My first time in the operating room (OR) was when I was a junior in college. I was beaming under my mask, so excited to shadow and observe my first surgery ever, a riveting and exotic procedure: a planned and standard laparoscopic cholecystectomy. A friendly circulating nurse that I had been chatting with asked me, “Sabrina, what’s your glove size?”
“Oh … I think medium,” I replied.
Silence from the rest of the formerly bustling OR. “Oh, honey,” the nurse sighed.
Lesson #1. Sterile gloves are not the same as regular gloves. Know your glove size.
I felt embarrassed and knew something was wrong, but I had no idea what I had done. My attending came over and kindly explained the system of gowning and gloving to me and recruited a nice resident to show me how to scrub, even though I’d only be observing the procedure. I ended up having a lovely time and walked away with a new wealth of knowledge.
Over the next several years, I continued to shadow a variety of surgeons who made the experience fun and took time to really teach and talk to me. I was amazed by the creative problem-solving and clinical mastery my attendings wielded to improve our patients’ lives, and I fell in love with surgery. However, I continued to make mistakes as I learned, much to my chagrin. In this daring act of catharsis, I have curated my most cringe-worthy moments for your reading pleasure.
The first time I scrubbed into surgery was in M1 year and I enjoyed working with a very nice resident and attending. The resident even advocated for me to scrub and join in! The case went well and as we were closing, the resident asked me, “Do you know how to tie knots?”
Me: *overthinking* “No.”
I had been practicing for months and could indeed suture and tie knots. Why did I say that? I think I was just not confident in my ability and didn’t want to “mess up” in front of them.
Lesson #2. If you know how to do something, say so. If you don’t know how and want to learn, or if you know a little bit and want more guidance, just say so! Surgeons like when people show an interest in learning and being helpful, and you don’t have to be perfect right away. They want to help trainees who want to learn.
Later that year, during a liposuction case, I was scrubbed with the same resident and an MS3. I was to close one liposuction site — easy! However, I had never seen such a small and transparent suture (5-0 chromic) at that point. Muscle memory kicked in and I made the first bite too far away since I was used to bigger needles. I tried again and the resident chimed in, saying, “Great wrist rotation, you got it! Now do an instrument tie.”
My mind went blank because I hadn’t practiced instrument ties in a few months, which might as well have been a few eons. To my dismay, my normally tremor-free hands were now quaking. I went to tie the first knot, and the suture snapped in two.
I paused, mentally ramming my head into the nearest imaginary wall.
The MS3 seethed at me under his mask. I was confused as to how this suture was so fragile. To make things worse, I inadvertently dropped the scissors because I was so shaken by my ineptitude. I didn’t even realize they had left my hand until I heard the metallic clatter on the floor. The resident looked over from flawlessly closing the facial incisions and joked, “I didn’t like those pickups anyway!” The disappointed MS3 snidely pointed out that it was actually a pair of scissors. My resident, with the understanding patience of a saint, said, “Oh. I didn’t like those scissors anyway!” From the other side of the patient’s rotund abdomen, he swooped in to flawlessly close the tiny incision. Gently he said to me, “You don’t need to tie it so hard, these ones are pretty delicate.”
I managed a “Thank you for letting me practice,” without my voice shaking as I thought it would. He looked at me and said, “Of course!”
Lesson #3. Be kinder to yourself and keep practicing. Your time to shine will come.
Okay, by the third year of medical school, I’ve spent two years shadowing and practicing extensively and have gained enough experience to never make a dumb mistake in the OR again, right?
Wrong.
On a rare day off from my OB/GYN rotation, I joined one of my plastic surgery mentors for a day of aesthetic procedures that I had never seen. We were playing the “Yacht Rock” playlist on Spotify and having a great time. My attending asked me a low-hanging fruit knowledge question, “So, why do we de-epithelialize the breast during the reduction?”
The only thing I saw in my mind was TV static. I had read up on this case and the related anatomy for a few hours and even dove into some of the most current literature to try to learn as much as I could, but I had no idea. All I could remember was one video underlining the importance of freeing up tissue to mobilize the breast, so I said, “Uh … to better mobilize the breast?”
