifully headed upstairs and downed a couple slugs of orange juice, a chocolate donut, and about a liter of water. Feeling completely revived, I came back down to the lab, re-gowned and gloved (the nice thing about doing a terminal surgery is that you don't have to worry about sterility, so I didn't actually have to scrub again), and completed the last 75 minutes or so of the lab without incident.

I felt pretty silly about the whole thing, because even though the other 20 students were busy with their own surgeries, they weren't so busy that they didn't notice me sitting down and later leaving. But all things considered, I would much rather have had things happen the way they did than end up out cold on the floor, in which case I'm sure everybody in my class would have heard about it, not just the 1/6th of the class in the lab. And afterward, my friend in the lab told me she got overheated on Thursday and had to take a break like I did, so I felt much better.

Anyway, the moral of this long story is at least fourfold:

1. Eat something before you go into surgery, even if you think you'll be fine.
2. It doesn't matter if you're not really participating in the surgery or under stress; just the fact that you're wearing surgical attire can be enough to do you in.
3. Sit down while you're just feeling strange; don't wait until you pass out.
4. 3.5 hours is a long time to be in surgery.