I'd like to teach the OR to sing

Dr. A, the chief of pediatric surgery, was pimping in the operating room again. I had been on his service for about a week and had heard about his mercurial mood swings. "Don't be freaked out if he starts swearing at you in the OR," my senior resident told me. I had heard him belittle my senior several times in his Long Island accent, "What the hell do you think you're doing, you moron?"

Dr. A's head was shaved but he wore a sterile cap as a formality. He was over six feet tall and I needed two stepstools to awkwardly reach the table he had raised to his working level. Silently, I started organizing the multitude of cords and equipment needed for the laparascopic appendectomy. "Have you done one of these before," he barked.

"Um, only seen one, sir. On an adult."

He sighed dramatically. I stayed quiet and under the radar for most of the rest of the operation, except for the occasional chastened "yes, sir." We were almost ready to take the ports out, examining the patient's abdomen for bleeding, when Dr. A's booming voice asked,

"Okay, Ilene, what's this?"

I stared at the video screen, my mind a blank. What did he mean? What was he pointing at? All I could see was abdominal wall.

"Uhh..."

"Oh, come on." The contempt was thick in his voice. "Do you know?" He asked, turning to the anesthesiologist. My ears burned. The shame of it, to have him turn to anesthesiology for the answer to a question that his own resident couldn't answer.

"It's Bon Jovi, isn't it? Garageland."

"Yessssss!" Dr. A steps back from the table, punctuating his exclamation with a gloved jab. "Exactly."

And once again I had to smile at how seriously surgeons take their operating music.

* * *

Some surgeons refuse to operate with music at all, saying that it distracts them from the task at hand. Others refuse to operate without any music; before iPods and online radios, some departments in my medical school had special OR boomboxes, labeled with the brightly colored tape used to differentiate anaesthetic medications. A thick binder of CDs was stored in one of the room's locked cabinets, next to the antibiotics and sterile gloves.

Often than not the DJ is the circulating nurse, who isn't "scrubbed in" or sterile, though one day our scrub nurse took a short break from the case and disvested himself of his gown and gloves so he could run out and get his MP3 player for our listening pleasure.

In the operating room, though, the attending surgeon is the autocrat.

Dr. G at the county hospital takes umbrage at the radio music piped in over the PA system, and states out loud, "I only listen to classic rock or Bach. No KFOG here." Another surgeon in his fifties, who emigrated from Hong Kong about a decade ago, listens only to rap music during his six hour long liver resections. My fondest memory of my clinical rotations was watching a 12 hour case with Dr. H, an ear, nose and throat surgeon who waltzed with his first assistant, crooning to Frank Sinatra, while we were waiting for pathology.

Some people worry that music in the operating room distracts people, and I've definitely seen some scrub nurses and techs laughing or singing along to pop songs when they should be paying attention to the case. But from the surgeon's point of view, the music is truly background noise. I've experienced myself how noiseless a room gets when I'm concentrating on sewing. A fire alarm or bomb warning could be going off without my noticing while I'm trying to stop a bleeder.

Listening to music breaks the monotony that can sometimes overcome even the most complicated procedure - every operation has a routine component where ones' mind can wander. Furthermore, even the softest ditty can lighten the mood over the table to the point where people remain loose, happy and alert.

The most malignant atmosphere I have ever experienced during an operation was in a musically barren room. Everyone was on edge, from the attending - who threw equipment and berated my resident, to the scrub nurses - who snapped at me when I asked for suture scissors. The circulating nurse, when answering pages, spoke in hushed tones to avoid drawing attention or wrath.

Near the end of the case, the attending scrubbed out to go speak with the family and everyone breathed out, slowly. "What did I do to deserve this," asked my resident. "Can we turn on some music?"

And with lifted spirits, we started closing to the strains of ABBA.