Estoy en guarda.

 One of the roles of a general surgeon on call is to cover intra-operative consults. This would be any surgeons in the OR currently operating, and deciding they either need another opinion or an extra pair of hands. This can come from another general surgeon, or a completely different service such as gynecology (which is the most common), urology, or podiatry. 

I do have to fight an almost automatic dread when called for intraop consults on specific cases which has built up over the years starting way back in residency. I was called into the OR the other day for a gynecology case. Hanging up the phone I pulled out my scrub cap and tying it below my hair at the base of my neck, headed in the direction of the OR not sure what I was going to be walking into. I scrubbed in to the case and glancing into the patient's pelvis could tell within the first 5 seconds the intraop consult was more than justified as scar tissue had obliterated the natural dissection planes of the pelvis. As we worked through the case I began to notice that the Gynecologist standing opposite me at the OR table was interpreting the surgical field differently than me. We were looking at the same structures, the same anatomy, but she was putting together an analysis not resembling mine. Where I saw a safe place to dissect, she saw unexpected tissue causing warning lights to ignite and her to hesitate. The biggest challenge was the intestine, which had prompted her to call for general surgical eyes and assistance. I am used to looking at intestines where, as a gynecologist, she does her best to keep all intestine as much out of view as possible. This allowed me to better judge safe dissection around the intestine. 

There was one point during the case that we were looking at the trajectory of the sigmoid colon as it dove down into the patient's pelvis. She kept exclaiming how close it was to the uterus, even "right on the uterus". I looked at the exact same scene and had the opposite thought. "Oh thank goodness, it's away from the wall of the uterus!" Isn't that just like life? We interpret what we see based on what we know. The anatomy of the patient above interpreted by either looking at the uterus first and then the colon versus looking at the colon first and then the uterus. Same anatomy, two different interpretations, leading to two very different outcomes. 

That's why it's always a good idea to stop, pause and look around once in awhile. Expand our own perspective and see what we are missing?

Much Love.