WHAT IS A NARCOTIC PRESS?

 There are many vintage nursing terms that are unheard of in these modern times: Johnnies for hospital gowns, snaps for hemostats, monkey bars for orthopedic framed beds or hypo for any drug administered by a needle, regardless of route. Some of these names, at least, made sense in that their origin was pretty easy to figure out. One term that really through me for a loop, even in my younger days , was "narcotic press." I tried to learn what was behind these obscure terms in a foolish attempt to appear smart or wise, but, like they say, you can't make a silk purse out of a sow's stomach.

A narcotic press was not a newspaper about the perils of addiction or a device for squeezing the exudate from the papaver somniferum  poppy. Narcotics were secured in a double doored locked  metal box prominently located smack dab in the middle of the nursing station and frequently referred to as the narcotics press.

I used to love the way Filipino nurses called it a nar-koe-tiks press in their lovely melodic way of speaking, so different than the harsh, Chicago midwestern dialect that sounded like a Stryker saw hacking through bone in the morgue. Native nurses had rather inelegant terms for this storage  device like locker, cabinet, or box. Narcotics press had a nice ring to it.

Since most Filipino  nurses used the lovely narcotic press term so freely, I wondered if it came from their native Tagalog language. After learning the term had no roots in their native language, I set off on a mission to learn where the narcotic  press term originated.

Old nurses, having seen it all and done it all, were not very tolerant of nursing terminology cognoscenti like myself. Well seasoned nurses were intolerant of foolishness regardless of source, patients, colleagues, or whatever, it didn't much matter. It was a tough battle liberating information from these hard core characters, unless it was a direct matter concerning patient care, but young fools can be highly motivated when the quest for esoteric information is on the line.

I got quite a few answers regarding the narcotic press nomenclature inquiries. One aging bat thought it had something to do with triggering a red warning light located above the medication room door. Regulations required a visual indication whenever the narcotics press was open. Newer narcotics storage areas had a switch automatically linked to the outside door that triggered the warning light, older boxes required manually PRESSING a button and thus the term narcotic press was born. This explanation seemed a bit far fetched, but I guess anything is possible.

And finally, the best answer, verified by more than one aged nurse is the following revelation. The narcotic press nomenclature is a coinage born of frustration with securing the double doors of the contraption. Rules from the grand nursing poobah upon high specified that  narcotizing drugs must be stored behind two locked doors. closing the first, inside door was easy, but to get the outside door securely latched, you really had to press on the margins to get it shut. A narcotics press was born!

The Doctors' Dining Room

 

Old school hospitals offered lots of special treatment to their esteemed  medical staff. Free front row parking with valet service on demand and an ornate dining oasis which was far removed from drab, utilitarian hospital environs were the more obvious perks. Physicians were the alpha predators in the hospital food chain, far removed from nurses and ancillary staff. There were no "mid level providers" in days gone by. It was just the doctors and everyone else.

Doctors' dining rooms were entered through a solid wood door conspicuously marked PRIVATE. Inside the door was a room paneled in dark mahogany with fancy brass grills covering the radiators. Maroon Karastan carpeting covered the floor. Pictures of the institutions hallowed great healers from the ages adorned the walls with an occasional pretentious bronze  bust tossed in for good measure.  Genuine white table cloths with a fresh floral arrangement salvaged from one of the many bouquets  left behind by departing patients added to the ambience. Fancy light fixtures illuminated these deluxe digs and sculpted plaster potentiated the high brow ambience of these over stated  eateries. A two year old with a plate of spaghetti could do more damage to an over adorned room like this  than a hurricane 

General practitioners and internists served the role of personal physicians and  asserted complete control over the care of their patients spending  many long hours in the hospital.  A readily available source of nourishment was essential.  These dining areas were a feeding lot open 24/7, serving snacks like Good Humor ice cream bars, bagels, donuts, and crackers laden with cold cuts or liver pate' during off hours. Normal operating hours featured  food from the hospital cafeteria embellished with little sprigs of parsley, ripe olives or whatever else the colorful characters known as hospital cooks could whip up. A distinctive touch to our hospital dining room were  bottles of hot sauce smack dab in the middle of every table.

Doctors'  dining rooms were the consummate private place for the boys to raise questions about care and explore  solutions to ethical dilemmas. Operating rooms were fertile ground for  mishaps and screw ups when  minimally trained general practitioners were  granted surgical privileges. Thankfully, they were prudent in restricting their services to simple procedures like vein strippings, tonsillectomies, and D&Cs. 

