New Years crashes sometimes resulted in torn aortas. Dr. Slambow
explains and acts out the mechanism.
When one year dissolves into the next, I often lapse into some serious retrospection of New Year's Days past. It's not the big time lifesaving trauma surgeries (I hate that all too common lifesaving balderdash. It's like a literate canker sore that shows up conjoined to it's favorite twin, trauma surgery.) No, it's not those bigtime dramatic measures. It's the feckless and stupid little frivolities that come to mind like the way ratcheted instruments so neatly clicked in your hand or the way overhead lights glimmered and danced off a freshly prepped surgical site or being called in to work with my all time favorite surgeon, Dr. Slambow. I really miss him.
I've never been one to celebrate on New Year's Eve. Maybe it has to do with the fact that every one of these occasions resulted in a trauma call when I was on duty. I remember a variety of injuries; beer bottle broken over victims head and then stabbed with the left over glass shards, a young man that sustained a 12 gauge shotgun blast to his butt (not a good way to lose 20 pounds,) and of course the usual automobile wrecks on Lake Shore Drive with the victim sustaining an aortic tear that usually resulted in the poor souls rapid demise.
One long night scrubbed with Dr. Slambow, I began asking questions as they popped into my young foolish, but curious brain, "Why do automobile mishaps cause torn aortas?" Dr. Slambow's eyes lit up like a New Year's Eve fire cracker and I knew I was in for a rare treat- the good doctor was going to act out his answerer. I could not wait.
He asked for a bloody 4X4 to use as a prop and as soon as I tossed down a needle holder that had been in play and fished around for the requested blood soaked sponge it was show time. Just as I expected, the rolled up sponge was going to play the part of the aorta and Dr. Slambow's partially closed fist was going to be a stand in for the chest cavity. This was going to be as good as his lecture on Sengstagen/Blakemore tubes when he inflated a used surgical glove (size 8) that was partially filled with blood until the thumb portion of the glove exploded creating a colorful scene. The mess he created rivaled that of the grandma wrecked on the Harley case we had last month. What a mess.
Dr. Slambow explained in his deliberate, eloquent tones that the great vessels in the chest were not tethered to anything and could rock back and forth in the mediastinum like a pendulum. He almost teeter- tottered of his booster stand as he rocked back and forth. Coleen, the circulating nurse was standing nearby to catch him in the event of a backward fall. OR nurses are taught to always anticipate the surgeon's action and we knew Dr. Slambow and his antics all too well.
The good Dr. made a partially closed fist and suspended the twisted sponge between his index finger and thumb so that it resembled the tubular aorta hanging freely within the confines of his partially opened fist model of the chest. His next move was to make a punching motion with his fist just inches from my masked proboscis and suddenly arresting it's movement just before impact with one of the overhead lights. "There you have the mechanism of a torn aorta-the movement of the patients chest is suddenly stopped by impacting the steering column, but the heart is still moving forward a 65 MPH. The shear force tears the aorta."
Thanks for enlightening us Dr. Slambow, maybe next time you could explain why ostomy patients have so much trouble with excess gas. On second thought-never mind.