Thursday, April 27, 2017

You Gotta See This!!

I'm happily at work in the equipment room packaging delicate, specialty surgical instruments  for ethylene oxide gas sterilization. My grueling cases (hehe) for the day are finished and I'm just trying to make myself useful. Like a bolt out of the blue an excited colleague bursts in shouting, "Fool.. you won't believe what's going on in Room X. You just gotta see it to believe it." It takes quite an event to rile up an OR nurse to this level of excitement so here are some of my recollections of things you must see down the hall. Perhaps it would be better to unsee some of these sights, but memories have a very persistent nature.

Positioning patients for surgery was a true art form. Commercially made specialty positioning devices were not available back in the good old days. We used things like IV poles, sand bags, rolled towels, 2 inch adhesive tape, scraps of egg crate mattress and whatever else we could scrounge together. In my profile photo there is a length of friction tape draped around my neck. We used this stuff to tape just about anything to anything else - sounds nonsensical, but it's true.

You gotta see this positioning technique for a parietal crainiotomy. Patient's head is placed at the foot of OR table to avoid interference with table control devices. Left arm is allowed to dangle free to avoid pressure on ulnar nerve and allow for anesthesia access. Right arm liberally padded with eggcrate and flexed out of the way.  Pillow placed between legs making sure the Foley catheter is in a dependent position to drain and there is no scrotal entrapment (OUCH). There is an open area preserved laterally under left chest by a rectangle of folded towels to allow for pulmonary excursion and the finishing touch is added by tying this all together with 2 inch adhesive tape to confer stability.

It's a darn shame to cover this positioning capstone feat with drapes. I always tried to keep a snapshot in my mind of how the patient looked before draping. Yes, this is  someone's  mother or father and I better do my very best for him and his family.

Obese patients can require unusual positioning techniques that sometimes you just gotta see. I vividly recall one man with a massive pandus (the overhanging mass below the umbilicus) that required some out of the box thinking to position. It was necessary to elevate the pandus and there were no commercial pandus elevators available. We positioned 2 IV poles on either side of the table at the patient's waist. Next we used an IV pole top section as a crossbar. Three towel clips were placed equidistant at mid pandus. The loop handles of the towel clips were threaded over the section of IV pole that was secured in a horizontal position secured to the standing IV poles on either side of the patient.  VIOLA... a flying pandus. "You gotta see it to believe it."

Human parasitic illness is fodder for some genuine nightmares and luckily rare (for me anyway) in operating rooms. I vividly recall a "you gotta see this" episode that involved a  taeniasis or tapeworm induced appendicitis in a teenager. The worm apparently deposited eggs in the appendix occluding the lumen. As the nasty critter grew, intraluminal pressure was elevated within the appendix. I remember seeing  a spaghetti like creature wiggling out of the excised appendix. The surgeon was hollering, "Quick throw that thing in a specimen bag." The last thing I recall was hoping that the specimen bag contained the wiry little beast.

Some adventures in OR nursing seem like they would be a "You gotta see this!" episode, but sound much better than they see - if that makes sense we are probably both in trouble. I'm thinking of various objects inserted in assorted orifices for purely recreational or amusement purposes. These self-inserted intrusive objects are the fodder for a great urban legend tale such as the overtold ditty about the snake inserted to deal with the previously retained mouse. The RFBs or rectal foreign bodies might be worth a story, but not worth a look. Not much to see.

The one case of this nature that I attended to involved the surgeon gaining "purchase" on the foreign invader   - his terminology, not mine, by using suction. I bet this is the only case where a cigar was twice purchased, once in a smoke shop and once in the OR. Our most pressing dilemma was whether the cigar should be sent to pathology.

Uncontrolled hemorrhaging is something else I don't want to see. All that blood obliterates interesting anatomy and bleed-outs all look depressingly alike. One of the most pathetic, dispiriting sights seen at a bleed-out was an intervention by a nurse theoretician who happened to rotate through the OR. She was a big fan of "energy fields" whatever that is, to help patients. She aggressively made harp strumming motions around all the IVs and blood bags to impart this energy to the patient. It did not work and the patient died. I was mad as a wet hen because the nurse theoretician did not even help us in cleaning up the room. That's the least she could have done.

I always had the sneaking suspicion that some  nurses fled the clinical area and became theoreticians because they did not like to wallow in the big messes we frequently encountered. I always figured the bigger the mess, the more a patient needed my help. Diving into a big  mess and helping the patient recover was one of the most rewarding aspects of nursing. Nurse office-sitters don't know what they are missing.

Opps, I'm starting to ramble off task so it's probably time to wrap this up. As ever, I really do appreciate your readership of my overflowing font of foolishness.


  1. Ick! I'd rather clean up a Code Brown!!

  2. Your writing style is a unique combination of Sandberg and Alfred E. Newman. Keep it up!