Cutting Remarks


The Many Faces of the Time Out

Wrong-site surgery happens. I am troubled to admit this. And while I'm all for the intent of the surgical time out, I'm amazed at the varying degrees of intensity with which surgical nurses call for one.

  • The laid-back easy rider. This nurse is so laid back that she needs to be resuscitated before the case begins. She has a resting pulse of 40. The Libyans could be in New York before she gets out of bed. Her favorite words are "what.....everrrrr" and "cool." During the case, she'll commonly ask, "Oh, did we start?" or "What are we doin' again?" Or even better, midway through the case, she'll suddenly exclaim, "Oh, we forgot to do the time out!" While the easy rider is far from intrusive, I sometimes wish she was a little more involved in the case.
  • The by-the-book detail champion. This troubled soul is cursed with a bad case of obsessive compulsive disorder. She can make coffee nervous. The word overkill applies to virtually all she does in life, and the initiation of time out is no exception. Not only must we identify the patient and the surgical site, but we must also follow every step of the surgical safety checklist. And do we really need to know the patient's zodiac sign, hobbies, favorite foods and fire risk? Or that he's allergic to shellfish, iodine and kumquats?
  • The ADHD pro. We all know the attention deficit hyperactivity disorder sufferers. They have the focus of a ferret on espresso. They cannot start a task and finish it without at least a half-dozen intrusions. The ADHD time out may begin with the nurse proclaiming, "It is time to perform a pause for safety," only to have her suddenly admit that she forgot to hang the antibiotics. The time out continues for a few seconds until she realizes that she'd better first check the autoclave. Ten minutes later (if we're lucky), the time out is completed, only to find the surgeon ready for a Xanax drip. In these situations, it is best for the surgeon to commence the time out by asking: "Did the nurse take her Adderall today?"

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