I’ve been practicing medicine for almost a decade – gulp – other than make me feel older and wiser, and chatting at my Tuesday-night book club about a 10-year reunion, that 10 years spent taking care of patients in the operating room, the hospital, and the office has taught me so very many things. I have learned more valuable lessons about medicine, life, love than I can count and I have enjoyed so much laughter and just as many difficult cases during that time. Today, in honor of those 10 years, I’m going to share with you 10 Things the OR taught me. Here are ten of those lessons I’ve learned and retained…
- Take what the defense gives you.
- Ask the nurses!
- Kindness is free.
- Sit when you can, eat when you can, pee when you can.
- Don’t MESS with the Pancreas.
- There’s no such thing as “just”.
- It IS your responsibility.
- It takes a village.
- Stay curious.
- Hope for the best, prepare for the worst.
- Take what the defense gives you.
Usually muttered in the midst of an exploratory laparotomy, an open abdominal surgery to investigate, find and fix a problem, while lysing adhesions, that’s cutting scar tissue that might have formed from previous surgery or infection. Adhesions are like little cobwebs that are thin, attach to any internal organs, and are particularly stubborn on the small bowel. We take down these adhesions or scar tissue to relieve obstruction and to be able to see what’s going on throughout the abdomen. The process is long, tedious, and painstaking. We want to remove as many adhesions as is necessary to find the source of the issue, fix it, and get the patient off the operating table as soon as possible.
We want to move quickly and make progress, but we are also being exceedingly careful, as the adhesions are stuck to things we do not want to cut, like the bowel. When we are trying and trying and trying in one spot but aren’t making progress, the surgeon repositions to try to take down adhesions in another spot – she might say “take what the defense gives you”…. Which means you try something different, a different spot, and a different approach… you do the things with the least resistance or the “easier” adhesions that are less stuck.
Outside the OR you can apply the same technique – go where the going is easy. Do the things that are going to make progress and get you where you need to go. If you are trying things one way and you are floundering, feeling like you are stalled or treading water, take a different approach. Look for the opportunity to make the biggest impact & focus your efforts there. If you’re feeling stuck, choose one area to focus on and celebrate the traction and victories that result. Then, with the power of momentum and the wind in your sails, start tackling the harder, bigger tasks that have more resistance. Small wins at first go a long way on your journey through life!
- Ask the nurses… those nurses are a wealth of knowledge, compassion and experience.
Ask the freaking nurses! They know the answer! That thing you’re wondering about? They understand it. That question that you have? They can answer it!
Be kind to the nurses – they have the ability to make your time in the OR terrible and akin to torture, but they also have the ability to grease the wheels, have things ready, help you out in a pinch and create some super smooth sailing.
The nurses are incredible! They are knowledgeable! They have supreme abilities and they know things you don’t know. They’ve seen things you’ve yet to experience.
In life – find the nurses – look for the mentors – seek out those who have been doing things longer, are wiser, and observe them, learn from them, and apply what they are doing in your life – if you can swing it, get them to teach you their ways – be curious and observant – regardless of someone’s position on the bureaucratic hierarchy, their knowledge and experience is valuable to you and to the team. - Along that same vein… Kindness is free.
One of the favorite and most profound things I have learned in my life and career is that kindness is free. Treating people with the profound respect they deserve and sharing kindness with them doesn’t cost you a thing.
Being kind to everyone – from the environmental services teams that help to keep the OR safe and sparkling, all the way up to the President and CEO of the organization – it can never hurt. Treating people with respect, asking kind and thoughtful questions, and being happy and helpful are traits that cannot be overvalued.
Maya Angelou is famously credited with saying “I‘ve learned that people will forget what you said, people will forget what you did, but people will never forget how you made them feel.” Making patients, colleagues, strangers on the street, and the person who rings up your groceries feel important and valued is so important. If you can treat those around you with the kindness and respect you’d love to receive, it will take you far! - Sit when you can, eat when you can, pee when you can.
Surgery, particularly surgical residency, the post-medical school training that takes doctors and makes them surgeons over the course of a handful of grueling years, crazy work hours, and incredible demands – it’s intense. When I was a new chipper PA, just out of school, ready to take the surgery world by storm I could be found running, skipping, jumping and dancing around the hospital. I LOVE LOVE LOVED my job. I was SO PUMPED to be practicing medicine, to be performing surgery, to be doing procedures and to be able to take care of real life patients as a big bad PA that I barely stopped moving. I came early, I stayed late, I offered to work through lunch. I didn’t drink enough water and as I result I definitely didn’t pee enough. I was all-consumed by my patients and my job.
One of my surgeons looked at me during my first month in practice and said – come sit with me, kid. He was a wise and seasoned surgeon who had been working for decades before me, his still-wet-behind the ears 23-year-old borderline-manic PA ever showed up. He looked me in the eye, I was sitting on a stool, bouncing on the balls of my feet, practically vibrating and ready to take flight. He said “Tracy, you need to sit when you can, eat when you can and pee when you can. This is surgery, we have long cases in the OR, we have many sick patients on these floors that are counting on us to take care of them, and we need to take care of ourselves.” It was the PA-Surgeon equivalent of him telling me to put my own oxygen mask on first. I wouldn’t be any good to my surgeon or my patients if I didn’t take a chill pill, a deep breath, and regular breaks for food, water and using the restroom!
