It happens to everyone

Just about everyone who has every been on a surgery rotation has had this experience at one point or another. Most may, and will deny it. Really, why admit it? It’s rumored to be shameful mark on your caliber as a person and for fear of judgement by others, most keep the event secret. What is it you may ask? What could it be that would be so horrible as to not publicly account, yet so many experience? Why, fainting during surgery of course. Or near fainting as it would be in my case.

This leads me to the story. It was not only my surgery rotation, but my first as a rotation of my third year medical student. Both are notoriously difficult. Interestingly enough, it didn’t happen on my first day either. It took me a whole 6 weeks and 30+ surgeries later to nearly faint. Perhaps, that is why I was in such disbelief when it happened.

Let me set the stage. It was an average sunny afternoon. I had actually gotten enough sleep the night before, and had actually consumed breakfast and lunch sequentially in the same day, before watching the surgery. I was at satellite hospital for the early part of my day and had to zip down to the university to scrub in on a total knee replacement surgery with my attending. After I got to the university I decided I would take my time to enjoy my lunch. By that I mean, I sat outside and ate it within about 15 minutes and took a couple more minutes to soak in some sun. I then found some scrubs and found my way to the surgery suite. I had never scrubbed in on a total knee before, but figured it would be essentially the same as every other surgery I had seen: wash hands and arms for 5 minutes, wear a mask and goggles, a beautiful blue bonnet, and a gown. I did, however, come to discover that once I walked up to the door and peaked in, it looked like an alien from another planet was being dissected in some top secret security room in Roswell, New Mexico. The surgeons were wearing these full respirators helmets that covered their heads and shoulders which had a face shield to view the surgery. They were then covered in large gowns that made sure they were covered by sterile fabric and big goulashes to protect their feet from the splashing of fluids.

As I stood at the door and peered in I saw a big red sign plastered on the door that read in large letters “Total Knee Surgery. Essential Personnel only. No excess traffic.” Given a normal surgery, I would walk in, get my gloves and gown and then scrub in after I let the occupants know I was there. With this warning, I was hesitant to enter to even announce my presence. The words “Essential personnel only” resonated in my head. I am a medical student. By being a medical student on a surgery rotation, by default I am rendered “non-essential.” Deciding to play it safe, and hopefully avoid getting my ass chewed for entering without permission, I went to the front desk and they called my attending to see if I should enter the room. Of course, he said it was okay for me to enter.

Upon my arrival the nurse guided me to the helmet room where I was to select one and assembled it with the ventilator and newly charged battery. All atop my head, I tested the helmet, and the ventilator fan whirled away signaling its proper functioning. I walked into the surgery suite and was properly gowned after I scrubbed. I stood there in awe of the surgery. It did not gross me out. It was mildly barbaric when they would saw off the distal end of the femur to shape it for the prosthetic and when they hammered the prosthetic into place and pieces of bone and oily fat splattered across my face shield. Unlike a normal surgical face shield during surgery which covers your face leaving only your eyes visible to others, the helmet has a clear face shield which leaves nothing to hide. You can’t stick your tongue out, or yawn secretly without being discovered. All of your facial expressions are there to be seen.

As the surgery wears on I start to get a little nauseated. I start thinking about what I ate for lunch and if maybe something was bad. I start feeling a little weak in the knees and start to rest my arm on the patient and lean on them as I feel I might fall over. I try not to think about my nausea, but it only gets worse. My stomach starts to rumble and I start to get that pre-vomit saliva pooling in my mouth. I swallow it down and tell my body it’s not happening. I can’t leave the surgery to use the restroom. That is a sign of weakness. One must endure the standing for hours and be able to hold their bodily fluids within. My stomach rumbles on, increasing in intensity. My face becomes very flushed. I can feel the heat in my face rising. The surgery is almost. “You’ve made it almost two hours, what’s 30 more minutes?”, I tell myself. To add to my misery, I now feel like I am about to have explosive diarrhea. I am doing my best to hold down vomit and squeeze in diarrhea. I feel faint. “I can do this” I tell myself. The Spock part of my brain is telling me to leave, it’s illogical to stay. If I faint I will surely loose what voluntary anal sphincter control I have managed to muster and I will crap myself. Which is worse? Leaving or fainting and crapping oneself?

As I have this internal conversation the nurse runs over to me and asks if I am okay. I don’t have an answer. The attending surgeon looks at me and says to the nurse to help me, with a bit of urgency in his voice. I hear someone say, “Get a chair!” They pull me away from the patient and the sterile field. At that point I realize how much I was leaning on the patient for support, barely able to stand on my own. As I am thrust into the chair and nurse is pulling off my helmet and trying to put a mask on my face in order to keep the room sterile. As she touches my face I feel that my face is mildly diaphoretic. I realize my face gave me away. It must have been pale and sweaty and anyone who looked at me would have seen it, completely visible from behind the clear shield.

The nurse walks me out to the break room with her arm under me for support. I fail to convince her I am fine and I don’t need help. She is very kind and reassuring and gets me a clear soda to sip on. Out of the surgery suite I feel better. The vomit descends and the diarrhea ascends. I sit and relax for a bit when the attending comes up and asks how I am. I am mortified I almost passed out and crapped myself, but his words are concerned and reassuring. He says it happens to everyone, even himself at one point. Later that day the resident tells me of the time he passed out during a surgery. I feel better, both mentally and physically. This happens to almost everyone whether they decide to admit it or not. It’s like a secret club and I am now a member: syncope during surgery.