STERILE procedure, old school

Scrubbed in or "washed" for a few cases today. Let me paint a picture of this. There are no blue shoe covers when you enter the Operating Room area (or as they call it here, the operating theatre), so we are required to REMOVE our shoes, i was wearing SANDALS! So i'm hoofing it, kind of grossed out, but slowly getting over it. given a pair of rubber flip flops to wear with my scrubs..entered the OR. Was told to scrub, looked for a scrub brush, was directed towards a bar of soap used by many, and a bottle of hand soap. After washing up, I was met by the scrub nurse, they are all referred to as "sister", all the nurses are, it's kind of endearing. She took a long pair of tongs, reached into a bucket of sterile cloth gowns, handed me it and said, use it to dry your hands then put it on. I'm still in flip flops by the way. Proceeded with the days cases just like anywhere else. One exception, there was a lot of care taken to save every piece of suture thread so as not to waste anything. The tools used by the surgeon were his own set that he kept locked up in his office, as were some of the more expensive tools, i.e. cystoscope, laporoscope, etc. The day only got more interesting with the cases I saw....

Case 1: Wilms Tumor metastasized to Liver, Spleen, Gut, Bone....no lie.
Pt was imaged with CT scan and bone scan, known mets, patient's mother wanted the surgeon to open him up and try to remove as much as possible. The boy is ten years old. His abdomen was so full of tumor that it was misshapen. Upon midline incision his insides literally busted out, tumor coming out head first. I stuck my hand into his abdominal cavity, felt tumor on his liver, felt tumor on his spleen and surrounding his gut. He was so emaciated you could actually see the mets to his frontal bone in the skull. Any part of the tumor we touched bled to high holy hell. Pt's father wanted to see him, he was brought in, and stared at his son and his busted open abdomen while he was told that if we continued there was a high chance he would bleed out and die...he asked the surgeon to put his faith in god and decide for himself what he thought was right. It was decided to close and try chemo/radiation again (although pt failed first round).And so he closed up the abdomen, using the toughest of sutures. I got to close with the superficial sutures, which is a small contribution but it felt nice to be able to do something in the OR...the great thing is that I actually remembered how to throw some knots...lucky for me because I didn't look like a complete idiot.

Case 2: Cystoscopy, pt is 5 y.o., mom complains of stool like material passing with urine, suspected fistulous tract between Urinary Tract and Rectum. Suspicion confirmed by cystoscope.

Case 3: 10 y.o. boy with extensive polyposis coli in descending colon down to anus, biopsy confirms dysplastic changes, ileoanal pull through performed...did I mention the patient is ten? Yea, crazy.