A ham fisted G.P. might ask an ENT specialist if it was OK to with hold information about a patent's uvula  that had the nerve to get tangled up in an errant tonsil snare. The ENT doc usually advised it was best to be truthful since the first time a patient looked in the mirror he would notice that little thingee hanging down in the back of his pharynx was AWOL. It's best to be honest when your mistakes are obvious.

Wrong site surgery was an egregious error but could be easily explained away by claiming that the errant surgery was necessary and not a simple minded mistake. Circulating and scrub nurses would likely be fired for wrong site surgery or  foreign body oversights, but the surgeons remained unscathed except, perhaps, for an admonishment to be more careful next time.

Doctor's private dining rooms were doomed by hierarchy busting youngsters and the welcome influx of women to the medical field. Most women did not take kindly to putting their own needs ahead of patient welfare when covering up mistakes, an issue frequently addressed in all male forums like doctor's dining rooms.. Corporate healthcare had a significant role in shuttering doctors' dining rooms because of their negative cash flow. Any use of space that failed to contribute to cash flow was history.

Smokeeters Cleared the Air at Downey VA Hospital

That coffin sized brown box hugging the ceiling of a Downey VA Hospital dayroom was one of the most indispensable elements of the therapeutic milleu; a Smokeeter. This machine droned on with an intestinal rumble as it digested hazy nicotine laden air and expelled a mountain fresh breeze from the opposing end. In with the bad-out with the good.

Downey VA Hospital dayrooms had a dismal aspect about them with bars on the windows and the walls reflecting a gloomy potatoe-y  noncolor with brown gravy like nicotine stains in just about every nook and cranny. Worst of all was the unbearable effluvium of cigarette smoke combined with the scent of men densely packed into a confined area. A palette rinse and sinus lavage was mandatory at the conclusion of a shift. The place just plain stunk.

 The lighting cast a yellowish pall over the entire unsavory mess reminding me of a Foley bag long overdue to be emptied. Smokeeters were an acknowledgement of the foul conditions and an inadequate intervention to remedy the situation, a microcosm of the mental health treatment system.

Serious mental illness does strange things to folks. Emotional channels become intricately wound together so they coagulate and strangle each other. Recreational chemicals like nicotine, alcohol, and caffeine are some how involved in the masking of the pain induced by nervous dysfunction. One of the mantras often heard on the ward was, "nicotine cuts thorazine." Patients truly believed in the therapeutic effects of smoking and would go to great lengths to ingest as much nicotine as possible.

Smokeeters worked by electrostatic precipitation and the nicotine that adhered to the electrodes in the device required daily flushing. In an addition to an electrical connection, Smokeeters required plumbing to provide a water supply for routine cleaning. This maintenance operation called for twisting open the supply valve and making sure the drainage line to a utility sink in the laundry room was patent for the final journey to the sanitary sewer system.. A kink in the drain resulted a most unpleasant blowback of the toxic brackish nicotine concentrated effluent.

Curiously, there was always a contingent of anxious, over eager patients volunteering to flush the Smokeeter. I soon discovered their strange motivation one evening  while making ward rounds. I was perplexed to see a patient whose entire upper torso was contorted into the depths of the utility sink where the foul liquid from the Smokeeter drained.

As I eased his head from the sink a syrupy brown exudate covered his lips. He had been guzzling  the foul drainage from the Smokeeter.  "What in the world are you doing?" I asked. With an ear to ear grin framed in the brown nicotine laden sludge he replied, "I'm drinking nectar from the nicotine gods courtesy of the Smokeeter.Try a swig-it's like smoking a whole carton of cigarettes in one drag. WOW..what a rush." I declined and made certain the laundry room was secure prior to flushing the Smokeeter.

Hospital Signage

Yesterday's sign was a model of stark simplicity

Today a ridiculous hodge podge of word jugglery. What a mess!

Hospitals Before Air Conditioning

Vintage Hospitals had very little in the way of mechanical climate control and patient care areas on the wards often became sweltering brick ovens. High ceilings and transoms over the door of each room helped some, but hot is hot and working in an overheated enviroment was accepted as part of the deal of being a nurse. Wide open  wooden double hung windows helped a bit and as an added thrill there were no screens above the third floor. The theory that there are few high flying insects might have been true but pidgeons did not follow this rule. We used to coral them in a corner with a draw cloth and send them back on their merry way via the open window.
 

We all agree. It's too hot in here.

