What not to wear

After years of anticipation, the golden day had arrived: the first day of my clinical clerkship. I reported to the obstetrics ward 15 minutes early, wearing my favourite shirt-and-tie ensemble and practically hopping with excitement. A half-dozen of my classmates, bristling with nervousness, were already gathered at the nursing station.

The staff obstetrician responsible for coordinating our rotation sprang onto the scene at precisely 0730 hours. After a brief introductory talk, she handed us over to the senior resident. The sleep-deprived young surgeon solemnly nodded at my colleagues and me as we were introduced. I thought I detected more than a trace of disdain in her voice as she looked at me and commented, “You are way overdressed.”

After a brief tour of the ward, our little group disbanded to begin our assignments for the day. To my delight, I was assigned to Labour and Delivery, the undisputed centre of action. I bounced into the change room, hastily stuffed my silk tie and starched shirt into the only empty locker I could find and quickly donned surgical scrubs. I emerged from the locker room in a flash, feeling invincible in my new hospital attire, ready to tackle any obstetrical emergency.

As if to spite me, the delivery ward was unusually quiet. Late in the afternoon, however, I followed the resident to Labour Room 3 to reassess a woman whose labour had been slow to progress. My understanding of the clinical decision-making process was somewhat fuzzy, but when the resident began explaining to the patient that a cesarean section was now the most prudent course of action, I knew what was coming.

An emergency cesarean section! I secretly thanked the gods of obstetrics for presenting me with this opportunity to go to the operating room on my very first day. My heart racing, I looked around to see where my services were most needed. The nurses, resident and attending physician bustled in all directions. I spun around in the middle of the fray, more than a little unsure of my role.

Suddenly I felt the pressure of a steady hand on my shoulder. I turned to see the warm, familiar face of an anesthesiologist whom I knew from my preclinical years. He offered an enthusiastic welcome to the hospital. Whether by his superior intuition or the dazed look on my face, he seemed to sense my disorientation and led me to the operating room. He pointed out the scrubbing area and suggested I immediately ready myself to assist. I thanked him profusely as he left to attend to his anesthetic duties. Left to my own devices, I rushed to don mask, hat and boot covers, and began vigorously but methodically to scrub up.

In the time I spent carefully scrubbing, both the resident and staff surgeon joined me at the sinks, completed their scrubbing and flew into the OR. The procedure was almost under way by the time I tentatively entered the room, but I was quite certain that my hands had never been cleaner. I was immediately gowned and gloved by a proficient scrub nurse, who placed me beside the staff surgeon. For the next few minutes, I stood over the patient's abdomen in awe as the operation proceeded, scarcely remembering to breathe until the baby was safely brought into the world. Behind my mask, I smiled and marvelled at how perfectly everything had gone. I daydreamed, visualizing a brilliant medical career lying before me, each day full of excitement, challenge, joy and success.

As the last of the staples secured the wound, I once again felt the anesthesiologist's reassuring hand on my shoulder. His voice boomed from behind me and projected across the OR.

“Mike, congratulations on your first OR experience, you did well! Next time, however, I recommend that you wear only two boot covers instead of three.”

As I tried to make sense of his comment, I felt all eyes in the OR fall on me. Suddenly there was uproarious laughter from all corners of the room as the nurses, doctors and even the new father guffawed behind their masks. I turned around to look at him questioningly.

He whispered the answer in my ear: “The boot covers are for your feet only, not for your head.”