Stephen J. Birchard DVM, MS, Diplomate ACVS

Thursday, August 29, 2013

Just say "There". An irreverent look at the world of surgery.

Many years ago when I was a surgical resident my advisor, Dr. Ron Bright, taught me a very important lesson. When something goes wrong in surgery, for example you accidentally cut something you should not have, there is a proper way to respond. What you do not do is say “Whoops!”, or “Oh my god!”, or scream some unprofessional expletive. (although one of my former residents claims that the “f” word has hemostatic properties.) What you do is step back from the operating table, look at the patient, and calmly say: “There”.  In this way, you maintain a stable and professional demeanor and maintain what little respect the surgical assistants may still have for you. Saying “There” makes people think you actually meant to do whatever that stupid thing was you did. Of course, after saying “There”, particularly if there is active bleeding or other potentially catastrophic event happening, quickly step back up to the operating table and correct the problem.

Surgeons are very modest people.

In the first blog we talked about Halsted’s principles of surgery. There are a few other principles that should be recognized by all surgeons:
  • Do not cut blood vessels that have names.
  • Especially do not cut blood vessels that have short names.
  • The worst kind of bleeding is that which you can hear.
  • Gelfoam is a wonderful hemostatic agent, but it will not stop hemorrhage from the aorta.
  • All bleeding eventually stops.
  • The incision heals from side to side, not end to end. (courtesy of Dr. George Wilson)
  • Do not use retractors that are bigger than the patient. (see Figure 1)
  • The only surgeons who do not have complications are those who are dead.
  • The surgeon is allowed to sing in the operating room.
  • Most surgery is to remove an SBI (“something bad inside”).
  • Pour sugar into an open wound, but not salt.
  • Do not cut something unless you know what it is.
  • When operating on a chicken around lunchtime, do not use electrocautery to control bleeding in muscle tissue.

Figure 1: This chihuahua and this Balfour retractor do not make a good match.


  1. not that I really needed any reminding because I quote often your dont cut a vessel with a short name quote, but this reminds me of how much I miss your class Dr. Birchard! If you had stayed at OSU everyone would have wanted to go into a surgery residency. I hope your still playing the danger zone in your OR.

  2. You taught us that in vet school and I still do it! Though I remember you saying "there it is." I usually put my finger on it to stop it - calm myself, say your saying and move forward;) Great advise!

  3. Gosh I still remember all of these to this day!!! You were the best teacher!! My assistants look at me weird when I shout "There" in the surgery room!