This was way before I became a wife, a step-mom, a mom, an entrepreneur and a podcast host. It was before I realized how incredibly easy it is to forget your own basic needs when you are spending your days and nights taking care of others. It was before I established a healthy self-care routine and started focusing on what was fueling my body and soul.
So, my friend, here’s your reminder to sit, eat, and pee when you can. Life is busy, motherhood is crazy and demanding and work can feel like it’s of the utmost importance… but it’s your life and taking care of you is the foundation for a fulfilled life where you are able to take care of everyone around you! If that speaks to you, scroll back and check out Episode 17 where I’m sharing my thoughts on why we should be ditching Mom Guilt and prioritizing our own self-care practices. - Don’t MESS with the Pancreas.
Honestly, in the OR the surgeon did not say MESS. He said a different 4-letter word for what we weren’t going to do with the Pancreas. The Pancreas is an abdominal organ that is responsible for releasing insulin and digestive enzymes that, released into your GI tract, help with enzymatic breakdown of your foods. It’s like a sponge and if you poke it, probe it, or otherwise piss it off when you are inside the abdomen messing around doing other things it can squirt out some of those digestive enzymes and cause pancreatitis and local inflammation and breakdown of the surrounding organs. It’s a sneaky and cranky organ and anatomically it’s near some other structures you might be going after – but unless you are there to the pancreas – you leave that thing alone.
In life, identify your pancreas. Maybe it’s an unhealthy coping mechanism or something that once you start doing, you backslide… figure out what that thing that you just don’t want to mess with and leave it alone. Understand the dangers of these things and avoid them like we avoid the pancreas! - There’s no such thing as “just”…
In the OR, even the most straightforward or simplest procedures have the potential for complications and bad outcomes if you aren’t careful and aware – therefore, there’s no such thing as “just”…
First of all, saying it’s “just” a straightforward procedure means you are being cocky – you aren’t taking it seriously – you are forgetting about the potential complications, or worse, you think you are so good that they can never happen to you. They can. Things can ALWAYS go wrong. I don’t say that to be a downer or negative, I say that because you want to pay attention to even the little things, the straightforward things – not to be in a full fledged panic attack, but to be on alert, to take things seriously and to proceed with caution.
This relates to my life as a working mom in that it reminds me to savor moments with my family. That time is precious and we can make it as rich and memorable as we can, if we focus on that. Savoring those moments is so so important. It’s not “just” a quick ride in the car, it’s the opportunity to connect with my kids. It’s a chance to let them ask me questions and for me to hear about their day.
Let’s consider daycare drop off. Yes, I know it’s a chore and it’s crazy and you are scrambling to make sure everyone has a breakfast, lunch, their water bottle and their goggles and swim towel. It’s a struggle some days and with three kids in carseats to assist and double check, to be patient with the two-year-old who wants to “DO IT MYSELF!” With all those moving parts we often leave the driveway with tension running high. Two things we’ve done to help defray this frazzled feeling are a morning prayer and some group affirmations.
As we leave the driveway I ask the kids who or what they want to pray for – their responses can range from “my baby doll” to their favorite teachers to praying for my oldests loose baby teeth AND his adult teeth that are growing in beneath them. The kids quiet down and we say a collective prayer – we share what we are thankful for, worried about or want to go well – we pray for other people. It calms things down and settles everyone’s nerves.
The other thing we do is to do some kid affirmations as we are pulling into the parking lot, just before drop off. My three kids under 6 repeat after me we say:
“I am smart”
“I am strong”
“I am important”
“I am a good listener”
“I use gentle hands”
“I am kind”
“I am helpful”
“I use nice words”
“God made me”
“Jesus loves me”
& “Today is going to be a great day”
Today is going to be a great day is my personal favorite affirmationg. The kids say it with such pride and enthusiasm! I love that they start their day feeling empowered to rock the day, and that they leave the car smiling at drop off.
We took a little detour there – but if you can remember that there’s no such thing as “just”… then even basic things like a daycare drop off or a straightforward operation are an opportunity to be careful and intentional. It’s your turn to think of something that you do everyday that you can enrich or be more intentional about and try it for a few days! - It IS your responsibility.
Before each procedure in the Operating Room there’s a nationwide safety measure called a timeout – the surgeon calls “Timeout” and things stop, people stop moving, opening instruments, the music is turned down and the focus is turned up. The surgeon and the team in the room review the patient’s name, date of birth, allergies, procedure to be performed, we confirm laterality – right vs. left side of the patient – we check and double check with what everyone has documented with what we are planning to do – we review potential pitfalls, what imaging we might need in the OR, and review if we are sending specimens to the pathology lab. Each detail of the case is reviewed while everyone in the room stands in rapt attention. We do this every case, every. Single. Time. We ask for undivided attention and at the end of the timeout everyone present says “I agree”.