My attending stopped operating to look me in the eyes. “If you don’t know, just say that. Don’t guess.”
My brain, trying to be helpful, offered up the “I’m an idiot sandwich” Gordon Ramsay meme in my head. I then felt marginally better about the situation.
Clearly, I had not reviewed the relevant material likely to be asked of medical students when I read up on the case. I later found several great plastic surgery resources that were designed for trainees, such as theplasticsfella.com and the Michigan Manual of Plastic Surgery (I have no disclosures).
Lesson #4. When reading up on a case, you should read up on the patient, the steps of the procedure and the regional anatomy. What students are likely to be asked are questions about anatomy, local physiology, indication for surgery and why certain major operative steps are done. There are many trainee-focused resources designed to give high-yield, focused tips that are not usually found on simple internet searches.
We resumed the operation and our lighthearted conversation, and the good vibe was restored. It was fun being able to help during surgery, even in small ways. My resident and attending started closing, and I noticed they didn’t ask for suture scissors. I didn’t know if they expected me to do that, since I’m an MS3 interested in surgery and should know to anticipate and do this, or if there was another reason. I asked the resident if I could help cut suture, and she said, “Actually, these cut for us! I’m so sorry!”
I looked down at their needle drivers and didn’t understand, until I saw my attending snip a suture with one. I had never before seen the small but mighty Olsen-Hegar two-in-one scissor and needle driver. I marveled at its ingenuity and then realized I could have just seen that if I had been looking harder.
Lesson #5. Pay attention to the tools on the field and how they are being used. Anticipating the next step or tool is useful, but it comes with time and experience. Spend enough time with a single surgeon and you will pick up on their style and operative flow.
I had peripherally paid attention to the names of instruments during surgeries and knew some by heart at that point, but this was a pivotal moment where I vowed to start taking it seriously. In surgery you need active listening and “active looking” — being acutely aware of what you’re seeing and taking stock of what’s there. This was my first time operating with that attending, but now I can look back and remember he prefers to use Olsen-Hegars. I then spent several weeks shadowing and operating with another attending and began to learn her particular preferences. This taught me how to anticipate accurately and helped us cut down on excess operative and closing time.
These days, I still make mistakes occasionally, but what has changed the most is my immediate reaction to the mistake and how I respond, learn and change my behavior moving forward. When I was younger, I was a big perfectionist. I absolutely dreaded making mistakes or failing in any way. For example, as a child, whenever I’d try something new and was not immediately perfect at it, such as a new piano piece, I would cry and feel deep shame over my self-perceived incompetence. However, as I have grown older (and especially once I hit 25 years old and my frontal lobe kicked in, like the triumphant beeep of a microwave) I have seen the multifaceted value of making mistakes. We often need to learn things “the hard way,”, i.e., by messing up, so that we remember and are aware of the experience, and the brain has an opportunity to come up with a solution to avoid this situation in the future. We must allow ourselves to briefly sit in the uncomfortableness of our failure if we intend to grow from the experience. Additionally, it can be helpful to seek specific advice from trusted mentors on how to improve after making a mistake. Often, they made similar mistakes as you did when they were trainees! To this day I hear my mentors’ words in my head when I’m closing with chromic suture or securing a drain, since I had previously sought their guidance about those after I had failed my first tries. Despite these mistakes, I have seen my skills improve significantly over the years, and I am learning to be less hard on myself. I still love surgery and am excited to be a resident who helps medical students succeed, like those who did the same for me.
Keep putting yourself out there and taking advantage of your learning opportunities — even if it means inadvertently making a mistake. You are not stupid! Just inexperienced!
The notorious Richard Branson put it best: “Do not be embarrassed by your failures, learn from them and start again.
Image credit: “Hand Surgery” (CC BY-SA 2.0) by esens91410
Contributing Writer
Albany Medical College
Sabrina is a medical student at Albany Medical College in Albany, New York, Class of 2025. In 2020, she graduated from UC Davis with a Bachelor of Science in Cell Biology and minor in Professional Writing. In her free time, she enjoys playing volleyball, Assyrian and Arab cultural dance, hosting dinner parties, and gardening. After graduating medical school, Sabrina would like to pursue a career in plastic surgery.