This particular day I arrive to the OR board pondering my assignment for the day. Scan the board looking for my magnet, seeing where my destiny is. Found it, Plastic Surgeon Dr L’s room, now looking for the other pieces of the puzzle for my day, who I am with. Scrub tech is Sarah, she always scrubs Dr L, so should be a good day. Check out who my anesthesia is, which can also impact our day and off I go.
Arriving in the surgical suite to find Sarah in a good mood and already opening and setting up the sterile field. Thats a great thing, she will have everything she needs, she scrubs his cases every week, so I should just be able to DJ some good music and have a smooth day. The CRNA arrives to the room, book in tow for the very long abdominoplasty case. I inquire if I can pick up the patient and get a sneer from anesthesia. Such a delicate power balance in the OR, each piece of the puzzle can make the other not fit quite right. If the scrub wants to drag your morning out she will continuously ask you to get stuff for her so you can’t get the patient, if the CRNA is in a bad mood they will say “I need more time to setup”, and make the day much longer.
Despite the sneer, I get a “walk slow” response from anesthesia. I arrive to preop to find the surgeon marking the patient at 7:26, which means the only way to be in my room “on time” (7:30) is to run like hell to the room. Dr L doesn’t care about “in room starts”, but my managers do. I try to get the fastest report possible from preop and run like hell to my room.
Arriving to the room, introducing the patient, verifying the procedure, and getting onto the operating room table. We get the patient positioned and I assist anesthesia going to sleep. I begin to position the patient, catheter in, and begin prepping. The preference card that I utilize for this surgery is very non-specific about the drugs that the surgeon uses and the quantity of each. I ask Sarah as she is the one on the field handing him the drugs and get a “not sure” answer. Odd I thought, as the scrub who is in this room every single time, you don’t notice how much of each drug you’re drawing up and labeling. Dr L arrives and we begin. With Sarah having no knowledge apparently on the drugs, I ask Dr L, he rattles off like an auctioneer ” its the same every time, 30 ml injectable saline, 30ml .25 Marcaine, 10ml exparel”. Same every time, meaning he hated I had to ask him. I respond “thanks” and keep it moving. Can’t ruin my day this early.
Abdominoplasties are such a long procedure, which leaves some time for daydreaming if you are prepared properly. The preparation for you day will determine how smooth it goes, how happy the surgeon is, which of course directly reflect everybody’s mood that is trapped in those four walls for 8 hours together. Lunch break time, in comes a scrub to give Sarah as break, a report is given and off Sarah goes. Seemed to be a quick report……..guess there wasn’t much to say.
Dr L asks for special stratafix suture, I observe the lunch tech scanning her table, not finding anything. At that point I get up to go scan the table myself before Dr L starts fussing, and advise the tech to move the bowl around, look between the instrument trays, no suture found. Off I go running what feels like a mile to the suture wall to retrieve the stratafix, wondering the entire walk why I am leaving my room in the middle of a case for a suture that he uses everytime? Did Sarah not have it, does Sarah hate me, did Sarah hide it from her scrub lunch relief? So many questions left unanswered. Arriving back to the room with the glare of the surgeon that obviously him losing 5 minutes of time for that suture was clearly my fault. Opened and added to the field, I sit back down.
Sarah returns from lunch and takes back over, I inquire about the stratafix and she stated she had it in this special kidney basin, tucked in her bowl with a towel over it. Oh, okay Sarah, so basically hidden, okay got it. We are finally beginning to get to closure, and I am setting up the dressings. Again inquiring to Sarah if the ace wraps are folded this way, ABD’s that way, and fluffs here, to which I get no response again. I am bumfuzzled, you don’t know how these dressings go on Sarah? You spend literally every day of your life with this surgeon; at this point the surgeon had stepped out.
I decide to do the best I can with the dressings with the PA in the room. At which point Dr L comes back in the room to check on patient and sees me fighting for my life getting the dressings on. When out of nowhere Sarah seems to know everything! Aggressively guiding the dressings on the “right way” and correcting every move I made that she seemed to have not a clue about 5 minutes ago. So, I quickly ponder, what has changed? Dr. L arrived back to the room.
This is the day I came up with the term “knowledge hoarding”. Sarah clearly wasn’t dumb, she clearly knew what she was doing, but chose to hoard the knowledge instead of sharing it with the team. Why would someone do that? Why would someone purposefully hoard knowledge and let the team look stupid and struggle? I determined that was where she got her confidence from, hoarding the knowledge gave her power over the case, and feelings of admiration from that particular surgeon. When she was in his presence, she knew “everything”. They probably had discussions over how dumb the rest of the room looked, all the while she is one of the reasons it continued to look so dumb. Never changing the preference cards, could even be purposefully making them wrong to keep her star shinning.
I decided not to take it personally, because while Sarah is a one trick pony in plastics, I truly enjoy learning about all the different surgeries and just know that I will not be getting the knowledge from that room.