“Let’s Take a Minute for the Time Out”

If you’ve ever spent time in the Operating Room, you are already familiar with the words the circulating nurse uses to signal the Time Out – the few minutes before a procedure begins when the surgical and anesthesia teams review a patient’s case. If you’re a non-medical type, or a medical student whose surgical rotations are scheduled late in the 3rd year, then you’re just as clueless as I was when I stepped into the operating room for the first time.

In reality, I didn’t so much step as I did tiptoe. And actually, I probably looked more like some sort of gunslinger – with my back to the corner, trying not to be noticed, and taking in my surroundings. Dressed head-to-toe in a light blue ghillie suit; a sterile light blue ghillie suit.

I was terrified.

I heard horror stories from other students about surgeons and scrub nurses yelling at medical students who didn’t use proper aseptic technique; understandable, considering that one tiny misstep could expose the patient to bacteria and increase their risk for infection and post-operative complications. I had been oriented to the goings-on in OR the previous day; all the “Do’s” and “Dont’s” about the choreographed dance more commonly known as “scrubbing” – properly cleaning my hands, putting on a sterile gown and gloves, and walking around on the OR to prevent contamination – were running through my head as jumbled words and phrases while the rest of the team respectfully stood in total silence. The circulator read the Time Out checklist, listing the patient’s allergies and anticipated complications, and naming the antibiotics that had been given. As the Time Out ended, each team member set in motion, creating  a sort of organized chaos where everyone goes in a different direction, each with a prescribed role.

Everyone but me.

There was no magical moment where everything suddenly came together and I saw an existential light calling me into the field of surgery. But as  the rotation progressed, I became more comfortable with my role as part of the surgical team. There were understanding, patient, and helpful nurses who showed me where to stand so I could see the surgical field and whispered instructions in my ear about what I should do to assist the surgeon. Sure, once I got reprimanded for bumping into a sterile table, but I learned that I wasn’t the first or last person (medical student or otherwise) to do so. There were incredible cases, and robotic surgeries that were so amazing I can’t imagine ever describing them as less than extraordinary. Once, I was asked to place my hand into the incision. I remember being totally awestruck and thinking, “Who would let me put my hand into a living, breathing human being?”

In reality, I was retracting subcutaneous fat. Never has a medical professional ever been so excited about fat.

I began to appreciate the beauty of the Time Out – those short few minutes where the chaos of the operating room came to a standstill, when the entire team reflected on the life before them, and the procedure they were about to perform. With that said, I can’t perpetuate any of those horror stories that I’d heard when I started my rotation. The advice I can offer is that no matter the rotation, there will always be situations that are uncomfortable or intimidating. In those situations it is important to take a “Time Out,” to focus on the aspects of the rotation that you enjoy or find intriguing. These are what will make your experience worthwhile.

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6 thoughts on ““Let’s Take a Minute for the Time Out”

  1. I always felt like crosshairs were drawn on me from the circulators, scrub nurses, and residents during my first week of general surgery; a week later, we were all friends discussing everything from politics to Almond Joys. :-D

    Thanks so much for writing this! It helped me relive a lot of the same sentiments I had a few months ago.

  2. Hey Allison! I don’t think I’ve ever mentioned that I really enjoy your blog. I start surgery on Monday so I am terrified, but I intend on taking a ‘Time Out’ whenever I get overwhelmed. Love from South Africa!

  3. Dear Alison. I have just discovered your blog. It’s excellent. I am a paediatric anaesthetist (or anaesthesiologist for your US followers). I intersect with medical students & Time Outs every day:-). Enjoyed your perspective on your first days and weeks in the OR. I still remember my first time in an operating theatre. I had some strange misconception beforehand of a silent world where everyone glided cleanly about. So far from the truth:-) The OR is intimidating at first, but we are all humans who enjoy banter & chat. But it’s a tight team environment, especially in paediatric surgery/anaesthesia, & must seem impenetrable at first to the uninitiated. Never be scared to ask for help. Best wishes, Simon

    • Thanks so much for reading and sharing your thoughts! I’m glad you enjoyed. Even though I have decided to pursue internal medicine, I still found that the rotation gave me a deep respect for what goes on in the OR. I truly had great experiences, and worked with some wonderful people. Thanks again!

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