Monday, January 28, 2019

The Smoking Finger

No, I don't have one of those fancy new fangled phones
that take photos, so I put what's left of my index finger in the scanner.
Surgeons and nurses toiling in an operating room become habituated to a very controlled environment where everything from lighting to air quality is subject to rigid regimentation. Unpredictable events throw a monkey wrench in the midst of this enforced order, often times, leading to a cascade of adverse events  which can result in personal  injury to staff.

Voice modulation morphs into a surgeons unduly harsh verbal  admonishment of the offending party. Harried nurses, desperate for a resolution to the problem throw caution to the wind and find themselves in a precarious situation while attempting to solve the problem. Desperation seldom leads to reasoned thinking. The ensuing pandemonium is enough to flummox a pope.

Operating rooms can be dangerous places. Surgeons waiting for someone to fall asleep before cutting them might, at face value, seem unsavory, but the notion of live by the sword; die by the sword holds true in the OR.  Those sharpened chunks of stainless steel do not discriminate when inflicting their trauma and Bovies don't care what  tissue they roast.

 As a circulating nurse I was known for constructing elaborate platforms for height challenged scrub nurses. My colleague, Janess, loved my elevation tactics and was so enamored with one of my creations she failed to notice an unusually low hanging overhead light. As she emergently  ascended my stairway to operating room heaven for an urgent trauma case,  the crown of her head struck the low hanging illuminary with a sickening THUD..CRASH. After finishing the case, a close inspection of her cranial vertex revealed a hematoma the size of the distal end of a Babcock. After a quick neuro check and 15 minutes with an ice pack she was back on duty. I've witnessed several intraoperative injuries to staff and not a single nurse or surgeon broke scrub, no matter the extent of the injury.

Karma can be a cruel mistress and I soon received my payback for contributing to Janess's unfortunate mishap. I was finishing up a case with Dr. Oddo that entailed resecting a menengioma. These tumors are outside the brain and with removal have an excellent prognosis. I was in a great mood thinking about how we were actually being  of some service to the poor soul suffering from this nasty,  neoplastic malady. One thing I've learned over the years is to be wary of those euphoric Kumbaya moments when everything seems to fall in place because a true shitstorm is often in the works.

Dr. Oddo had been using a foot pedal actuated Mallis bipolar cautery during the case. This nifty little device looks like a pair of tweezers with an electric cord attached to a high voltage generator. When Dr. Oddo tramped on his foot pedal electricity flowed between the tips of the tweezer like device cauterizing anything in between. It was a great little gadget for controlling bleeding in small vessels.

Dr. Oddo loved to instruct the anesthetist to lighten the anesthesia near the end of a case. One  of his favorite phrases in the post-op report was, "The patient was able to transfer from the OR table to the awaiting carriage independently." This sometimes made for exciting moments near the end of surgeries when the patient took ambulatory surgery to a new level and decided to bail out before the final skin sutures were in place.

Sure enough, just as Dr. Oddo started closing the skin flap the patient began to emerge from general anesthesia. As he came to, his right leg spasmed into a mighty lateral kicking motion impacting Dr. Oddo's leg poised with his foot just above the Bovie actuating pedal. I was tidying up by clearing off the operative field and was preparing to wipe down the distal, business end of the Bovie forceps. The patients kick to the good doctor's leg turned the Bovie forceps ON and as the juice flowed a sickening burnt flesh/charred rubber glove malodorous scent filled the air.

The Bovie had cooked my right index finger on the distal phalange. As the smoke cleared I requested a new glove and plunged  what was left of  my smoking finger into a fresh sterile barrier. There must be some truth to the notion the body releases pain killers when traumatized because initially I was pain free. Upon finishing the case and pealing off the second glove the extent of the injury became apparent. The end of my finger had extensive "remodeling" with the distal aspect about 1/3 AWOL.

Dr. Oddo helped me remove the melted latex glove from the wound and suggested wrapping the finger with iodoform gauze. Dr. Slambow was consulted and said "welcome to the club" while showing off a massive scar on his right palm. After about 4 weeks, it was time for the unveiling. Dr. Oddo involved himself in a spirited debate with Dr. Slambow questioning whether  the nasty blackish tissue around the wound was eschar or scar tissue.

After the unveiling and the scar/eschar mess was pealed off I had a functional but rather disfigured index finger with a square tip and missing 1/2 the nail. I never missed a day of work and today I regard what's left of the end of that finger as a badge of honor. It's better than thinking of it as a living monument to my foolishness.