Staff nurses frequently draped towels  soaked in ice water around their necks, but such luxuries were not permitted for student nurses. Misery and suffering were vital elements in the quasi-religious initiation into the nursing world and belly achers soon found themselves on the outside.
I had it much easier than the female students who wore a heavy apron over their blue dresses. A common problem was sweat running down legs and pooling in fluid containment  vessels like Clinic shoes. A memorable sight was a student in the break room removing her shoes to drain the sweat. I had a different problem because my primary sweat generator was my back. The perspiration would slide down my back and soak my underwear and seat of my pants. I stopped one day to purchase a Chicago Tribune from the corner news stand and after producing a dollar from my hip pocket the vendor commented, "Hey..This dollar bill is soaking wet." I kept my mouth shut and just smiled rather than explaining the embarrassing source of the moisture.

Patients were the ones who really suffered in the heat. Working on the ortho floor meant dealing with a particularly uncomfortable bunch of patients. The casts often exacerbated the sweating which almost always produced itching in remote areas of the casted extremity. Clever nurses produced under cast scratching devices by taking an ordinary coat hanger and straightening it out. The business end of the scratching device was twisted into a tight loop which could be threaded down to the area of itch. They were crude but effective anti-itch devices.

The hospital director's office and operating rooms were air conditioned and clever nursing personnel learned to take advantage of an occasional whoosh of cold air. The ORs were accessed by a manually operated elevator that moved cold air down the shaft like a giant piston. An oasis of cool air greeted anyone standing near the old elevator doors when the device was on a downward plunge. We concocted a variety of excuses to linger by those doors. My favorite excuse was awaiting the arrival of a fresh post-op patient.

Hospitals were not early adopters of air conditioning. For the first couple of hundred years after it's invention, the wheel was only used for making pottery. Nobody could figure out how to make wheeled carts as effective as sleds on runners. The same situation applied to hospitals and AC. The roof of a hospital was not designed to support refrigeration units and there were no ducts in radiator heated hospitals, besides nurses and patients were meant to suffer. It was just the way the world worked.

Hospital Signage - Yesterday and Today

Visits to contemporary hospitals always throw me for a loop. The hodge-podge assemblage of signage is indeed mind boggling, at least for me. Practically every vertical surface or door has a sign of one sort or another dutifully posted. Guide signs, financial responsibility notices, warning signs, nursing award plaques (none of those back in my day, that's for sure,) and mystery signs that my foolish mind simply could not decipher.

Signs were few and far between in vintage hospitals.

I found myself asking myself, how in the world did old school hospitals function without the copious ( that "c" word is one of the all time  favorite words of my generation of nurses) use of signs? The hospital building itself was without an identifying sign. It was completely unnecessary because everyone intuitively knew it was a hospital. A hospital was a hospital and everyone knew where it was. Does God sign the sky?

Walking through a modern hospital corridor with all those solid, opaque doors with confusing (at least to me) signage does cultivate a sense of mystery. When one of these  modern, occlusive, door  contraptions swing or magically whoosh open, I scramble to peak inside. I could have read the ever present, omniscient signage, but I like the feeling of being an explorer on an adventure. It's like a series of hidden little worlds where computers and electronic doo-dads seem to dominate.

Old hospitals were not like this. No signs necessary. You could sense where you were by the various olfactory, auditory, or visual  cues. The radiology department was defined by the scent of photographic fixer and all those lead aprons hanging outside the mostly open doors. No mysteries here. Morgues and central supply were always in the basement and the ORs were always on the top. I rambled on about this in a previous post.

Emergency rooms were always on the same level as the street and there was  a memorable sign nearby. Old school  emergency triage began at street level and an actual sign began the process by a stern warning: AMBULANCE CASES ONLY. There was always an assemblage of police cars at the ER and I suspect hospital emergency rooms were one of the safest places in all of Chicago.

Hospital labs were easy to navigate. Everything was out in the open. Hematology was defined by the click-clck-click of manual tabulator gizmos used by the technicians to count the various lymphocytes and eosinophils in a sample. I used to love that sound because it reminded me of crickets. A bit of nature  in the midst of an urban jungle. The microbiology department was easy to spot with banks of incubators and rows of microscopes. The chemistry lab division smelled, well chemical. You couldn't miss it. The hospital laundry was easy to find, just follow that lovely clean linen smell and as you got closer, little flecks of lint falling like snow clearly defined the locus.

