The Medical Student Gloves Phenomenon
I'm going to use today's post to discuss the Medical Student Gloves Phenomenon (MSGP).
The MSGP is a proposed principle of universal functioning, observed by yours truly (and probably several hundred thousand other people before me, but they didn't put it on their blogs and if they did I'm not following their blogs, so it's their fault). It is basically summed up thusly: The Medical Student's gloves will almost always be the cleanest gloves in the OR.
The Corollary to the Medical Student Gloves Phenomenon(MSGP-c) is that whenever the medical student's gloves are NOT the cleanest gloves in the room, one or more of the following things MUST be true:
1) it's a trauma, and blood just goes where it goes. Just as likely to hit the student as the ceiling. (90%)
2) the medical student contaminated him/herself (8%)
3) resident or attending just changed gloves (1.9%)
4) it is an extremely boring case and they're letting the student do everything (0.1%)
5) it is truly a very exciting case (it is too rare for this to be represented by a real number percent. Not because no cases are interesting (on the contrary - most are, especially when you're at my level and haven't seen some basic things) but in the truly exciting (read: "scary") cases, the attending's and residents' gloves are always way messier than the medical student's, unless one of the first three conditions is satisfied)
Now, let's apply this to a real-life scenario:
Yesterday, I had the chance to get in on a laparotomy case. The procedure was a distal pancreatectomy and splenectomy to remove a suspicious mass in the body of the pancreas overlying the splenic vein. It was the first laparotomy I was scrubbed in on, and I have got to say, it was very cool.
It started out as a laparoscopic procedure with the intent to break up some attachments to free up the panc and spleen, and during the laparoscopy I was just mostly chilling there, identifying structures I had only previously seen in static forms - cadaveric, axial imaging, textbook drawings, etc - as they lay in situ. The small intestines peristalsed before my eyes. The diaphram pulsated with each heartbeat. I had seen laparoscopic procedures before, but never when I really knew what was going on, and had fully prepared for the case - it's a world of difference. Looking at the images on the screen and thinking "wow, that's a person's insides n' stuff!" is not remotely the same as looking at the screen and thinking "wow that's peristalsis, there's the liver edge, and the gallbladder, and look, the stomach... and is that the spleen in the corner? Yes, I think it is! There he is, hiding out there in his little nook, being "tickled" by the pancreatic tail, good ol' spleen. We're gonna cut you out."
Later on, after the case had been converted to laparotomy (euphamism for we made a midline incision which is another euphamism for we cut her belly open), my mind was again blown away. I watched in awe as tiny little organs, which seemed larger than life on the magnified endoscope, were exposed to the air. Perhaps, if they could, they'd be sitting there looking up at us and thinking, "Hey, who invited you? And what do you think you're doing with that knife?!"
At one point, the stomach kept getting in the way, so the attending asked me to come around to his side and hold the stomach. My hand dove straight into the retracted abdomen (thankfully there's a big metal retraction system for these cases or the medical students would all die trying to be brave and tough it out holding open the laparotomy for 5 hours - they call it the Iron Medical Student) and held the flimsy, rubbery, slimy stomach in place as the attending continued cutting away out of my field of view.
It was at this point that my gloves MAY have been, possibly, ever so slightly more bloody than the resident's gloves. I didn't get the chance to do a side-by-side comparison. If it was true, though, and for argument's sake we will say that it was, then according to the Corollary to the Medical Student Gloves Phenomenon, it was a very exciting case.
Either that, or I contaminated myself. Hopefully the former.
Incredible stuff. It's a shame this rotation is only 8 weeks long. With all the post-call days, holidays, and weekends, it doesn't end up being that many OR days at all. But hopefully, I'll have the rest of my life to get OR days in, so that's not really a major concern at this point. Now, I'm just getting my feet wet.
Or hands, really.
The MSGP is a proposed principle of universal functioning, observed by yours truly (and probably several hundred thousand other people before me, but they didn't put it on their blogs and if they did I'm not following their blogs, so it's their fault). It is basically summed up thusly: The Medical Student's gloves will almost always be the cleanest gloves in the OR.
The Corollary to the Medical Student Gloves Phenomenon(MSGP-c) is that whenever the medical student's gloves are NOT the cleanest gloves in the room, one or more of the following things MUST be true:
1) it's a trauma, and blood just goes where it goes. Just as likely to hit the student as the ceiling. (90%)
2) the medical student contaminated him/herself (8%)
3) resident or attending just changed gloves (1.9%)
4) it is an extremely boring case and they're letting the student do everything (0.1%)
5) it is truly a very exciting case (it is too rare for this to be represented by a real number percent. Not because no cases are interesting (on the contrary - most are, especially when you're at my level and haven't seen some basic things) but in the truly exciting (read: "scary") cases, the attending's and residents' gloves are always way messier than the medical student's, unless one of the first three conditions is satisfied)
Now, let's apply this to a real-life scenario:
Yesterday, I had the chance to get in on a laparotomy case. The procedure was a distal pancreatectomy and splenectomy to remove a suspicious mass in the body of the pancreas overlying the splenic vein. It was the first laparotomy I was scrubbed in on, and I have got to say, it was very cool.
It started out as a laparoscopic procedure with the intent to break up some attachments to free up the panc and spleen, and during the laparoscopy I was just mostly chilling there, identifying structures I had only previously seen in static forms - cadaveric, axial imaging, textbook drawings, etc - as they lay in situ. The small intestines peristalsed before my eyes. The diaphram pulsated with each heartbeat. I had seen laparoscopic procedures before, but never when I really knew what was going on, and had fully prepared for the case - it's a world of difference. Looking at the images on the screen and thinking "wow, that's a person's insides n' stuff!" is not remotely the same as looking at the screen and thinking "wow that's peristalsis, there's the liver edge, and the gallbladder, and look, the stomach... and is that the spleen in the corner? Yes, I think it is! There he is, hiding out there in his little nook, being "tickled" by the pancreatic tail, good ol' spleen. We're gonna cut you out."
Later on, after the case had been converted to laparotomy (euphamism for we made a midline incision which is another euphamism for we cut her belly open), my mind was again blown away. I watched in awe as tiny little organs, which seemed larger than life on the magnified endoscope, were exposed to the air. Perhaps, if they could, they'd be sitting there looking up at us and thinking, "Hey, who invited you? And what do you think you're doing with that knife?!"
At one point, the stomach kept getting in the way, so the attending asked me to come around to his side and hold the stomach. My hand dove straight into the retracted abdomen (thankfully there's a big metal retraction system for these cases or the medical students would all die trying to be brave and tough it out holding open the laparotomy for 5 hours - they call it the Iron Medical Student) and held the flimsy, rubbery, slimy stomach in place as the attending continued cutting away out of my field of view.
It was at this point that my gloves MAY have been, possibly, ever so slightly more bloody than the resident's gloves. I didn't get the chance to do a side-by-side comparison. If it was true, though, and for argument's sake we will say that it was, then according to the Corollary to the Medical Student Gloves Phenomenon, it was a very exciting case.
Either that, or I contaminated myself. Hopefully the former.
Incredible stuff. It's a shame this rotation is only 8 weeks long. With all the post-call days, holidays, and weekends, it doesn't end up being that many OR days at all. But hopefully, I'll have the rest of my life to get OR days in, so that's not really a major concern at this point. Now, I'm just getting my feet wet.
Or hands, really.
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