A theatre assistant pops their head around the coffee room door.
“The patient is ready.” A moderate hint of urgency.
The snap of a laptop lid and a rustle of fabric as the “in-between-cases” administrative work is hastily stowed. A final sip of water, a quick stretch, and a therapeutic eye rub. It’s time to go again.
Taps open and water vigorously drums into the metal trough as liberal quantities of antiseptic detergent are dispensed. The surgical scrub begins; a methodical sterilisation process of the surgeon’s hands and forearms during which the pathogens that reside on the surgeon’s skin are progressively removed through repeated mechanical and chemical cleansing. Skin damage is an appreciable byproduct as the natural oils and healthy flora are also stripped away.
The surgical scrub brings with it a moment to pause and mentally prepare for the upcoming operation. For the umpteenth time, a visualisation of the steps involved in the case commences. What surgical instruments will be utilised? How will the patient be positioned? What are the possible risks? What are the possible pitfalls? The hectic din of the operating theatre begins to fade away as a calm focus sets in. Dispense, wash, repeat. Methodical, meditative, measured.
Yet, deep within the calm also lies a thrill. A thrill that is shared with the countless who have stood in this exact place. The thrill of fine dissection and skillful tissue handling. Every movement purposeful and precise.
The thrill of performing surgery.
As the final stages of the surgical scrub are drawn to a close, and the attention is turned to the sterile paper towels for the drying process, the surrounding cacophony returns with a newfound urgency. Operating theatre practitioners rally back and forth, ferrying instrument trays from the store room to the stainless steel trolleys that surround the operating table, performing instrument counts, and completing serial safety checklists. The anaesthetist is drawing up the final few vials of life-saving medications in case of an emergency and adjusts the depth of sedation using the relevant gauges on the anaesthetic machine. A united workforce performing critical due diligence to ensure optimal patient safety. A final call for the World Health Organisation (WHO) surgical safety checklist, also known as the “Time Out”, is issued and everyone quietens to direct their full attention to the patient safety protocol. The patient’s name, date of birth, and hospital number, as well as the planned operation on the consent form and final confirmatory checks, are all announced by a theatre practitioner.
The sterile gown is now donned and fastened, and the gloves are adorned, one after the other. First, the under-glove, then the over-glove, and a final third pair of gloves for removal after the patient’s skin is cleaned with an antiseptic preparation.
Pupils dilate. Breathing intensifies. The pulse quickens. Ready to rise to the occasion. Emerging from the scrub room, care is taken to not touch anything with the gown and gloves. Hands held up in front of the chest, solemn and resolute. Antiseptic preparation is applied to the patient’s skin and sterile drapes are deployed. The patient is now ready for the operation.
The rhythmic beep of an electronic heartbeat from the anaesthetic machine. Stillness in the room; the equipment in position, the scrub nurse poised. Peak focus.
“Are we ok to start?”
The anaesthetist vocalises their assent. It’s time to begin.
“Skin knife, please…”
Vasudev Zaver 