Cut - but where?

The junior community in surgical lines has a word to describe operative work - "cutting". It means the process of operating. It has to do with the process of using scalpel and scissors. Sadly it implies that they are concerned with the technical process of operating experience, rather than treating a patient who is a live human being. Sadly it also implies that they want to cut, not suture, or rather cut, not heal. That is life! That day I was assisting my Registrar perform a vaginal hysterectomy. She was to go on exam leave soon after. That meant she was as good as a consultant, should she pass that final exam. She had clamped, cut and ligated both of the uterosacral-cardinal ligament complexes. While I was telling the nurse about some suture material we would require next, she applied her clamp to the uterine vessels on the left side, cut and ligated them. Then I realized she had taken the previous uterosacral pedicle along with it. The stump was attached to the uterus, with its holding polyglactin 910 thread hanging from it. There was nothing on the lateral wall where the pedicle should have been. I was stumped. I had never seen anything like that before. I kept a cool head because that is what being a head of unit is about. I asked her to proceed with the operation, planning to put a figure-of-eight suture on the raw area later. She clamped, cut, and ligated the other side uterine vessels satisfactorily and clamped the left side cornual structures. To my amazement, she proceeded to cut it lateral to the clamp. I stopped her just in time. Within a matter of five minutes, she was committing another grave error, not realizing that it would defeat the purpose of the clamp which was to prevent the cut vessels from bleeding until they were tied. That patient did well postoperatively and went home fine. I recall assisting my houseman similarly, when I was a Registrar. I was actually supervising another resident on the other table at the same time, giving advice as asked. While I was looking the other way, this houseman started cutting the left cornual pedicle that he had clamped while I had been watching him. When I turned my attention to him again, I found him starting to cut the pedicle lateral to the clamp. I stopped him just in time. That patient also did well postoperatively. This fellow is in USA somewhere practicing obstetrics gynecology. One can draw many conclusions from all this. 1. They tend to commit this mistake on the left side. 2. They do things mechanically without knowing why they do it, and that leads to mistakes. 3. Perhaps they take such people in the USA, where they do well. This last conclusion will be valid if my current Registrar goes to USA.