Am I Too Slow?

Cut to the Chase: General Surgery Survival Series — Post 11

It's the third throw, and the room changes before anyone speaks. Not loudly. You hear the circulator on the phone — "I don't know. We just started the anastomosis." Someone shifts their weight and a Calzuro clicks against the floor.

Your second hand was supposed to come up by now. Instead it hovers, deciding. In that two-second pause where nothing is happening, you can already feel the sentence forming somewhere above the drape.

"Let me just do it."

You walked into the case worried about being slow. You should have been worried about something else.

The room is not measuring you in seconds. It is measuring whether each motion looked like it knew where it was going before it left.

The instinct, when you feel slow, is to speed up. So you snatch at the suture, drive your hands harder, race through throws you haven't actually learned. It doesn't work.

Speed isn't something you can do on purpose. The senior across the table isn't moving faster than you. They're making fewer movements. You make fourteen motions where they make four. Reach, reposition, re-grip, reload, glance up, adjust, try again. Each one takes about as long as theirs. You just have ten more of them.

The fix is not faster hands. The fix is fewer hand movements.

Pearl: The senior isn't quicker than you. Their hand moves three times before yours moves once because they already know where the third motion lands.

The other thief is hesitation mid-motion. You start to reach, then pull back, then reach again. You load the needle, decide it's not quite right, unload, reload. You begin tying a throw, then let go halfway through and start it over.

None of those is slow on its own. Each one costs you half a second. But you do twenty of them across a closure, and the case stretches ten extra minutes for no real reason.

And here's the part that matters. That pattern doesn't read as slow to the people across the field. It reads as unsure. The attending isn't bothered by a slow trainee. The attending is bothered by a hand they can't predict. A confident slow motion is invisible. A tentative fast one is exhausting to watch.

Pearl: Eight seconds of confident motion reads faster to the room than fourteen seconds of hurry. Hurry is not the same as hustle.

Here's what's actually happening when you feel slow. You are doing two jobs at once. You're executing the motion, and you're monitoring yourself for signs that the motion is wrong. That second job is eating the brainpower you need for the first one. The self-surveillance is the bottleneck. The hands aren't.

Under real pressure, your internal clock runs about three times faster than the wall clock. A five-minute anastomosis turns into fifteen minutes of painful internal debate over which layer is the strength layer. When you feel slow, you are almost always less slow than you think. And when you try to compensate, your shoulders come up, your breath gets shallower, and your sutures get sloppy. Panic costs precision. That's not a metaphor. It is a fact about hands under stress.

Slow and stuck are not the same thing. Slow means deliberate progression. Stuck means you've stopped because you don't know what comes next. Slow is expected at your level. Stuck is a teaching moment. And if you're stuck, say so. "I want to make sure I'm in the right plane before I go further" is exactly what a safe surgeon sounds like. What actually wears on experienced surgeons is not slow hands. It is hands that won't commit.

One more thing about that silence. Most of the time it isn't disappointment. The attending you think is running a stopwatch on your knot is usually thinking about the next step, which happens to look like waiting for you. When time is genuinely tight, they take back the field. They will tell you.

I watched a third-year once. Sharp, careful, wanted to do well. She froze at the field for about four seconds after a stitch because she was certain the attending was about to take back the instrument. He wasn't. He was looking at the monitor.

A surgeon thinking, a surgeon judging, and a surgeon needing a sandwich all look identical. There's no fix for that.

She handed the needle driver back anyway, preemptively, to get ahead of what she thought was coming. He looked mildly confused. She spent the rest of the case kicking herself for a rep she didn't have to surrender.

Don't hand it back early. Take the rep.

Pearl: Giving up the instrument before you're asked isn't humility. It's self-interruption. Finish the step.

The trainees who eventually get quick are the ones who stop trying to be. They commit to the motion. They let the room wait the extra half-second. I've watched a lot of people come through, and the ones who got fast weren't the ones who wanted it most urgently. They were the ones who stayed patient long enough for the work to compound.

You will get there. Not by deciding to. By showing up and doing the next rep correctly.

Nobody in that room expects you to be fast. They expect you to keep showing up and to keep getting smoother. That part is on you, and it's enough. One thing I remember learning is to tie with my left hand so the needle driver never leaves my right hand. This save putting down and picking up of the needle driver.

Pearl: The reps that build your speed don't happen during the case. They happen on your couch the night before, and the night before that.

The day someone tells you the case is closed already, and you hadn't noticed — that's the day speed arrived.

You didn't chase it down. It walked in behind you while you were busy doing the work.

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What to Read Next: Post 12 — Drains, Tubes, and Lines. The OR section ends here. From here on we shift to what happens after the patient wakes up — the things hanging off them, what each one is doing, and why the tubes and lines you barely noticed during the case portend outcomes more often than the operation itself does.