Fainting in the OR

"We cannot change anything until we accept it. Condemnation does not liberate, it oppresses." - Carl Jung

"I can't believe this is happening again," I thought to myself in a slight panic as I felt the blood leaving my brain and pooling in my legs.

My heart rate accelerated as my heart attempted to pump against the systemic vasodilatory effects of the vasovagal response. Despite the OR being maintained at a crisp 62 degrees Fahrenheit, I could feel myself sweating through the multiple layers of my surgical outfit.

"I think I'm going to faint," I managed to say.

This was my experience during my OB/GYN rotation during my third month of MS3. Unfortunately, I could not stand through a single C-section without feeling presyncope sensations. Although, I never fully fainted – I always said something before losing all control – I still felt extremely embarrassed.

How are you going to be a doctor if you fail to stand through surgery?

This was a common question asked after I shared my story, if I even felt comfortable enough to do so in the first place. The truth is, I was so embarrassed that I rarely ever told anyone about my vasovagal episodes. Even though the nurses and scrub techs would tell me that this happened all the time, I couldn’t believe it. Or at least, I couldn’t believe that it was happening to me.

The strange thing about it was that it wasn't the sight of blood that caused me to faint. I can draw a patient’s blood without any issues at all. But there was something about scrubbing into the OR that got the better of me. I found myself fearing the OR.

My mom is a psychotherapist. I tried talking through my thoughts and emotions with her. I tried meditating, daily self-check-ins, squeezing my glutes when I felt the blood leave my brain, but none of it seemed to work.

Over the next six months leading up to my General Surgery rotation, my wife would ask me, “What are you going to do when you get to Gen Surg?”

“I don’t know,” I’d reply. Truthfully, I had no idea how to make it stop.

On my first day of my Gen Surg rotation, I was terrified. I couldn't stop ruminating on the fear of fainting in surgery. Intellectually, I knew that this was only making things worse, which only frustrated me further.

I met with Dr. G, an Orthopedic Surgeon, who I was scheduled to go into surgery with that morning. I told him that I was very nervous.

"It's okay," he told me. "I'm not going to ask you to do anything. Just watch."

"Okay, sounds good," I said, thinking that it wouldn’t make a difference to me anyway.

I scrubbed in with the scrub tech’s help. He was patient with me as I gingerly tried to guide my sweaty hands into the sterile gloves and do that silly spin to tie my gown without contaminating the sterile field.

I stood next to the patient already prepped on the OR table. The only thing I could see was her knee, an unnatural orange color from the betadine prep, poking out from a hole in the sterile blue sheets that covered the rest of her body.

As the nurse read the time-out script I lost myself in thought as I imagined the gruesome medical carpentry about to take place in front of me. Then, I began to notice that tingly feeling in my head and fingers.

"Please, God, don't let me faint," I pleaded silently.

I turned to Dr. G and said, "If I need to faint, can I just step back?"

"Yeah, no problem. It's not a big deal. Just step away if you need to and come back when you're ready," he said.

Incredibly, the tingly sensation began to fade. A few minutes later, it passed entirely. I soon found myself standing next to Dr. G as he cut his way through the patient’s knee, gearing up to saw it off and replace it with a new titanium prosthesis.

As he progressed through the procedure, I would ask Dr. G if I could stand a little closer. He noticed my interest and gradually gave me more and more responsibilities, like holding tools (you know, med student stuff). At one point, I even hammered one of the nails. And I did it all without having leave the OR to gather myself!

I left that surgery with a newfound confidence that carried on throughout my Gen Surg rotation. After that experience, I was able to attend multiple surgeries a day without even the slightest feeling of having to faint.

I was battling with this syncope problem for nearly all of MS3. I drafted this essay for myself about 7 months ago, but didn’t have the courage to publish it until now.

When I tell this story to others, many people have their own opinion on what it was that made me feel faint, but I am still not certain why it was happening. I think that it was a combination of things mostly related to a lack of self-confidence, intimidation of the OR and surgeons, and fear — fear of failure, fear of being a bad medical student, fear that I’m not good enough. I associated the presyncope feelings with negative perceptions of myself, resulting in a feedback loop that was difficult to stop.

When Dr. G, a successful surgeon, told me that it was not a big deal to feel faint, and that I had his permission to step away from the table and return when I was ready, it somehow disrupted that vicious cycle of negative thoughts. There was no longer anything wrong with feeling faint. The negative self-talk suddenly had no legs to stand on. The shame evaporated.

With my new-found confidence I was more comfortable sharing my experiences with my peers in school. To my surprise, when I opened up to others, some shared that they had similar experiences with fainting. Some even shared episodes of panic attacks. Not only medical students, but residents and physicians, too.

This story serves as a reminder to me of the power of the mind and our thoughts. What we believe about ourselves can not only influence our perceptions of the world around us, but it can also affect our physiology.

Having peers and colleagues who support you can be life changing. Dr G’s empathy and kindness to me fundamentally altered my medical experience for the better. He probably doesn’t even think twice about his actions, as it comes naturally to him. In just a few short months I will be a resident physician working in the hospital. I hope to emulate Dr G’s compassion and carry it with me throughout my medical training, using it to support both my patients and my colleagues.