Perspective: Attending Transplant Surgeon (Adult and Pediatric Liver and Kidney)

A transplant surgeon with over 4 years as an attending at a top-tier academic institution provides her perspective on running her Operating Room and managing her Surgical Team.

How do you prepare for cases?
The night before I re-read the chart of each patient. I also review any imaging studies they have had. Since transplant can be a 'spur-of-the-moment' type of job, I always make sure to talk to them in the pre-op area because often the patient can tell you more than the chart.

Are there any rituals or superstitions that you have when you operate?
Ritualistic is an understatement. I have a lucky necklace given to me by a special person that I wear every time I operate. Other than that I'm not as superstitious as some surgeons that I know. Again, you could be in the OR on a moment's notice in Transplant so part of my training was to learn to become flexible.

How do you set the tone for your Operating Room to ensure the best chance at a successful outcome?
I think most of the OR nurses and scrub techs that I work with would describe me as laid back. I almost never raise my voice when the stress level goes up. If I'm operating with a new resident I like to find out more about them. I try to keep the vibe "chill" and collegial. I am a firm believer that yelling and throwing temper tantrums never encourages people to work harder for you, it just makes them flustered.

How do you deal with underperforming team members during a case?
The first step is to explain how you would do it differently. If that isn't clear enough I will often demonstrate what I'm trying to say. If we are at a critical part of the case then sometimes I just have to take over until we get through the tough parts.

Do you have any ‘pet peeves’ that O.R. Nurses or other support staff could alleviate?
It gets frustrating when the circulating nurse is often out of the room, but sometimes they are just so busy grabbing stuff in the halls. Which leads me to my second pet peeve, I can't stand it when something that is on my case card, and I use every case, isn't even in the room.

How do you control emotions and composure when a case is not going well?
Getting angry with the team never helps anyone. If I want people in the room to know things aren't going well, I usually ask to turn the music off. If I get frustrated with anyone it's usually my surgical partner (who by the way is 25 years my senior and also trained me to do a pediatric liver transplant) because he usually understands the stress level more than anyone else.

What is most important for you when dealing with a patient that is crashing on your table?
In liver transplant it's not uncommon to have someone near arrest or in cardiac arrest on the table. The most important thing is to make sure the surgeon, anesthesia and the circulating nurse are all communicating. If everyone is doing everything they can possibly be doing, you all just keep working as a team until the patient is resuscitated.

How do you view the Operating Room hierarchy - do you view it as very formal and strict?
Yes and no. Most of the team I work with is the same team that has known me since I was an intern. We mostly all call each other by our first names. I also happen to work in a very laid back region of the country where it is relatively normal to address people by first name. What bothers me more is if I am standing next to a male partner (either in the OR or on the wards) and they address him as Dr and me by my first name.