  1. Owie!! In today's world that might be a work comp early retirement, "I'll never play the violin again!" kind of lawsuit. Times have changed since those days of grin and bear it.

  2. Jono, yessiree those were the days without pesky lawsuits and greedy lawyers. We never heard of medical malpractice or workman's comp back in the day. It was definitely a different world where your self worth had nothing to do with how much money you had.

  3. I had a chuckle reading through that OFRN! And you're right, medical negligence claims were unheard of, and when I went for my interview for admission to the School of Nursing I was told "you work for a hospital for the honour of it, not the money". Which was oh so true as the nurses' pay was pitiful... but imagine being told that now!

    1. PS: I'm glad Janess was OK I rather like her. S.

  4. Sue, how true, nursing in of itself was supposed to be reward enough. We were not even permitted to have money as students; that was grounds for dismissal. Of course the school provided for our every need from books, to meals and housing. It's tough to be critical of today's whippersnapperns being so money oriented when they have hefty school loans hanging over their heads. It really is a different world today.

  5. Hi OFRN I don't think our study costs here are anywhere near as high as in the USA - I don't know the current cost of becoming an RN, I think between 30 to 50 thousand dollars (Aus) perhaps but this is paid off slowly as you reach a certain income.

    Our local veterinary surgeon here is a young American lass from Pennsylvania and when she told me her college fees for doing her Vet Science degree I nearly fell over with shock.

    But yes, the students aren't given accommodation, meals and uniforms like we were, and travel is another problem (we only had to walk from the nurses' home to the wards, no driving or need to use public transport to get to and from shifts). We didn't need a lot of cash as meals, accommodation (a small cost taken out of our wages) and uniforms were supplied - and uniforms were washed and ironed by the laundry staff, we only had to make up our caps! And yes, we finished our training owing no money.

    All in all I think we had it better back then! Sue

  6. Thanks for your comments, Sue. I had a post on May 31, 2015 "What was the tuition for a three year diploma nursing program in 1970," that delineated the cost involved. If you type "diploma school" in the search box it should pop up. I had trouble with the link. The picture with the post shows me with an unusually full head of hair with Janess just visible over the top of my head. We somehow always wound up in the same clinical group and she was almost always one step ahead of me. We had procedure check off lists that had to be completed on each rotation. Her eager beaver attitude got her in trouble once for celebrating completion of post mortem care before me. The instructor did not think caring for the deceased was a cause for celebration.

  7. So what approximately would the cost be now OFRN - say to become an RN in the USA - what amount of tuition costs would you owe on completion?

    We actually paid nothing except the cost of our textbooks and a small weekly accommodation cost that included meals, laundry done, snacks (we were always provided with cake in the evenings, the carbohydrate was supposed to boost our energy) and yes we had a swimming pool & tennis court.

    I was interested that you were warned not to mention pay at your interview - I was pre-warned that Matron's first question was always "What does your father do for a living?" (And indeed it was her first question to me!) I'm afraid I attended a "swank" school of nursing and your father's profession was actually considered important! I'm horrified at that now. My father was in a senior business position so that go me through... what high school you attended was also important. Hard to believe now...

    After graduating I didn't feel I knew enough theory and took up further study in thoracic, gynaecology and orthopaedics at another teaching hospital for a couple of years which I paid for. If I had my time over again I'd have trained there - the Tutor Sister was wonderful, a German woman, very funny and knowledgeable - but the whole hospital had such a relaxed, informal atmosphere about it, it was a real joy. In retrospect I would have fitted better in that environment than the very strict, stuffy hospital I trained at - although I must say the training I received was first rate. Sue

    1. And gosh you do look young and trendy in that pic OFRN!

      The young veterinary surgeon here from USA told me her college fees were something around US $400,000.00 which blew me away... she said to me "I will never have a house, I will never own anything!" Sue

    2. And now I've seen Janess - do you know what happened to her? You all look very nifty in your uniforms. 1960s I'm thinking? S.

  8. Sue, I think that photo dates from 1969-1970. Janess and I both started working together in the OR after graduation. She had tiny, very nimble fast hands which were so much more dexterous than my oversize lunch hooks. We both worked together for a long time and always had each other's back. I really loved the family like atmosphere in the OR and always felt a sense of belonging there.

    I have no idea what a nursing education would cost today. The availability of school loans has made education unaffordable for almost everyone.