Saturday, September 2, 2017

PAIN (Purposeful Affliction Isn't Nice)

Nursing presents the practitioner with an assortment of mind boggling difficult and unpleasant (to say the least) circumstances. Putrid and pungent odors, horrific sights of blood and gore along with unimaginable suffering. Every nurse has an Achille's Heal of a hospital situation that brings forth light headedness, tears and a cold sweat.  For some it was blood and or trauma, Bovie smoke got to others, and odors elicited a vaso vagal response in many.

My weak spot was seeing patients in pain, all pain was blood curdling to my soul, but the inadvertently inflicted avoidable pain was what really what got caught in my craw. Needless suffering was the  stuff of real nightmares for me. So in a lame attempt to unburden my tortured soul here is a laundry list of completely avoidable painful events I witnessed over the years. When I have trouble coming up with a coherent post on a single subject, laundry lists are my best friend.

This one really rankles my hackles and I always tried to put a halt to it when I was a circulating nurse in the OR. Eager beaver, out to impress, surgical residents sometimes jump the gun with inserting Foleys or starting lines before the patient is anesthetized. "Whoa not so fast, Dr. Speedy, how would you like that done while you are awake?" usually put a halt to the proceedings.  Keeping Foley trays and other pre anesthesia induction paraphernalia out of sight until the patient was asleep was another effective tactic.

Last minute pre-op exams involving probing wounds or orifices could be stoped dead in their tracks by a good hard smack to the back of the hand with a sponge ring forceps. I never had the temerity to do this, but Alice my beloved supervisor was an equal opportunity sponge stick smacker. Anyone committing a wrongful act was fair game for aching knuckles. A crude but very effective deterrent that I have personally experienced. OUCH!

Hair follicles share the same neighborhood as sensory nerve endings so extricating hair really does smart, a fact some girls know all too well. My usual place to hang out in nursing school was in the lobby right next to the elevator. Occasionally nursing school stressors promoted disagreements among students which then led to hair-pulling donnybrooks. Standard procedure involved forcing the combatants into the elevator and hitting the down button for student nurse Fool to break up by squeezing the hand of the aggressor. I never knew what to expect when that elevator door opened but screams emanating from the elevator shaft was never a good sign.  Somehow I was able to peacefully resolve the altercations, but the clumps of hair on the elevator floor always  turned my stomach.

Every nurse is well versed in the inexcusable pain inflicted by aggressive adhesive tape removal. Kind hearted nurses knew that moistening the adhesive/skin interface zone with acetone helped minimize the hair pulling. Whether to remove adhesive tape slowly or rapidly was a hotly debated topic  in nursing school. I always thought that giving the patient a choice was best and if they expressed a desire self removal, let them have a go at it. At least I was not the culprit inflicting pain.

Here is an unusual and little known unjustifiable hair pulling event that can occur in a very sensitive anatomical site. Pelvic exams place the patient in a vulnerable position and novice physicians have been known to entangle and twist pubic hairs out with those old metal speculums adjusted with set screws. The hair gets caught in the inclined plane of the set screw and subsequent  adjustment yanks pubic hair out lickety-split. One of the reasons nurses were taught to always carry scissors was to cut free entangled hair.

Of all the surgical instruments, it's not those ghastly saws or chisels on  top 10 lists that elicit revulsion in any sentient being - my vote goes to misused towel clips.. These innocent looking devices have two very sharp points that can be engaged by opening and closing the clip like a scissors. They were designed to securely attach towels to each other while draping. The practice of surgeons affixing towels directly  to patients skin  was history, but anesthetists found a use for towel clips that was unsavory at best.
Towel clips are for towels - not patients skin

The tips of the towel clip were engaged  in the patient's skin at various levels to gauge the level of spinal anesthesia. When the patient screamed it was obviously  the limit of the spinal's effectiveness.   There were few of these towel clip wielding anesthetists, but just one is far too many.

Although never witnessed, I have heard horror stories of old time OB practitioners engaging the points of towel clips in a patient's hip to test their saddle block causing new mothers to wonder what demented doctor depredated derieres -  developing devious deep puncture wounds (please excuse the alliteration, it's one of my very bad habits.)

Surgeons from my generation simply loved silk sutures and some even proudly bragged about being a "silk man." Surgical knots never slipped on silk sutures and they never assumed a coiled or unwieldy shape. The nature of these suture's surface was akin to a lattice-like structure owing to the fact they were braided from many fine silk strands. As tissue healed, it became enmeshed in these tiny lattice spaces. Removing silk skin sutures was like trying to pull a bone from a dog's mouth - lots of resistance and growling.

Surgical staple clips put an end to the misery of silk  suture removal but many older surgeons wanted to remain loyal to the history of surgery and refused to accept them. Previous surgeries could be easily identified by the archaeologic artifacts  left behind by black silk sutures. They were highly visible and always a sure sign that man had been in this wound before.

I'm getting off track so it must be time to wrap this post up but minimizing discomfort or aiding a patient in pain is something a nurse can do to minimize hopelessness and promote healing and recovery. A trauma patient will never notice how carefully a scrub nurse cuts ligatures but will always remember if they were patient and caring when transferring them from a Gurney to the table.


  1. Ohhh...flashbacks to being a much younger whippersnapperrn.being the diligent professional RN , I had postpartum patient turn to the side so that I could examine perineum. I have limited OR experience beyond circulating and rarely scrubbing in on c-sections. After vag deliveries, OB’s always asked for chromic or vicryl.. So that’s why suture approximating epis was black

  2. I had zero experience in OB, but always greatly admired OB nurses. My friend, Sheila, could always locate the urethra-no matter how distorted the anatomy was by pregnancy. Amazing!