Monday, September 12, 2016

The Problematic Protruding Proboscis

Hair encroachment, protruding proboscis
and probable perineal fallout. Aseptic atrocities
of the highest order. Alice will be right with you.

The problem of nostrils escaping from a surgical mask was an uncommon occurrence because Alice, our beloved operating room supervisor dealt with it in a very harsh manner. The most common rationale for this practice was that it made the mask feel less occlusive for the wearer. The usual excuse for the harmlessness of this practice was "I don't breath through my nose so the practice is completely benign."

Alice had a very unique way of testing the claim of only breathing through the mouth. She would take 2 dental rolls which were dense gauze devices about the same diameter as a cigarette. Then she would instruct the careless mask wearer with the exposed nares  to tip their head back. Now for her practiced coup de grace, she deftly inserted a dental roll into each overhanging nostril. "There that should not bother you in the least since you are not breathing with your nose" Alice proclaimed.

I have been scrubbed with several residents after Alice finished her nostril occluding ministrations and it was hard to maintain a serious demeanor when you are handing surgical instruments to someone resembling a walrus. Those two dental rolls dangling from someones nostrils looked just like tusks. It did not take long for the offender to beg the circulating nurse to pull the plug on the dental rolls and cover his nose with a mask. Alice then remarked, "Some people have to learn things the hard way." The dental roll nostril plugging was most unpleasant.

Alice had the restraint and good judgment to avoid the dental roll ram - rodding procedure with attending surgeons, but all residents and nurses were fair game. Attending anesthesiologists usually got away with the exposed nostril stunt claiming, "My nose must be exposed to detect any anesthetic agent released to the ambient environment." Since old time anesthesia circuits did leak, it was a very viable excuse.  This excuse combined with a speedy dive under the ether screen  to purportedly check a line worked like magic when Alice was making rounds.

Urologists were also very fond of having nostrils overhang their mask and usually got away with the exposed nostril trick in the cysto room. The rationale used here was that an exposed nose was less likely to fog the eyepiece of the scopes. Alice rarely made rounds in the cysto rooms so this became a favorite nostril exposing zone. If a careless  urologist tried to extend the exposed nostril trick to a surgery OR, Alice would quickly pounce and volunteer to reposition their mask. If the offender was an attending, Alice would merely slide the drooping mask up. Residents were fair game for the dental roll ram-rodding procedure.

I was so paranoid and afraid of Alice that I would frequently tape my mask securely in position high  on the nose when she was on patrol. Thankfully, I was never subjected to the dental roll nostril plugging procedure. An inch of preventive tape on the nose and mask was worth a pair of patent nostrils.


  1. I did have the issue of fogging glasses when I first started wearing the masks, but my solution was to tape the mask in place (as you did) on my nose, and breathe more slowly and carefully so that the fogging didn't happen--or at least happened slower so I could still see the vitals! As a pretty junior nurse I could never do what Alice did, but boy would I have loved to ;)

  2. I am a lifelong glasses wearer too and as a novice had some issues with fogging. The tape trick does help. I hate Bovie smoke and experimented with different mask breathing patterns to minimize the impact on my sensitive nostrils. One smoke evading maneuver involved retracting my mandible and extending the upper part of my lip so it was overhanging the lower lip and mandible. I was essentially breathing the fresh air from the bottom part of the mask. A serendipity finding was that this maneuver completely eliminated the fogged glasses even if I forgot or was too lazy to apply tape across the mask top.

    Dr. Slambow used to make fun of my Bovie smoke phobia and although the mask hid my strange facial contortions it was tough to disengage my eyes from my expressions. He always said that "I've been breathing Bovie smoke long before you were even born and it does not bother me."

    Thanks so much for your comment. It makes my day to hear from you bright, young whippersnappers.