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The orthopedic ‘Fortress of Solitude’: The scrub sink
The scrub sink should aid us in getting back into the ‘zone’ where we can perform at our highest level.
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by John D. Kelly IV, MD
We all know the drill; Just before the case begins we start the ritual at the scrub sink. Here we spend precious few minutes washing away any gross potential contaminants from our hands, fingers and forearms. While we can debate for hours the medical merits, or lack thereof, of a thorough scrub, I believe what is going in our minds is far more important than what is transpiring on our hands.
The scrub sink affords us the opportunity to prepare ourselves mentally for the upcoming surgery and to set the stage for the case. The next time you are before the faucet, try asking yourself: “Where is my mind? What am I thinking? Am I sowing the seeds of a difficult surgery? Am I questioning myself about my abilities to do this case? Am I thinking of the golf match this weekend? Am I still harboring resentment at my spouse for the disagreement last evening?”
Mind management
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I do my best work when I manage my mind; there is no better reminder of our mental status than the ‘at the sink’. I put the scrub sink to my advantage by doing the following:
- I judge my level of preparedness for the case by my comfort level at the basin. If I prepare and rehearse the steps of the surgery the prior evening and I visualize the case and picture the steps flowing seamlessly and successfully, the sink is a place of peace. If I am obsessing or ruminating while scrubbing, I simply did not prepare. Prof. Maurice Müller, the great Swiss surgeon and innovator, said the OR is a bad place to think. In other words, the steps of the surgery should be performed fluidly and instinctively without conscious thought. The scrub sink should be our haven to aid us in getting back to the “zone” where we can perform at our highest level. It is not the place to increase our fears, anxiety and second guessing. I know we all have room for improvement in this regard. The scrub sink can teach you to be more prepared next time.
- I assess my level of mindfulness, or living in the moment, at the sink. When my thoughts wander and my mind “gets away from me,” I am more anxious or moody. When I am in the present, time stands still … I am totally immersed in the “now” and fear and anxiety dissipate, I am in the zone. When I can feel the water on my hands, the soap running down my forearms and hear the flow of water, I am mindful of the present. When I am immersed in the present moment, my alertness, mental acuity and creativity blossom. I am tapping into my best self and feel that a force bigger than me takes over. Call it what you want – the Universal mind, the force, God — I simply am a better surgeon when I am mindful. Use the scrub sink as a means to get to the present. Develop awareness of dysfunctional thinking, like excessive guilt over the last case, a delayed start, or substitute team. Let these thoughts play in the background as you return your attention to the act of washing your hands. When you are in the now you will have extraordinary peace and ability.
- I cultivate a spirit of positive expectancy. At the scrub sink, after I have quieted my mind by returning to the present, I begin to summon feelings of good will and optimism toward the patient, the surgery and the surgical team. I simply try to expect the best for all involved in the operating room (OR) which I am about to enter. Feelings of good will can only be generated after we have squelched the chatter in our minds. It is impossible to harbor loving feelings and worry at the same time. When we return to the present we are free to give our best to our patients and our staff. With all the background noise of my mind squelched, I am free to give my best self to my patient and my team.
- I usually end my ritual with a little prayer to my Higher Power … that I will subordinate my interests to the best interest of the patient. When I do this “sign off” I am literally leaving my ego in the hallway. I am in the game to heal, not to serve any self interests. Peace soon follows.
Sanctuary of healing
When I am able to negotiate the above steps, I am ready to enter our sanctuary of healing — commonly known as the OR, with positive energy and the ability to bless the staff, residents and the patient. The positive emotions we bring to the OR are indeed contagious. We can truly set the stage for either a masterful and thoroughly enjoyable performance or a tense, fear filled, ordeal.
I suggest we all use the scrub sink as an emotional “weigh station.” Take responsibility for what you are about to bring to your staff and your patient. Quiet your mind by practicing mindfulness and returning to the only moment we have: the present. Learn from the days you were a little less prepared and be better the next time. Before you swing through those doors to the OR, expect the best … and you will get it.
Ours is a profession like no other. Orthopedic surgeons can heal and mitigate suffering perhaps more than any other medical discipline … and we can have fun at the same time. Next case, become aware of the blessing of the surgical scrub and try the sink ritual in order to get back to the zone. Wash away thoughts of fear and anxiety and get back to the present. Your satisfaction — and those of your patients — will flourish.
For more information:
- John D. Kelly IV, MD, can be reached at University of Pennsylvania, Dept. of Sports Medicine 235 S. 33rd St., Philadelphia, Pa. 19104-6322; 215-615-4400; e-mail: johndkellyiv@aol.com.