Cost cutting has limited surgeons’ incomes in Canada as well as in the United States; money considerations mean even more surgeries are booked. If anything goes wrong to delay the assembly line of cases, surgeons—already working in an anxiety-provoking field—may become more anxious and irritable. They may thus take their frustrations out on those who have a lower rank in the hospital hierarchy.
Although Dolan thought she could manage the surgeon, she was, she said, nonetheless worried enough about his reputation to ask a more experienced nurse to scrub with her. Because she was relatively new at the job, she didn’t want to be distracted by any of his antics and felt that moral—and, if necessary, clinical—support might steady her in case he “started acting up, or going crazy.”
Both nurses scrubbed and worked with the physician on a femoral nailing. In this operation, a titanium rod or “nail” is placed into a femur that has been damaged by either a fracture or cancer. In the operating room, the surgeon creates a canal inside the femur, inserts a titanium rod to stabilize the bone, and fixes it in place with one screw at the head of the femur and two at the base. Although the surgeon seemed a bit unsettled by a new spiral blade they were using in the hospital, the operation was going well. The more experienced nurse stood on the opposite side of the operating table and didn’t lift a finger throughout the procedure.
Near the end of the operation, the surgeon asked a circulating nurse to release the traction on one leg of the operating table. The table moved away too quickly and the motion upset the already tense surgeon, who screamed at the nurse. The quick release of the table also jarred a basin that held the drill the doctor would use to drill the hole in which the last screw would be inserted. When Dolan reached out to remove the drill to maintain its sterility, the surgeon misinterpreted the gesture. He thought she was contaminating it as well as other objects in the sterile field. Without hesitating, he reached out and grabbed her hand and shook it “nonstop,” Dolan said.
Because the patient was under epidural anesthetic—an anesthesia that leaves the bottom half of the body without sensation while the patient remains conscious—Dolan tried to stay calm and keep her voice low. Quietly, so as not to frighten the patient, she told the surgeon he was hurting her and asked him to let go of her hand. The experienced nurse watching from across the table also asked the surgeon to release Dolan’s hand. He finally did, but the harm had already been done.
The surgeon put in his screw and left the operating room. Dolan, her hand painful, stayed while the resident sutured the patient. After she cleaned the table she left the OR, shaken and hurt. Her hand was blue and swollen, the marks of the surgeon’s fingers imprinted on the flesh.