Today was the first time I've ever gotten to scrub in for an OR case! And I didn't screw up too often! For those not in the know, in an OR there are two broad groups of people: those that are scrubbed in and those that are not. The scrubbed people are extensively washed, gowned and double gloved so that they are sterile and may be involved in the procedure. The unscrubbed people are just wearing a mask and aren't allowed within a foot or two of anything sterile (which is most of the room). The unscrubbed are like wallflowers; they lurk on the edges of the room watching the cool people in the middle and wishing they were invited to dance... er... tie a suture?
Today I scrubbed in on a laparotomy (exploratory abdominal surgery) and even go to hold a retractor (twice!). It's amazing how many obscure muscles you can exhaust by holding a glorified spatula for ten minutes. I also cut fancy string with a scissors. Woot!
Something I found interesting was that the scrubbed-in folk must either hold their hands to their torso (which is sterile) or they can rest their arms on the sterile dressing covering the patient. There's something reassuring about the latter because you're not just resting your arms, but you're touching the sleeping patient (through many layers of bedding and dressings). Even though s/he can't feel you due to the anesthesia, it's tempting not to pat his/her leg and say "There, there; we're taking good care of you."
The other exciting happening was that the anesthesia suddenly wore off a smidge too early and the patient started waking up just as we were finishing sewing her up. I go to hold her kicking legs as the anesthesiologist gave her something to calm her back down while we finished up. She wasn't really awake and won't remember any of it, but it was still freaky for everyone involved.
TIL: I apparently need size 8 gloves, not 7½.
When they tell you to go back to back when switching spots around the operating table, it's more normal to turn in the direction you want to go, side step behind the person you're leap frogging, and then turn back facing the same direction. If you twirl in a full 360 like a square-dancing weirdo you get laughed at.
Endometrial biopsy (scraping off a bit of the uterine lining) is only useful for diagnosing simple endometrial hyperplasia (abnormal growth of the uterine lining) if you know when the patient's last period was. This is pretty intuitive. The uterine lining grows throughout the menstrual cycle and sheds with the menses. So if you do a biopsy and it shows a thick endometrium, that could be totally normal towards the end of the cycle, but very abnormal immediately post-menstrual.
When the recommendation is to schedule a repeat test every 3-6 months, it is wise to interpret that as every 3-4 months just so that if something comes up and the test is postponed, there is still a chance that it will happen within the 6 month window.
Uterine fibroids require estrogen to grow and thus should either stop growing or even shrink after menopause. If a postmenopausal woman with a history of fibroids has new onset pain or bleeding, do not write it off as being caused by the fibroids, as that is unlikely given their postmenopausal behavior and you risk missing a far more dangerous diagnosis like cancer.
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