Old hospitals had very few people just strolling through as outpatients because there were no outpatients. Any nurse would be all to happy to direct any lost soul moving about the halls so there was little need for signs. The loud, ubiquitous hospital paging system clearly announced visiting hours and instructions for hospital visitors. One of the greatest advances in modern hospitals is the absence of verbal loud speaker pages. They could really jangle your nerves.

Occasionally, a modern hospital sign will cause my foolish, old brain to crash in a state of persistent befuddlement. What the heck is an outpatient ICU?? I was completely  bamboozled by a sign pointing the way to "Ambulatory Surgery."  How in the world, I wondered, can you perform surgery on someone while they are walking around? I suspect it is a great way to prevent post op complications like atelectasis and clots, but do the benefits outweigh the risks of surgery in motion?

I' getting carried away here so I'll leave you with some contemporary hospital signage that got my attention and made my blood boil. The sign below serves to provide the patient with all the respect and dignity of a visit to Wal Mart. The remuneration request is for something that is an abstract concept concocted by an office sitting bean counter which  contrasts with the mission of healthcare to provide tangible care for a person in need. Money and associated big business  is what robbed both doctors and nurses of their status as caring professional care givers and relegated them to nothing more than dollar sign driven minions. It's a sin and a shame.

Montefiore Hospital Pittsburgh - A Unique Design

Architecture is not my area of expertise ( at my age about the only expertise left is shooting off my mouth) but I know a really special hospital building when I see it.  Pittsburgh's Montefiore Hospital was built into a hillside, ala, Pennsylvania bank barn style. The main entrance was located at the top of the hill which meant that a substantial portion of the hospital was below you as you entered. A subterranean wonderland of caring catacombs.

Montefiore Hospital, Pittsburgh, like a tree, it's supporting

roots were underground

The apex of the hill entrance floor was aptly named MAIN. There were three floors below main identified by letters."C" level on the very bottom  contained the operating rooms and recovery rooms, "B" level housed critical care units and "A" level contained the morgue and  cafeteria which served the best homemade bagels I have ever tasted. This was the only hospital I worked at that had the morgue so close to the cafeteria. This hospital made exclusive use of those double decker gurneys to transport bodies and morgue supplies were delivered in a cart that looked exactly like patient tray carriers so the general public was unaware of any morgue related activity near the dining area. Pretty clever.

Locating the OR on the very bottom of the hospital was a real switheroo for an older hospital as the most common locus was the very top floor. Explosive anesthetics were never used at Montefiore because a basement explosive mishap would have been catastrophic. There was little foot traffic on "C" level and this was a very quiet OR.

Montefiore's ER was underground on "B" level and accessed by ambulances entering a tunnel like opening from a side street. When recovering trauma patients related stories about near death experiences involving journeys through a tunnel, nurses set them straight by explaining that their near death experience was not all that ethereal. They were just entering the ER.

Having worked at Catholic, Protestant, and Jewish Montefiore, my nursing journey (I hate that journey business) has been an ecumenical experience. Of the three permutations, Montefiore was special. Some hospitals are focused on research, education, or making money but Montefiore was patient care oriented to the highest degree. Patient needs were the highest priority here.

There was never any of that "We will have to see if you are covered" or "That  treatment is unavailable because it's against church teaching."  Patients migrated to Montefiore like salmon swimming upstream knowing that once in the hospital, kindness and concern reigned even if their journey was one way. Dying patients never received a hospital bill.

The director of nursing even made rounds to the nursing units and never harangued or harassed a soul. She frequently inquired if we needed anything. If it was for a patient, we got it pronto.
Montefiore had its own 3 year nursing diploma school that was open from 1902-1974 and floors were staffed almost exclusively with RNs

In 1990 Montefiore was bought out by a giant healthcare corporate entity, UPMC. The first thing to go were the homemade bagels - they fired the baker. Next on the corporate agenda was renaming all the hospital floors; "C" became "1" and so forth. They even installed kitschy computer screens in subterranean rooms and connected them to an outside camera.

Maybe the renamed floor numbers made sense, but you cannot replace caring with virtual window  kitsch. Today a patient is lucky to find a pleasant nurse that is not umbilicated  to one of those computer on wheels monstrosities. It breaks my heart to return to Montefiore today. What is gone will never be replicated

Thanks for taking the time to peruse my foolishness. I have no idea how that stray line crept in at the conclusion, but I cannot seem to get rid of it!




could be wheeled from an ambulance to the ER without even having to open a door. si sized o

A Vintage Operating Room - Circa 1930

When I started this blog I envisioned it as a  museum of nursing history with an emphasis on life in the OR. After reviewing some of my previous posts,  I came to the realization that my endogenous foolishness has resulted in a blog that more accurately resembles a carnival side show. It's time to put the foolishness on the back burner and restore some credibility with a straightforward post.

