Advice for Observing Surgery

I’ve been invited to shadow an Anesthesiologist for a day this Thursday. Does anyone have any advice as to how I should prepare, or how I should conduct myself? I want to get the most out of this experience (learn the most).

And, it may sound stupid, but what should I wear? I have scrubs (from volunteering at a local hospital), but should I go that route or bring the scrubs and wear something nicer (I usually say it is better to be overdressed)?

Any insight is appreciated.

Can you ask the anesthesiologist what he/she suggests? I am figuring you have a decent rapport with this individual if you’ve been invited to observe, so you could, in theory, simply ask them what appropriate attire would be.

My humble suggestion, when I was observing surgery, I wore khakis and a polo. Since you must scrub in, even when just observing, then they had given me surgical scrubs. So, that is what I had done, and this was with the surgeon performing the actual surgery, he did this as well. So just my take on your situation…

I would definitely ask the person you are going to shadow what you can do to prepare for the experience. I would thing they will provide you with scrubs - most ORs require clean scrubs and from ‘this’ particular hospital. But again - you can ask if they will provide you with scrubs.

I shadowed an anesthesiologist as a pre-med once and he told me to just come and have fun.

I guess you can always prepare a list of questions you would like to ask him/ her. But even if you don’t, the questions will be coming to you along the way… I wanted to know everything and I kept asking and asking and asking. By the end of the day he must have thought that I have a 3-year-old syndrome :).

Enjoy your experience on Thursday,


They will most likely tell you once you’re there, but unless you’re scrubbed in, don’t touch anything draped in blue (blue = sterile surface).

And most importantly, have fun and ask questions about what you’re seeing! Hope you enjoy. =)

I’m happy-jealous too…and also eagerly awaiting the full report!

Thank you all for the advice. Some quick background. I met this doctor shortly after my grandmother took a bad fall and was going into surgery. My grandmother tells everyone in the world that I am going to be a doctor…and that includes doctors (as if they’d care). In this case, she requested that I be able to observe her surgery…the surgeon and anesthesiologist gave it some thought and decided against it saying that for family it is often too close an association and they weren’t comfortable with it. But the anesthesiologist paused in thought for a while and then added “but call me here at the hospital later, and I’ll get you in to see some surgery” This was the later. Up until this point I’ve worked very hard to get opportunity to observe or shadow and had little success. I’ve had about 40hrs of shadowing in the last 6 years with a family friend who is a family practice doc in urgent care and that is the extent of my experience. This kind of opportunity was a huge break…huge enough that it took me months to get the gumption to call the guy.

The day went extraordinarily well. The anesthesiologist who invited me met me at 7am, had me change into scrubs provided by the hospital, and then we had a long look at the board to see what the best procedures were for me to observe. He chose a laproscopic cholecystectomy (gall bladder removal), a “nose job” and a mastectomy.

I signed a number of papers agreeing to keep details confidential etc…and after meeting the patient and getting her approval to observe was ushered in to the first surgery pretty quickly, and without any particular directions except to keep close (the anesthesiologist who invited me is the department head…and though he was not the one assigned to this procedure, he was the one keeping an eye on me). In reading various blogs etc before my day in the OR all the med student had said that “silence is the rule when observing in the OR.” That you touch nothing, say nothing, don’t enter unless invited specifically, and don’t approach the table unless the surgeon motions you over. None of this was true in my experience. The Anesthesiologist walked me in, explained a few things about the particular approach the working anesthesiologist was taking to putting her under, and then told me to “really get in there and take a look at her vocal chords” during intubation, to get a feel for what the doc was up against in getting her positive ventilation started. He then told me to “ask questions, and learn what I could” and walked out of the OR. The surgery was fascinating (my dad went through this procedure about a year ago). It was particularly impressive how much could be seen on the monitor. No one said a word to me, and I didn’t ask anything…still trying to get a feel for the communication culture of the room and not make a nuisance of myself. My original contact came back (we’ll call him Dr. Awesome), and asked if I understood the anatomy of what I was looking at…I explained that while anatomy is not necessarily my strong suit, I was not lost at the moment. I stayed through waking the patient up, and then Dr. Awesome told me to follow him to his office.

