Lessons from the Operating Room

January 17, 2023

by Tom Console

The operating room has a habit of magnifying everything. All scrubbed up and ready for surgery, the leadership lessons of detailed planning, decisive action, and teamwork really hit home for me.  

This past September, as a part of my Veterinary school curriculum, I was able to perform an elective surgery on a dog. Third-year students were broken into teams, with two students acting as both the primary and assisting surgeon, alternating roles throughout the surgery and performing either a spay or neuter under the guidance of a board-certified Veterinary surgeon. 

Obviously, I’m still an incredibly novice surgeon with a lot of learning left to do. However, in my time as a football player, coach, and Army Officer, I’ve learned a great deal about the principles of leadership, particularly in stressful, high-pressure situations. This surgery opportunity allowed me to view some core leadership lessons from a different perspective. 

“Plans Are Worthless, But Planning Is Everything“

Students of history may recognize this quote from General Dwight D. Eisenhower. While apparently contradictory, it is incredibly accurate when describing the preparation a leader must take. 

For our surgeries, we had to prepare to both neuter and spay a dog. We wouldn’t know until the day before our surgery whether we were getting a male or female, and so we had to learn how to properly perform two different surgical procedures. 

The approach my group took was very similar to how planning a mission is approached in the Army: identify the “Most Likely” and the “Most Dangerous” courses of action. In the Army, we plan for what we’ll probably see, and then what the worst-case scenario might be. 

In this surgical exercise, the neuter was the most likely, and the spay was the most dangerous. A spay is a more invasive procedure because it requires an intra-abdominal approach, increasing the chances for damage to surrounding anatomical structures (mainly major blood vessels). There are more steps involved, and it requires more practice. The stakes and pressure are higher. The neuter is much easier and common. 

For someone doing their very first surgery, this can be pretty nerve-wracking. So, we decided to split our prep time up. We spent about 30% of our study learning how to perform the neuter, and we spent the remaining 70% understanding how to perform the spay. 

In this way, we prepared for both the Most Likely and the Most Dangerous courses of action and felt extremely prepared going into our surgeries. 

Act Decisively

Well, it was the most dangerous. Either way, leaders need a solid plan going into any situation and confidence in their knowledge and skills to act decisively.

In our prep, we relentlessly practiced suture techniques, talked through each step of the spay (back-brief for military personnel), reviewed the surgical instruments, and studied the blood vessels, nerves, and other anatomical features. All these items together ensured we didn’t start our surgical experience off by cutting something we weren’t supposed to, and this approach allowed us novice surgeons to begin to grow in our Confidence by building a strong foundation of Knowledge (see my previous article).

This preparation would prove incredibly important during the spay. Too much force while locating the ovary can rupture adjacent vessels and cause a major bleed. 

This is exactly what happened. I used more force than necessary and ruptured both the ligament and the blood vessels. The overseeing surgeon was right next to me, and I’ll never forget the surgeon saying, “Well that’s not good,” and the immediate feeling of my heart sinking. 

But thanks to our prep, my partner acted decisively, and by the time the surgeon had stepped in to take over, my partner had already grabbed another set of forceps to clamp down on the vessel and stop the bleeding. Quick thinking, extensive preparation, and inherent knowledge helped keep a bad situation from turning into a potentially disastrous one.

Acting decisively is critical.  

There is No Such Thing as a Solo Achievement

Finally, people like to be acknowledged for their hard work, and you really can’t blame them. Talking from my experience, veterinary school is hard, and sometimes a little recognition for all your good grades, achievements, and perseverance is motivation you to keep going. 

However, it’s vitally important for a leader to understand and acknowledge that absolutely nothing is accomplished alone. Everyone has some sort of support system. I know for a fact that I could not have performed well on my surgery if it wasn’t for an outstanding and brilliant assistant surgeon and a phenomenal and encouraging anesthesia team. 

If I am being completely honest, I don’t think I could get through vet school at all without my friends, family, and loved ones. I firmly believe that you must acknowledge, loudly and frequently, how much you appreciate the people who help you. The support I receive, both academically and personally, is truly remarkable. 

It helps when the people you work with are also truly close friends of yours (and smarter than you as well). Remind yourself that it is okay accept help. Lean on your people when you need them and allow them to lean on you when they need it. Reciprocate the love you receive. And always remember that no matter how great the accomplishment may be, nothing is done alone, and you have an obligation to thank those that have supported you. 

Lessons from the OR

Every time I go into surgery, I learn something new. This time it was how a team of students who work together, support each other, prepare, and rehearse, is ready to tackle any problem they face.   

Tom Console is a Second Lieutenant in the United States Army and the recipient of the Army Health Professions Scholarship Program. In this program, he is a third-year student currently earning his Doctorate degree at the University of Pennsylvania School of Veterinary Medicine, Class of 2024. He intends to work with Military Working Dogs and pets of Military families upon graduation as an Army Veterinary Corps Officer. He is also a student of leadership and a two-time author to The Maximum Standard.

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The views expressed are those of the author and do not reflect the official policy or position of the U.S. Army, Department of Defense, or the U.S. Government.