Like most exclusive groups, surgery has its share of rites of passage—activities ranging from the silly and harmless to those bordering on hazing. As you will soon find out, the OR can be a stressful place, and different surgeons have different ways of relieving the tension there. While some techniques are funny, harmless, and effective, not all are. Hopefully the only thing you will need to take away from this chapter is that someone managed to use the words “tomfoolery” and “shenanigans” in a medical textbook, but unfortunately this chapter exists because tomfoolery and shenanigans aren’t the only things that happen in an OR. We will try to describe, from the point of view of a current surgery resident, specific events that are likely to occur in the OR and how to respond to them.

OR Scut (Mostly Isn’t Scut)

Most of what occurs in an OR is clearly NOT hazing. Tasks such as retracting, “driving” the camera during laparoscopic surgery, and placing a urinary catheter are necessary components of an operation. Intraoperatively, these tasks fall to students because the surgical resident and attending are needed to perform more in-depth pieces of the operation and because table space is limited. In order to get close enough to the field you have to actually be AT the field, and everyone at the field has to contribute to the operation. Providing exposure and visualization for the attending and resident gets you exposure to the operation itself and the teaching that occurs at the table. Retracting isn’t the most fun part of the operation, but it is one of the more important parts (and that is why we get so annoying about keeping the retraction JUST SO). Those of you who go into surgery will doubtlessly look back at your experience as a medical student and think “That’s why they were so annoying about the retraction/camera view.” Not as embarrassing as the first time you say something and realize you sound like your Mom or your Dad, but close.

We ask you to place the Foley for a similar reason: there are few other opportunities for students to learn how to do it. Having you do it gives you practice and gives us a chance to assess your technical abilities and how well you respond to technical direction. If you perform well, you’ll probably find yourself doing more in the operation.

Always Cutting Sutures the Wrong Length?

Every suture you cut will be the wrong length. It just will. If the resident takes your hand and places it exactly perfectly and nothing moves a millimeter before you cut it, it will still be the wrong length. This is one of the eternal truths of surgery. The correct length for a tail (the free end of suture coming off the knot) is whatever length your attending or resident tell you it is, even if 3 seconds ago it was a different length. For some reason telling medical students they cut the suture the wrong length (spoiler alert: a fair amount of time the length is fine) has propagated across all of surgery as a fun thing to do. Why? Who knows. It isn’t funny. It isn’t (always) true, but it is something we do (and even though I’m now forever on record saying it is silly, I’ll probably still do it).

Of course, depending on the type of suture or its location, the length of the tail you leave does matter. Monofilament sutures, like PDS, can unravel and needs a longer tail to prevent the entire knot from coming undone; braided sutures, like Vicryl, can be cut closer to the knot.

To cut: