Wednesday, September 9, 2020

Lights Out in The O.R.

 



Late night trauma surgeries were performed in  a parallel universe diametrically opposed to run of the mill, day-to-day, elective surgery. In place of the measured orderliness, gowned and gloved players were often blinkered by an all consuming bone tired, sense of fatigue that descended on the room like a choking mist. The emergent condition of the patient spurred a driving sense of expedience among the weary staff. Fatigue and the hurry-up nature of trauma surgery can have bad consequences no matter how well intentioned the staff, a lesson I was about to learn the hard way.

Delusional thinking, fueled by the infinite wisdom of youth, falsely told me that fatigue was a nonissue.  I sometimes played make believe, telling myself  that fatigue actually made me perform better by focusing on the things that really mattered.  I often felt like the grand wizard from the land of OZ. Hidden behind the curtain of mask and gown, I was just pulling on the strings and manipulating the levers to quickly load needle drivers and collect bloody sponge sticks.

My delusion of being fatigue proof was about to be shattered when the phone in the call room awakened me with an 0200 hour  emergency one early Sunday morning. The trauma gods always got restless on Saturday nights in Chicago. It was a harried nurse from the ER advising me that a hot trauma was being loaded unto the elevator for a nonstop flight to the 7th floor OR. A teen aged stabbing victim with volume depleting abdominal bleeding was our patient and the ER nurses had applied a scultetus abdominal binder in hopes of slowing things down. Not an encouraging prognostic sign.

The Lakeview  neighborhood was home to the Aristoctats, a youth gang that often meted out punishment with the blade of a knife. Firearms were thought to be unmacho and eschewed with youthful vigor. Not a bad concept in my book, as knife  wounds were more amenable to surgical repair. 

Although these kids looked menacing on the street, on the OR table they looked like the vulnerable little children they were. Their vicious behavior was often mixed with the typical adolescent sense of humor and more than one of them smiled as they related, "It's not how deep you stab your knife, it's how you wiggle it around."

I had just finished setting up my back table as the bleeding youngster crashed through the doors accompanied by the usual cast of lifesavers, pushing the gurney like it was a guided missile. Dr. Slambow had gowned and gloved himself while I quickly tossed  together a basic laparotomy setup. I was loaded for bear, complete with a boatload of Satinsky vascular clamps. My heart always did those little flip flops when an attending surgeon volunteered to gown and glove independently without the help of a nurse. Something unsettling was usually close at hand.

Dr. Slambow urgently announced that this was going to be a "Whoop-dee-doo" case. (His unique vernacular for an O.R. free-for-all.)  He  was going to start cutting  immediately without the anesthetist present. The patient was unconscious with a secured airway, but cases like this always hit me with  a feeling of raw, primal panic. Obeisance to sterile technique was tossed to that void behind the vacant ether screen and  questions like, ""What if he wakes up while we're inside his belly?; Can we stop the bleeding in time?;  Do I have all the instruments and supplies?;  What happens if that fenestrated sheet that I hastily tossed over the patient for a crude drape falls off?" I don't think there is anything more pathetic  when a drape falls to the floor exposing an unfortunate  little kid with a big hole chopped down the middle of his puny, little bread basket. Truly the stuff of nightmares, at least for me.

Things went better than expected. After Dr. Slambow carved a midline incision and  sucked out the blood things began to slow down. The inferior vena cave was intact along  with all of the other major vessels. The bleeding was brisk but confined to lots of superficial venous circuits and the spleen. After a quick splenectomy, the bleeding was pretty much under control. Dr. Slambow would clamp off a group of bleeders together and give the command to "meatball it" so the resident would tie the mess off in the shape of a little sphere. After making a few meatballs we were done cooking and the patient was doing well.

The O.R. room for trauma  was one of the oldest on the floor, selected because of its proximity to the elevator and nearby autoclave which although vintage, worked great for flashing a last minute instrument or preparing Thanksgiving dinner. We even nicknamed the old autoclave Mr. Yell N' Cuss because that's what we did when the door was unbolted and we got hit with a burst of steam due to a constipated venting mechanism.

During  the emergency trauma  surgery  I noticed, Clarence, our diligent housekeeper, peering through the porthole-like window in the door. I thought  that he was admiring our lifesaving surgery, but when the case was over, Clarence wheeled his mop bucket in with a perplexed  expression. "You folks 'spear- menting again?" he asked. "What do you mean by that Clarence?" I asked.  "You done that whole operation without the great big overhead lights tuned on!" Oh my gosh, I could not believe what we had done. I ran to the surgeon's locker room and updated Dr. Slambow on our oversight. In a tired voice he wearily explained, "Well the ambient lighting was pretty darn good and we weren't deep within a body cavity. Sometimes things work out in spite of our screw-ups."

