Monday, February 19, 2018

Major Operations and Thoughts and Prayers

A long, long time ago the mere mention of a major operation had genuine meaning for surgeons and nurses. It commonly referred to entering the peritoneum (abdominal cavity,) chest, or cranium. This was big time intervention and "major operation"  was a call to arms.  Hypervigilance and extra care were to be expected when it came to aseptic technique and surgical procedure.  Damp dust the overhead lights with alcohol soaked rags and be extra diligent with those hard to reach areas.  Buff those instruments to a nice shine with that trusty 4X4 during the case. Implement hypervigilance when it came time to count sponges.

"Major operation"  as a call to special action began to lose luster as more aggressive open procedures became commonplace. The term was tossed about casually and soon devolved into jocularity. Say, have you heard about Lansing Michigan? that was a major operation.  As a nurse scraped that brown crud from a coffee percolator (remember those?) someone was bound to wise crack, "That looks like a major operation." At the end of my nursing life  in the OR, the term had fallen into extinction. That was the end of the blathering about major operations.

Lately I have been thinking about all those thoughts and prayers platitudes extended to the victims of mass violence. Mass killings have been occurring with the regularity of a Circadian Cycle and the predictable avalanche of thoughts and prayers has likewise crescendoed.  Mass killings...thoughts and prayers, rinse and repeat.

I betcha God has had a bellyful of these thoughts and prayers when they become a substitute for accepting responsibility and taking meaningful preventive action.

It makes my head spin when I consider the logistics of treating so many gunshot victims. In the good old days, which in reality, were not all that good, a couple of  Chicago style gunshot wounds would upset the apple cart. Rounding up appropriate staff  at all hours and disrupting OR schedules for the next day. Thoughts and prayers has become the linguistic equal to major operation.


  1. Am careful how to comment, not wanting to attract unwanted comments to your site - but the attitude to the most recent incident in the US here in Oz has been one of everyone shrugging their shoulders and saying "there they go again". I'm forever thankful I live somewhere where apart from police, military and farmers, arms are prohibited. In years of nursing in a major city I never saw a gunshot wound.

    Car smashes however are another thing altogether - our road rage here is appalling and the number of people killed or injured in road accidents is spiralling out of control. I'm glad I'm out of the hospital system altogether now - it was a much calmer world when I worked there. Sue.

  2. I relish all comments, Sue, except perhaps the spammers attempting to sell something. This blog has never been about the transfer of funds and will never be monetized. Unfortunately, I've seen plenty of gunshot wounds that I would like to forget. I don't think all gun users realize the devastation that a projectile moving through tissue can cause and the difficulty involved in putting things back together.

    It always amazed me how benign an entrance wound could appear..almost like a little pimple. Once inside and the depth of destruction would become astonishing. Lacerated livers that challenged all attempts at hemostasis or shredded small bowel that required endless suturing to put back together. I often thought that if gun users could see and appreciate the internal damage they would be more cautious.

  3. I didn't see gunshot wounds until I moved to work in a military hospital - and they were mostly accidental ones from field practices. I still remember the senior trauma surgeon telling me he had asked the new army recruits why they had joined up knowing what danger they could be placed in, and they replied they weren't worried because if they got shot well they'd be dead.

    He said to me they'd been watching too many movies. With modern bullets they were more likely to have their bowels ripped to shreds and be incapacitated for the rest of their lives. He said they had absolutely no understanding of the reality of what guns could do to the human body.

    Mind you the military-trained nurses were fantastically efficient and their ability at rapidly triaging trauma cases had me in awe. Cheers, Sue.

  4. Old television westerns like The Rifleman perpetuated lots of gunshot wound myths. Getting the bullet removed was top priority and once that was accomplished all was allegedly well. The truth is once a projectile stops moving it's fairly benign. Repairing the damage along the bullets path was the key.

    I remember a tale from high school history class involving President Garfield's assassination. He survived the initial wound, but the surgeon's of the day had a new invention that involved magnets to locate the bullet. The good doctors made incisions wherever the locating device indicated a response. Turned out the fancy new device was responding to underlying springs in the bed and they incised him in multiple wrong sites.
    In the end sepsis proved fatal.

    1. I probably shouldn't have laughed at that story OFRN but I'm afraid I did!

      Problem is modern bullets can be designed to explode on impact into the human body into lots of tiny fragments - hence shredding your insides very nastily. Cheers, S.

  5. Yikes.. Thank heaven I never encountered one of those exploding bullet cases. However, I vividly recall a New Year's Eve celebrant that presented in the ER with his buttocks completely blown off by a 12 gauge shotgun blast. Dr. Slambow constructed a colostomy to divert stool, but the poor soul passed on after about a month after the injury.

    1. My particular interest is WW1 nursing and your unfortunate reveller's dreadful injury sounds like some that were described by nurses in the 1914-18 war as a result of mortar fire. Glad I haven't come across a case like that. S.