A Heminephrectomy and a Stock Tip

I really, really, disliked scrubbing in surgeries that involved partial removal of a kidney. The positioning of the patient  on the OR table involved a number of hacks worthy of a MacGyver  Award.  A side lying position, with a break in the table at the inferior thoracic level was a worthy challenge to maintain with sand bags, chunks of foam egg crate mattress, bean bags sans the beans, rolled up surgical towels, and long lengths of 2 inch adhesive tape which were all  included in the patient  placement armamentarium. Anesthesia was worried about compromised gas exchange with gravity pulling abdominal contents downward on the diaphragm while nurses fretted about a tumble from the table.

Once the procedure was underway the nephrology surgeon began his solemn narrative of all the challenges involved; too much monkeying around near the adrenal glands atop the kidney could blow blood pressures sky high, the renal artery had lots of anatomical variations so it was tough to figure out where it ended and the arcuate artery began, and finally, modifications to the fascia were required to hold what was left of the kidney in place. Old school surgeons just loved to hang the crepe before a difficult procedure because then even a bad result might look OK.

After a lengthy discussion of renal pyramids and poles (I could never make sense out of the difference between the two,)  the surgeon excised the pathologic portion of the kidney that most commonly  harbored a benign tumor or cysts. At least most of the partial nephrectomies offered a cure.

Now the fun part for the hapless scrub nurse begins.  To seal the exposed surface of the incised kidney, miniscule pea sized chunks of fat are sutured in place. This time consuming task requires lots and lots of sutures and by the time about half the job was done my bony fingers were aching from loading endless needle holders.

Fatigue can be the impetus for saying stupid things and my preternatural foolishness didn't help matters as I muttered, "Why don't you just throw a couple of stitches around one big hunk of fat and be done with it."

The surgeon gave me one of those churlish looks and quickly changed the subject to one of his particular areas of expertise, stock marked tips. According to this  financially savvy surgeon,  Abbott labs was a sure fire winner and a must buy stock because the share value had been temporarily  eroded by a contaminated IV fluid SNAFU. As soon as the problem was corrected, the share value would soar. As  he enthusiastically  expounded about this must buy stock, the old Airshields ventilator pumped a potent halogenated anesthetic agent into the deeply obtunded patient.

The case proceeded along uneventfully and I helped gently transfer Mitch, the still anesthetized patient unto the gurney. A nurse was always with a patient like this to maintain an airway on the  open road to the recovery room.  I was carefully making sure his silver metal oral airway (no cheesy plastic throwaways like those in current use)  was in place  as I  guided his mandible forward to keep him breathing.

With unexpected gusto Mitch suddenly aroused, pushing my hand away and yanking out that pesky airway. His first words upon regaining consciousness? "Call my broker. I want in on some of that Abbott Labs stock."