11 comments:

  1. I just love your tales from the OR, OFRN! I always read them in awe of your competence ... I would miss the contact with live patients, although surgery is fascinating.

    You lived in Chicago didn't you? Have you read the wonderful (autobiographical) novel of that name by Brian Doyle? It's written with real heart by someone who loved that city. Do read it if you haven't yet! Sue

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  2. I've read some of Brian Doyle's writing about Chicago. His story begins a couple of years after I moved to Iowa, but he lived in the same North shore neighborhood as I did. His description of the youth gang activities were right on. The Aristocrats were the main gang when I lived there and I think they were assimilated into the Latin Kings later on. Gang symbols were plastered all over the retaining wall leading down to our basement ER. The Aristocrats tag was a capital "A" surrounded by a circle of barbed wire.

    My favorite book about Chicago was "BOSS" by Mike Royko. It was the political story of Richard J. Daley the long time mayor and power broker. Like him or not, he got things done. My favorite memory of him occurred right after pay toilets were installed at Ohare Airport. The good mayor was on the news that night on every station, indignant
    and proclaiming "There will never be pay toilets in the City of Chicago." A small victory for the common man!

    Thanks so much for commenting, Sue

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    1. OFRN that is fascinating! I loved the book - he manages to make you really care about the characters - and was sorry to read about his death from a brain cancer.. and you know the area well too - I didn't know whether to believe the way he talked to the gang members. I loved Howard the dog! I doubt the other book is available here but I'll have a look.

      What is so clear from your blog is how safe patients were in your hands OFRN - You were/are clearly a highly competent, caring nurse. It's rather wonderful to read. Makes me miss nursing. So glad nurses like you were and are around. You take care of yourself over there!

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    2. Thanks Sue, I tried my best as a nurse but failed quite a few-you can only do so much, I guess. I'm safely isolated in my comfortable little hovel and hope you are safe too.

      The Aristocrat gang members were respetable to most of those outside their sphere of influence. When we had a good result in the OR, Dr. Slambow often encouraged me to visit them on the ward. They were all courteous (for the most part) and very grateful for the help. I think there is an old post about the time I mentioned to a gang member that on some late nights I was nervous walking to the hospital...He offered to escort me and all I had to do was make the back gate to our apartment squeak and he was there for me!

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    3. I like that story OFRN! He was a journalist so he probably did chat to them... that book Boss is available here, wondering how I'll find it never having been to Chicago - I'm tempted to read it on your recommendation!
      We're good here, no virus in my regional city... glad you're hunkered down safe.

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  3. I would guess that not only were lights not critical, but it could have been mostly done by feel. Sounds a lot like a M.A.S.H. unit.

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    1. I didn't want to ruin the story, but in that old room there was a huge skylight shaped like an inverted cupola that served as a skylight. Lots of old O.R. s had these and they were great during daylight hours. Unfortunately most traumas happened during the night. Lucky for us, the inside of the skylight was lined with a bank of florescent lights that were pretty good, but not near the same as the traditional overheads. The circulating nurse was usually responsible for adjusting and maintaining the traditional O.R. overheads consisting of a large diffuse light with a satellite spot for contrast. In traumas the circulator was tied up with running for blood and could become preoccupied. This was the only case I've seen that was done solely by ambient light in a big hospital. A for real OOPS moment that should have never occurred.

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  4. What a cool story. It was easy to be drawn into the single mindedness of the OR crew focused on saving that young man.

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  5. As the person who is part of the team frantically depositing a trauma patient into the OR in the middle of night, I can sympathize with your singular focus to the detriment of other necessary things. I distinctly recall the one time we had a trauma that we stripped naked in order to start blood, give meds, intubate, etc - we then threw a warm blanket over them en route to the OR...imagine my chagrin when we got down there and realized we'd left the patient's sneakers on. We cut the pants off and covered him so fast that we forgot to remove his shoes. Oops.

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  6. Good story writing! I wish I had an exacting memory like yours but unfortunately either my brain is losing grey matter quicker than I thought I would or my brain is choosing to forget via PTSD. Either way - I am glad I wrote some of my nursing memories down from my 43 year full time career - I don’t remember as many details anymore

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  7. My long term memory is pretty much intact, but what I just had for lunch is one big mystery. One of the blessings of aging is forgetting all the bad stuff that's in the back of every nurse's head.

    I miss the days when nursing was a modest, predictable occupation with the tradition of helping sick people without concern of self. The rewards had little to do with self enrichment, but were worth lots more than money.

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