Just so you get the full experience. I’m 5’6" and Dr. Awesome is like 6’5". I literally had to take two steps to his one to keep up with him. We got to his office, he sat me down and started explaining the history of Anesthesiology. He told me that it’s like flying an airplane (I’m a pilot, so I think he chose this analogy to draw me in). “You have a checklist, you plan for emergencies, and the most important and dangerous times are during takeoff and landing.” He explained intubation and extubation and methods for each (I’m suddenly realizing this could be a very long post).

I’ll tell particulars of this talk (and procedures) if people are really interested. It basically consisted of my taking notes for about half an hour as he explained the basics of each aspect of keeping someone alive and then half an hour of giving me scenarios and asking how I’d respond to them. I fancy I did ok. By asking a question or two I was able to come up with a solution to each. We also discussed three different kings of positive ventilation (intubation “the gold standard”, LMA, and a mask). Again, I’d be happy to relay this whole discussion if you all voice interest, I took pretty good notes.

During this 1+hr conversation he got a call saying the nose job started without me. Bummer! He commented “you’ll learn more this way anyhow” in reference to my talking to him. I was disappointed and admittedly a bit miffed.

We sat down in the doc’s lounge to talk to some vendors who had bought us lunch, and just before we began, he got a call saying that he was needed for an emergency C-section (he was working OB all this week). We obtained permission from the surgeon (who didn’t act thrilled to have an undergrad student around), and the patient (who was having contractions) and next thing I knew we were in the OR. This time, it was his world. It would be a spinal (epidural is the common term…but he used spinal) and he explained to me that it is much easier to find the spot on a tall woman who is skinny. This patient was about 4’8" and overweight. Unlike the first, he not only explained to me everything he was doing, but had me participate. I hung bags and handed him needles. Once he’d found “the spot”, got a needle in (second try), and confirmed fluid flow (all in under 8 minutes) she couldn’t feel a thing. He instructed me to take a spot on the wall facing the patient and not touch anything… warning me that this was the bloodies procedure they do in the hospital and to sit down if I got faint. I was astounded that so much damage could be done, and internal organs pulled so far out of place, without her feeling anything just from .3ml of something injected into a spot on her spine. It was absolutely unbelievable. Skin was separated from muscle, muscle split, intestine pushed out of the way (regular cauterization throughout). A plastic sleeve was inserted under the skin all around the incision to make what appeared to be a synthetic and short birth canal. Then a hole was punched in the uterus and the surgeon and resident pulled on either side to split it open. The surgeon reached deep inside carefully to get her bearings, and then with one swift motion rotated the baby out supporting her neck. The child cried instantly, and the surgeon passed her off to the nurses for weighing etc. The surgeon and resident then sewed her uterus (now 1/16th the size) shut using two handed knots (surgical sutures are tied by hand…go learn… it will impress your friends). Muscle was reconnected and then skin. Pretty incredible.

We went back to the lounge, Dr. Awesome expressed how happy he was that I’d seen both a general and a spinal since these are the two schools of anesthesiology. And I then sat down to an hour or so of listening to a company sell their new monitor for the OR.

At 1330, we were done with the sales campaign, and I was late to observe the mastectomy. Dr. Awesome gave me the option to go home, or “get in on it.” Since the procedure was underway I’d thought it was too late. After expressing this he smiled and said “I think we can make it happen.”

As soon as I walked in, I could tell this OR was different. Despite this being a somber surgery for a woman to undergo, there was something positive about the room…and at first I couldn’t put a finger on it. After a few moments of Dr. Awesome explaining what the anesthesiologist was doing, the surgeon invited me closer to get a good view (really close). She (the surgeon) explained every single step she was taking, the reason she was doing it, the technique she was using, and other opinions on how it could be done and why she preferred this way. She also asked me a number of questions about my education and what interested me about medicine (she was phenomenal at multitasking). It was here that I realized what was different about this OR. There was music. She had country music on, and the Georgia accent was seeping through her surgical mask.

