Advice #4: When things go wrong in the OR, go zen


Photo: Rafael Vila

“When things go wrong in the OR, have a mantra, repeat slowly…”

Every surgeon I know has had something abruptly go wrong in the OR. A natural instinct when we face an unexpected surgical complication is to tense up. An occasional F-bomb may slip out or sphincter may relax. Things can rapidly deteriorate.

One of the best pieces of advice came from my vitreoretinal surgery fellowship mentor, Rich McDonald. Rich was one of the best surgeons I’ve had the pleasure to observe in the OR and it was a great honor to train with him. What separated him from others was his ability to keep cool in the OR when things went awry.

One time when we were operating the OR nurse accidently pulled the infusion cannula out of the patient’s eye and the eye went soft. The patient quickly developed a choroidal detachment and blood pooled beneath the retina- a potentially blinding complication.

Softly under his breath Dr. McDonald repeated, “very good… very good.” Swiftly, he switched the infusion cannula to a different access point into the eye, regained pressure, and then promptly evacuated the choroidal hemorrhage from beneath the retina and proceeded to finish the case. Postoperatively, the patient recovered beautifully.

Rich explained that repeating a mantra softly and slowly will lower your heart rate, give you a moment to reflect on the situation and come up with a solution. More importantly, it lets the OR staff and the patient (if awake under local anesthesia) know that everything is under control.

To this day, this is still one of the hardest teachings to incorporate in practice, but also one of the most essential.

Previous blog: In Residency, learn one new thing each day

#medicaleducation #advice #ophthalmology #medstudent #acgme #dellmedschool

Robert Wong, MD
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