Thursday, March 28, 2019

Looking Good - Feeling Bad

Back in the late 1960s  cures for serious illness were few and far between. Undaunted by bodies mutilated by serious illness, old school nurses were true artisans when it came to making sick, debilitated  patients look good. That old adage, You can't make a silk purse out of a sow's stomach, did not apply to these embellishment minded nurses. Cachexia never looked so gorgeous.

Every bedside nurse was a master when it came to the quick shave. A wash cloth heated in the blanket warmer served to mollify the most robust beard. A few deft strokes with a prep razor produced a dapper looking patient despite the paroxysms of sustained DTs of an alcoholic in the process of sobering up.

Shaving had one well known complication. Intubated patients always had  that pesky pilot balloon dangling in the razor's path and slicing into that tiny little bubble resulted in lots of excitement. A massive leak around the deflated cuff of the endotracheal  called for a STAT reintubation, but, at least, the patient looked nice if you could overlook the terrified expression elicited by a crash intubation..

Another trick in the looking good procedure manual was fooling  around with the lighting. Jaundiced patients always looked much worse under incandescent illumination, so open the drapes and turn off the overheads in the room. Avoiding yellow bedspreads helps too. Patients with an elevated bilirubin of 4 mg/dl  never looked so good.

Out of sight, out of mind was the philosophy of wound management and the bigger the surgery, the bigger the dressing. Abdominal surgeries incorporated another layer of obfuscation, the scultetus binder. A patient might feel as though their belly lost a battle with a chain saw, but hey, they can't see a thing until that dreaded dressing change.

The importance of accessory items such as eyeglasses and wrist watches in the looking good gambit  is illustrated by the sad tale of a 47 year old man suffering from terminal heart disease. Haskell Karp of Skokie Illinois was the first recipient of an artificial heart. Famed Texas heart surgeon, Dr. Denton Cooley made quick work of the situation and in a 47 minute surgery the artificial heart was in place. The device functioned for 3 days when a transplant became available, but death came 2 days later from operative complications.

It was especially important that a patient  fortunate to receive  doomed by the first totally mechanical heart to look attractive. This was international news and lots of folks were watching. Nurses went all out  to convert what was a terminal event to a flattering photo op. The illustration below shows Haskell fresh off the operating table awaiting the return of consciousness and the delivery of The New York Times. Reading glasses in position for a cursory perusal of the business section. Looking good!

Haskell Karp   Circa 1969


  1. Fernando Lamas once said, "It's better to look good than to feel good." Billy Crystal added, in character, "You look mahvelous!"
    Leave it to nurses how to bring the nearly dead back to life.

  2. At least Mr. Karp wasn't intubated!! Thanks for my first big laugh of the day ~

  3. Jono, sometimes when I feel in a judgmental mood about whippersnapperns and their self-promotion, I realize some of the tricks we pulled were in the same boat. Old nurses were not media influencers, but we liked to buff our image and having an attractive looking patient was part of the story.

    Bobbie, My first thought was how could they wean Mr. Karp off a ventilator so quickly. Maybe they extubated him for a room air challenge and decided to snap a quick photo before reintubating.

    Those lovely Emerson respirators ruled the roost in the 1960s and I still miss their no nonsense chugging sound as they cycled. MA-1s sound like a transistor radio compared to the symphonic old Emersons.

  4. That giant oxygen cylinder in the background grabbed my attention. An advanced ground breaking procedure, but no piped in gasses?