Unlike the first two surgeries (the first being internal and laproscopic, and the second where I was 10 feet away), here I was less than 2 feet from the procedure, and I ran into the other piece of knowledge I’d read online. Cauterizing doesn’t produce a real pleasant smell. During the c-section (at that distance) it smelled like burning nitro-methanol (model airplane fuel), but here it was much stronger.

Unlike what you see on Grey’s Anatomy or other shows, the initial cut is made with a scalpel, the rest by arcing a current from the cauterizing tool to cauterize as you cut. The smell was pretty substantial and rather unpleasant. I decided pretty early on, that I was going to breath as deeply as I could, and deal with it…it’d get better. If it did get better, it wasn’t real noticeable. About 15minutes into the removal of the breast (she had made her incisions all the way around, and was now arcing through tissue, making her way down to the muscle) she asked the nurse to “put on something else” (meaning music). When asked what she wanted to hear instead the surgeon responded “I don’t know…maybe that Red Weezer one” I stood stupified for a moment…and then queried “the red album?” and after affirming this… I laughed and told her I’d just seen them live at SJSU in December. She was jealous…but then said she was probably too old for a Weezer concert. To which I responded that even I was too old for a Weezer concert…and that I’d been the only person in the concert hall over 15…to the best of my knowledge. We all laughed for a moment or two.

I learned a tremendous amount from her. Unlike the “standoffish” picture portrayed by many of the things I’d read, she was friendly, open and willing to both teach and answer questions.

Once again I observed the extubation process…taking careful note of how the anesthesiologist watched for signs that the patient was functional enough to remove the tube…and looking for the problems signs that Dr. Awesome had clued me in to. None arose.

I spent the next half hour or so meeting a new anesthesiologist that Dr. Awesome had just hired, and talking with them in the lounge. Dr. Awesome told me I was not obligated to, but I may leave whenever I like…and that I was welcome back any time I liked. This surprised me. I jokingly warned him to be careful what he offered, because I’d probably take him up on it. He told me to feel free to do so.

I don’t know when I’ll return. I have a pretty busy semester ahead, but perhaps afterwards, or during spring break? We’ll see.

I really do feel privileged to have had this opportunity. Up until this point, I’d not had a lot of success in getting experience in the field. This was inspiring. I’m already studying more earnestly. As I was changing out of my scrubs, so was the surgeon from the laproscopic. He commented as I was leaving that surgery is changing and that “you really have to love surgery, to be happy in it these days.” It was obvious that he loved it, but it was also obvious that there was something underneath that that he was trying to communicate. I wish I’d asked more questions.

I think the moral of the story is to be persistent in looking for opportunity to learn and get a foot in the door. I’ve pursued 20+ different options over the last few years, with no success…pretty much deciding that there weren’t opportunities available to me. The doc I’d shadowed 3 years ago had even told me “you’ll never get into an OR as an undergrad.” To finally have something pay off, made it all worthwhile.

Best of luck to you all. If there are q’s you have, or if you are interested in the dissertation on anesthesiology I got from him, I’m happy to share.

Absolutely fascinating! I’m green with envy, but thank you so much for detailing your day. It took sitting down a few times after being interupted but I got through reading the entire day. It was grand. Thanks again.


That sounds like a great experience. I’m a little jealous!

On a side note - y’all know what else is great about being a non-trad premed? I have live footage of my own emergency c-section from 11.5 yrs ago. . . Most 22 year olds have had a few school physicals, and that’s it.

What was also cool about my c-section is that my now-doctor cousin was on her ob/gyn rotation at the hospital and got to see it!

It sounds like you had a great day!

This sounds AWESOME! You’ve inspired me to look for a similar opportunity. Thanks so much for sharing all of the details!

That was the coolest. Great day, indeed.