Muscle

"Give me what I need, not what I ask for!"

In the stress of surgery, at least when there is a difficult bit, like frustrating atypical anatomy, or unexpected bleeding, often surgeons simply want what will help, and the proper name eludes them. The automatic, inarticulate part of everyone's brain, takes over, as it should. An experienced scrub (yes, this includes me, however rusty I get doing mostly the circulator role) will simply hand them an appropriate instrument, regardless of what word they say. There are also hand positions to accept that instrument. This is all held in a common muscle memory, no doubt akin to athletic teams, trapeze artists, dancers, musicians in bands, construction workers, any group of people who do the same physical process repeatedly, with time constraints. I may fumble a new set of specialty implants, but in a crunch, my hands know what to do, and the flow happens.

I had this occur last year, not having scrubbed regularly for years, with residents on an ortho case. I needed coaching through the drilling and measuring for the hardware, but as soon as they hit an artery, they had clamps, ties and scissors in their hands before they could ask for them. And I felt alive to every nuance, passing three, four instruments at once as though I had extra hands.

Surgeons need to learn how to use a scrub as much as to use any piece of equipment. The hand out and back for a clamp or scissors, slightly curled as though holding a pen loosely for a pick-up (Debakey, Addison's, rat-tooth), palm open and down for a free-tie. D has leaned to take scissors and pens from me over the years as well as any surgeon. There is nothing more frustrating than not being able to just hand a suture, and I have hit knuckles sharply to alert them that they are hindering their own process. Only once have I had a resident ask how to do it properly, which I gladly did.

Last night I toppled a full pint of Tetleys beer across the rug, sent D to get towels. "The... the... blue one." He brought the blue hand towels, I got frustrated, shoved past, got the cheap fluffy one. Today, I apologized (again) at losing my patience. It was mostly at my own lack of fluency. He was returning all the towels he'd pulled out of the closet and dumped on the floor, rejecting them in favor of the more disposable ones. They are all blue. Instead of the cheap blue ones he takes to the gym, kept in the bedroom with his bag.

"If you'd told me the gym towel..."

"I know, that word got to me about five minutes late last night. Sorry. It's really obvious, though. I wanted the BLUE one. Give me what I need, not what I ask for!"

We laugh, understand, forgive.