I USED to really enjoy scrubbing up
ready for an operation. Plenty of
povidone iodine, lots of bubbles, a
good five-minute ritual cleansing.
There was never much evidence as
to quite how necessary it was, mind
you.
We never had problems with wound
infection but I know colleagues in
general practice who seemed to get
away with showing their
hands the
disinfectant
for a moment
or two, giving
them a quick
rinse and then
plunging in
for the cut.
Everything got a dose of long-
acting antibiotic and no harm seemed to
come about. But now, at least for us, all
has changed. No longer the five-minute
scrub, no longer the soapy lather and
the brisk feel that you were immersing
those nasty skin bacteria in a deadly
disinfectant even if you were rubbing
off half your epidermis at the same
time!
Now we’ve moved to an alcohol-
based system that only needs 90
seconds of rubbing in. I grant you that
it smells obnoxious – if I were
immersed in it for a minute and a half I
doubt I would survive. But we’ve lost
the whole performance of scrubbing
up.
At least we still have gowns and
gloves and masks and hats, though the evidence there is apparently that after 20
minutes masks increase bacterial
contamination. Soon they may have to
go. But just a minute! Where are we
when we do this? The operating theatre.
And what happens in theatres? People
perform!
You don’t go to watch A Midsummer
Night’s Dream and hear people talking in
normal English and wearing their everyday clothes do you? And isn’t part
of the joy of operating to dress up and
perform? Perform surgery that is, of
course!
At least now we have a new ritual:
the check-list. Until recently nobody
asked who was in the theatre, what the
name of the animal was or which
operation we were about to undertake.
And the same was the case in human
theatres.
Which was why all too often “never
events” happened. Operating on the
wrong patient or the wrong leg,
removing the wrong kidney.
To tell the truth that’s never
happened to me or in our hospital to
my knowledge. Once we nearly
removed the right eye when it was the
left that was meant to come out. But
when left is right, then right is wrong!
Ready for the unforeseen
We stopped before we had even started,
but just one near miss is enough that I
am quite happy to go through a check-
list of who is in theatre, which animal is
going under the knife, what unforeseen
events might occur (although of course
just listing those stops them being
unforeseen!) and whether we have all
the equipment we might need. It’s all
part of the performance.
But of course the whole of life is a
performance, isn’t it? Erving Goffman,
back in 1959, wrote a seminal sociology
text entitled The presentation of Self in
Everyday Life in which he pulled together
years of research on how people acted
in their interactions with others. And
acting was what he came to see they
were doing.
Putting on a performance for those
around them in which there was a front
of stage persona they fulfilled and a
back stage character who might be quite
different.
Although he came from Chicago he
undertook his doctoral studies
researching the people living in the remote Shetland island
of Unst and in particular
how they interacted with
visitors and other staff
in the main – indeed the
only – hotel there. And
he came to see that the
island and the hotel
within it were like a
theatre.
Not that this was
new, of course: 400 years
earlier Shakespeare told us
that the whole world is a stage and we
all actors in it. And so it is in the
operating theatre and indeed in our
consulting rooms.
The question is
whether we realise that
the whole thing is a bit
of a play. Perhaps
understanding this a bit
more would help new
graduates in the
interactions they have
with the public.
I’m not sure that
how they are taught
using the Calgary
consultation plan helps quite as much as seeing
it all as a bit of theatre.
But perhaps that would
be seen as a bit too
much like fun. That
would never do would
it? But I worry that
there isn’t enough of
life these days that is
seen as a bit of a laugh.
When I smile at people as I pass them in the street there are
very few who smile back – but perhaps that’s me and not them!
And a quick survey of the people in the train carriage I’m in today shows
only about 5% with any sense of enjoyment on
their face. Those are
young couples and even
then only the girls seem
to be having much in the
way of fun.
My goodness, we have
come a long way from
theatre hand-cleaning
procedures haven’t we –
but even those can be fun
if we let them be!
