When the urologist is starting the vasectomy on James, and his assistant comes in to bug James about his parking and offers to move his car, instead of the assistant retrieving the keys the doctor does. This is despite that he is already wearing the medical gloves for the medical procedure he was starting. This would not be sterile or medically acceptable, and he doesn't change gloves to resume the procedure. He should have let the assistant do it herself, there is no reason he needed to or should have gotten the keys himself.