Gowning and gloving

I bought a camera at the PX at Gunter as soon as I learned I'd be going to Europe. This is an image of one of my Gunter OR school classmates in our mock operating room. Neither the blood nor the patient were real, but the experience was valuable nonetheless. (Don Dale photo)

At Gunter AFB in Montgomery, Alabama, I discovered exactly how fascinating work in an operating room would be. Concomitantly I discovered how exacting and demanding our training would be.

No longer would we be giving shots to oranges. We gave shots of sterile D5W solution to each other. We learned about surgical instruments -- mosquito, crile, Kelly, Ochsner and Halstead hemostats, to name but a few types of clamps; rongeurs; cannulae; retractors and elevators; gouges and probes; scalpels and blades; bell clamps; needles and needle holders; sutures; and orthopedic instruments that looked like stainless-steel versions of what was in my dad's toolbox. We learned how to sterilize them and pack them so they'd be ready for instant use. We learned how to scrub our hands and forearms with hard brushes for the prescribed length of time. We learned the process of donning gowns and gloves while preserving their sterility in a process that seemed ritualistic and balletic but is actually quite practical.

We learned the names of surgical procedures -- from circumcisions to hysterectomies to cholecystectomies -- and what instruments would be needed for each. We learned how to pass those instruments to the surgeon so that when they hit his hand they would be in exactly the right position for immediate use. We learned how to pass a scalpel and avoid having our hand sliced open when the surgeon grabbed the handle. We learned about anesthetics, how to hit a vein to start an IV drip, how to tie a suture in a wound so full of blood that you couldn't see the knot, and how to anticipate what a surgeon would need next. We learned how to keep track of sponges so that none would be left behind. And we learned to estimate blood loss by looking at those bloody sponges.

There were essentially two major jobs we'd be performing in the OR: we'd either be scrubbing or circulating. Scrubbing involved working directly at the OR table, gowned, masked, hatted and gloved, performing tasks ranging from holding retractors to passing instruments and assisting the surgeon in cutting and suturing. Circulating meant working the perimeter of the OR in scrubs and mask -- assisting with gowning and gloving, fetching supplies, noting the exact start and end time of a procedure (and sometimes the exact time of a birth or death), re-sterilizing dropped instruments, and handing off excised tumors or amputated body parts to lab techs waiting just outside the OR.

Naturally, there was an Air Force manual for Operating Room Specialists -- a very thick manual -- and we were expected to know it from cover to cover. Mediocre grades were not an option. We had to know it all. Average wasn't good enough.

The OR school's instructors were demanding, and rightly so. There was no room for error. After a day of difficult classes, we'd go back to our rooms to study the manual.

For me, the whole learning experience was exhilarating.

We were, however, young men and women in our late teens and early 20s. We found time to have fun. Montgomery was a lot like Richmond. We toured the State Capitol and the White House of the Confederacy (which had preceded Richmond's). We sampled the bars. The city's pace was more Southern than Richmond's, but the local menu specialties were similar and just as good, and the accent didn't sound so strange to me as it did to my classmates from the Midwest. The politics of the place was even entertaining: George Wallace was governor, and he was about to be succeeded by his wife, Lurleen. The Alabama State Fair was in town, and the rides, food and displays kept us busy for a weekend. Back on base, we drank our share of beer and liquor at the club.

But mostly we studied in our off-duty time. The stakes were high: Finish No. 1 in the class and you'd have first pick of assignments and get to choose where you'd spend the next three years. I wanted to go to Europe. I knew there would be few, if any, European assignments on the list.

I knew there was one other person in our class who might get better grades than I. The instructors would calculate our rankings weekly, and sometimes he'd beat me out. Most of the time, I beat him. In the end, I edged past him by one grade point. When the assignment choices were posted, there was only one in Europe: Bitburg Air Base in Germany. I had never heard of Bitburg, so I went to the base library to look it up. It was a small town, about the size of Ashland, nestled in the Eifel Mountains not far from Luxembourg, Belgium, France and the Netherlands. That was all I could find out, but I picked Bitburg. My classmate who finished second picked Tripoli Air Base in Libya. There but for the grace of God ....

There's one anecdote about OR school that I can't leave out. There was no hospital at Gunter, but there was one at Maxwell Air Force Base on the other side of Montgomery. One of our last experiences before graduation was spending a day working in a Maxwell OR. On the appointed day I was assigned to an amputation. A dependent grandmother with diabetes had lost all circulation in her lower left leg, which had turned gangrenous and had to come off.

I scrubbed diligently, and the circulating nurse helped me with gowning and gloving. When the patient had been anesthetized and the surgeon was ready to begin, he told me to hold the patient's foot and elevate the leg. I had been predictably nervous about my first actual OR experience, but, when the surgeon and his assistant began, my nervousness disappeared. I was fascinated to see that everything I had learned about was happening now right in front of me. The procedure went quickly. The surgeon made an incision through the skin and sliced down to the bone. He clamped the bleeding vessels and sawed through the tibia and fibula. He folded the skin flaps over, sewed them together, and it was done.

But, remember now, I was holding the leg. It was no longer attached, and I didn't know what to do with it. Clearly, I hadn't thought this thing through. The enormity of what I had in my hands hit me. I was holding an amputated leg that just moments before had been part of a living human being. Dear God!

I turned to the scrub nurse beside me. She took the leg out of my hands, gave it to the circulating nurse, hooked a stool with her foot and sat me down on it. "Airman Dale," she said, "You're white as a ghost. Take a deep breath." I did, and the moment passed.

There would be many other tough moments in my time as an OR medic. But that was my first. And I will never, ever, forget it.