I worked with a surgeon who says after every timeout and before he makes his incision… “Patient safety is a team effort. If you see something that you feel is unsafe, please remember that it is your moral obligation to speak up, ask questions, and tell me about it.” In saying this, he vehemently reminded each person in the room that is IS our responsibility to keep that patient safe. It IS your job to speak up and say something.
I LOVE working with this surgeon. Not only is he incredibly skilled, he takes his work and safety of those patients who have put their lives in our hands so seriously… but he doesn’t shoulder that responsibility alone. Yes, he’s the ultimately responsible person because he IS the surgeon – but in saying this he’s sharing with each person in the room that, regardless of your training, the letters behind your name, or what role you play in this room, the patient’s safety IS your responsibility.
This can apply to so many areas of your life – in being helpful and in taking ownership for your life. You know that thing that you are wishing would “just happen”? It IS your responsibility. You are responsible to get it done, to make the phone call, to send the email or to simply start and do the darn thing.
In life there are roles that we play as part of a team, but ultimately it’s your life, your home, your family, your business, your dream and your future. You are the one who can create change. You are the one you can build a future that leaves you fulfilled and keeps you safe. Don’t ever forget that your life IS your responsibility and you have the ability to change your life – today, tomorrow, and every day in the future! - It takes a village.
In the Operating Room there is a huge team of diverse individuals that all have a unique and important role to play in the well orchestrated dance that is a smooth surgery. These individuals have vastly different training and skills to employ in keeping patients safe, comfortable, to maintain sterility and cleanliness.
Just like in life, where you’ll hear that it takes a village to raise a human, it takes a great team in the OR to keep things safe. Choosing people in your life who surround you in wisdom, love, and positivity is just like having a team in the OR who works well together.
You don’t get to choose your “family” in the sense that you get to choose who is biologically related to you, but you DO get to choose who continues to have a say and play a major role in your life and the life of your kids. Creating a support system is HARD and it takes intention and sometimes some trial and error to find those friends and family members who are going to be there for you, to compliment your skills and abilities well and to treat you with kindness and respect.
Here’s the thing – in the OR your team will support you and work harder for the greater good if YOU support them and work hard to help them, too. You should be helpful and a great team player “just because” it’s the right thing to do, but if you need a bigger kick in the pants… know that people will follow your lead. They will work hard and pitch in if they see you doing the same… in the OR and in your life.
Here’s your reminder to be a team player and to build a team that’s supportive and helpful to you. This journey can be hard and it can feel lonely, but you truly are not alone! - Stay curious.
Staying curious is how I learned most anything that I consider myself to be proficient in doing. I asked questions. I kept trying to understand HOW and WHY we did things the way we did, why we did one thing differently on today’s surgery than we did yesterday. I would watch closely and help with the anesthesia team intubated the patient. I would help the nurses to move the patient and untie their gown. Not only did this make me helpful and useful in these areas, but it helped me to understand many of the pieces of the puzzle that go into a safe and effective surgery.
This strategy of asking why, seeking to understand, trying, failing and changing your approach applies to everything from major robotic surgery to the way your family schedule functions on a weekly basis. It will serve you well in relationships and business, with parenting and meal planning. In life there will always be someone who is further ahead of you on their journey or more advanced in their skillset and seeking to understand WHY they do things the way they do and HOW they go to where they are will serve you well.
This curiosity is so much more fruitful than comparison. If you see someone doing something well your first inclination may be to compare your beginning their middle… to look at where you are and how you are doing and think that they are more skilled, more advanced, and sailing through on something that is tripping you up right now. I certainly know that this temptation to compare is ever present for me. If we can instead get in the habit of being curious… how does she do things and how could I adapt her strategies to my life we will spend so much less time frustrated and see traction and progress in our own lives. Curiosity and understanding beats the trap of comparison every single time. Stay curious at work and in life! - Hope for the best, Prepare for the worst.
Have you ever heard the phrase “Pray like it all depends on God, work like it all depends on you.”… in the OR we like to hope for the best… we pray for great anatomy, stable patients who aren’t sick, functioning equipment, the A-Team and working speakers so we can jam out as surgery is going smoothly… but we prepare for the worst. We have contingency plans out the wazoo. We have extra equipment and staff on standby, just. In. case.
In life and in surgery it would be great if things always went the path of least resistance with ideal outcomes and the best case scenario, but if you are listening to this and you are a human being living on earth you’ll know that’s not the way the cookie crumbles. Things go wrong. There are things beyond our control that don’t go our way. We can be as ready as we want, as prepared for all possible outcomes and there are still things that don’t go the ideal way. And that… is what you have to prepare for.
It’s a delicate balance between optimism that things will go well and the prepper that is pessimistic enough to be prepared for when things go wrong. In life it’s much the same – hope that it goes well but be ready in case it doesn’t!
Well, my friend, there you have it. Ten years on the job as a surgery PA boiled down to an equal number of nuggets of advice that applies to the OR and the playground, work and home alike!
Take what the defense gives you.
