Sunday, January 13, 2019

What if Pathologists Performed Surgery?

A pathologist's Mayo Stand.  " Pass me the hack saw, nurse."

Delay of game is not limited to football. Action in the operating room can be subject to breaks in the action too. Waiting for a frozen section report to come back from the pathologist  or a time out while the circulating nurse scrambled to flash sterilize an esoteric instrument that the surgeon just had to have were common interrupters of what had been feverish goal oriented action in the tiled temple.

I liked to busy myself with buffing surgical instruments until they shined in the overheads or wrestling with wiry twisted chromic suture in a vain attempt to get the kinks out during these postponements. Dr. Slambow did not like my heightened activity during these surgical layovers. One of his life lessons was to take a break whenever you have the opportunity, and as an oldster, I've put that lesson into practice way too many times.

As the intense intraoperative activity ground to a halt, he dropped his usually tense voice  an octave or two as  he admonished, " Take a break Fool, and rest those oversize lunch hooks of yours, I've got a little joke for you; In a perfect world the English would be police officers. The Germans would be engineers, and the French would be the cooks. In a more ghastly universe things would be different. The English would be cooks. The Germans would be law officers and the French would be engineers." Ha..Tee..Hee.

Every scrub nurse knows the obligation to laugh at the surgeon's jokes and make a comment about his clever wittiness, but my mind sometimes wandered and thought about what would happen if physicians other than surgeons performed surgery, just as the characters in his joke switched roles. Standing at my Mayo stand in a post joke moment, I came up with an off the wall  idea that made the notion of German police officers sound like a good thing.

What if pathologists performed surgery? The instruments they would bring to the table are enough to shiver just about anyone's timbers. I had never heard of a #60 knife blade because it's exclusive to the morgue. This monster blade made a meat cleaver seem like small potatoes. It's the only scalpel blade I'm aware of that has an edge sharpened along it's entire length. This blade eschews attachment to an ordinary scalpel handle and prefers mating with an autopsy handle that resembles the throttle of a Harley Davidson Electra Glide. This sabre like snickersnee  reduced cutting to it's most barbaric level. In surgery millimeters mattered. A pathologist's  mindset was calibrated in meters. Monster incisions were OK in the morgue, but wouldn't make for a happy ending in the OR.

A pathologist is experienced with slicing through chilled skin that doesn't bleed. I wonder how the novel experience of dealing with those little bright red bursts erupting from the yellow subcutaneous fat would be dealt with. I wonder if a foul smelling liquid like formalin would cauterize a bleeder. There certainly is an abundance of that nasty stuff in a morgue, but surgery is no time for foolhardy experiments. I suspect they would have to learn how to use a Bovie like everyone else.

That's just about enough of my foolish ramblings. I don't want to even think about those giant hedge pruner implements found in a morgue would be used for. Pathologists are conditioned to simply cut structures  out of the way to expose anatomy. Could they adapt to using retractors for accessing organs?

I pondered that last notion while sipping bean soup for my midday sustenance. Glancing down at my fasciculating fingers and realizing I forgot to take my Sinemet, the thought suddenly occurred to me. Dr. Slambow was right, I do have oversize lunch hooks for hands.


  1. The different version of Dr Slambow's joke that I've always known is:

    Hell is when the cooks are British, the police are German, the lovers are Swiss, and it's all run by the Italians!

    Cheers! Sue

  2. I love all of your posts, but this is now one of my favorites. Thank you for so eloquently wording something I've always mused about.

  3. Thanks so much for your comments. I had this one sitting around as a rough draft for quite some time. I finally just went ahead and posted it. At my age, the more I fiddle around with writing (if you could call it that,) the worse it becomes.

  4. Late to the party, but at least no one mentioned chainsaws. I like the English, German, French ideal worldview, too. I wonder what an Italian lawyer would be like?

  5. I don't know about Italian lawyers, Jono, but I worked with an Italian surgeon who was superb. His English was not too proficient and my Italian is non existent so we communicated with hand signals.

    Oh and..It's never too late for foolishness!

  6. Hi Old Fool Reg.RN,, I’m trying to post comments but having a hard time,

    1. Comments really do make my day, so thanks for persisting. Readers have emailed me about this problem and about the only thing that seems to work is clicking the "anonymous" box when submitting.

  7. Hi there Old Fool Reg.N, I’ve been following your posts for sometime now and find it addicting to check in always, it’s amazing how old school nursing has changed, Im no whipper-snapper by no means and find when you blog of the mighty green walls we have of the OR and the sorrily beautiful black terrazzo floors covered now with thick ugly vinyl flooring the only remanents shine through when they have removed an old thick steel stainless cabinet or the odd door threshold the beauty black stone with white flecks shines through ! Your most interesting post was about the old stainless sponge racks with hooks and understanding the blood loss based on how soaked they were and the dripping below on the bottom tray ,,not knowing before but since you posted I’ve realized when they have gotten rid of them they had made very functional coat racks in our OR and around the hospital (the engineering dept cut and smoothed the rungs and left the top rung to hang our coats on!that was in the Olden functional days of the hospital of recycling lol, now everything old gets thrown out! I’ve got pictures and would like to send them to you! Thank you so much for your delightful and informative posts of the mighty years of nursing/hospital days of past! ;)

  8. I have many pictures to share of the two OR’s /hospitals I’ve worked in, and thankfully they are original prints of the one OR and EOR(Emergency Dept) when they were brand new opening circa’1960. the present hospital I’m in opened in mid 1958 but don’t have any old pics but none the less very interesting! Thanks OF for your dedication of posting. There is another generation that appreciates your tales of the past 🏥

  9. Thanks for your kind words of support, Mr. Paul. My surgeon hero, Dr. Slambow was an avid photographer and I treasure the prints he left to me. That dumb looking photo of me standing under the OR lights with my colleague, Janess, fiddling with them is a Dr. Slambow original. I remember the occasion like it was yesterday. It was New Years Day 1974 and we just finished up with a trauma case from the previous evening's over zealous celebration. Dr. Slambow liked to unwind by clicking off pictures. As I stared with a deer in the headlights look into his waiting Argus C-3 , Dr. Slambow hollered, "I gotcha." The rest is history.

    Over the years, the most impressive surgical development to me is todays world of replacement and -orrhaphy vs. the old school -ectomy of just about anything and everything.

    The most distressing part of health care today is the invasion of big business and preoccupation with monetization. On a recent hospital visit as a patient, I actually observed a nurse driving an expensive European vehicle with vanity plates advertising her chosen profession.

    In my scrub nurse hey day I thought my fiscal habits were out of control when I spent an extra $50 or so to purchase a Raleigh Super Course bicycle instead of a more reasonable Schwinn. Old nurses like me never expected to own much in the way of expensive transportation appliances. It's a different world today.

    I'm getting carried away, but I really do treasure your loyal consumption of my foolishness and appreciate the time you took to leave a comment.