So here it is; a guided tour of a 1930's operating room. Prominent in this overhead view is the unique shadowless lighting system. A very rare, explosion proof resistant black Operay. That black Sputnik-like orb contains the light sources and lenses to focus the beams of light on the reflecting mirrors arranged around the periphery. The goal: shadowless lighting.  Here is the link to an old Operay post.
tp://oldfoolrn.blogspot.com/2016/07/the-operay-1930s-operating-room-light.html

This old photo  illustrates one of the problems with Operay surgical  illumination.  Shadowless lighting failed to live up to it's hype and the folks in this OR augmented it with a floor stand pedestal spotlight which is visible in the upper left hand corner. Unlike contemporary operating rooms that are filled to the hilt with electronic equipment, Old ORs had plenty of floor space for pedestal lights that could be moved about on wheeled platforms. If a light bulb element went kaput in the middle of a case, no problem, just wheel it to the corner and bring in another light.  Pedestal mounted lights were very versatile and  tons of  fun until you stubbed your toe on that unyielding massive pedestal. OUCH.

One of the mysteries in this photo is the use of the black explosion resistant Operay in a room that could never be used with flammable anesthetics. Cyclopropane gas anesthesia was in vogue back in the 1930s, but despite the correct Operay for an explosive environment, that beautiful  ceramic tile floor could never be condutive so as to minimize static electricity. No Cyclo allowed in this room.  Ether and chloroform were popular agents and you can see the agents being delivered by mask on the laterally positioned patient. Intubation was yet to come.

Old school hospitals were very cost conscious and you can see the scrub nurses using an old wooden pallet to gain some necessary elevation. It would have been considered fiscal recklessness to splurge on a fancy metal platform when old wooden pallets could be had for nothing. Function trumps form anyday in this acient OR.

The twin scrub nurses suggest a training situation. As an eager  youngster learning the trade, I had the opportunity to scrub with a veteran nurse only once and  then I was thrown to the lions surgeons. I spent many happy evenings perusing Alexander's Care of the Patient in Surgery and mentally planning my cases for the next day, praying that I wouldn't get yelled at or forced to duck a thrown instrument.

Where is the back table in this old time OR? My favorite OR supervisor, Alice, loves yammering on about this feature of vintage  operating rooms. "We used one massive curved back table that was stocked with all of the supplies and instruments for a full day's caseload. The curve facilitated corner placement of the table with maximum usable surface area," she explained.

"Old school nurses were motivated and did not sashay in and out of the rooms like you youngsters are so fond of doing. Once that back table was stocked, we stayed put in the room until the day's caseload was finished. Between cases the circulator carefully covered the back table after the scrub nurse fetched her instruments. It was considered bad form for the scrub nurse to need an item from the back table once a case started, so we had to use our head's for something other than a hat rack."

Alice was an OCD nut and insisted her charges prepare for and conduct cases in a  Kabuki Theater like style. Everything had to be planned for and conducted exactly according to her rigid authoritarian rules which was fine until something unexpected happened. There was only one way to open an instrument set or thread a suture needle in old school ORs. The scrub nurse in the photo has her left hand under the Mayo stand. A  definite no..no according to Alice and grounds for getting a knuckle slap with a sponge ring forceps. That'll learn ya to keep both hands above the Mayo stand.

What's missing in this old OR? There are no electronic monitoring devices or piped in medical gasses. Anesthetists monitored vital signs using a precordial weighted stethoscope that was taped to the chest. An earpiece connected to a stop cock enabled toggling back and forth between the stethoscope and blood pressure cuff. Anesthesia sans any type of electronic monitoring.

These old time ORs were places to have something removed and every case was an -ectomy of one type or another far removed from the repair and replace surgery of today.

Whatever Happened to Sluice Rooms?

It's a conditioned response. Whenever I observe a Whippersnappern wearing gloves for routine patient care or  worse, comingling sheets soiled with scatatolgical resideue and run-of-the-mill dirty linen my anxiety mounts to intolerable levels. Someone is going to be raked over the coals for these misdeeds. Hospitals of yesteryear had unique protocols for these unpleasant circumstances.

Any sheet soiled with solid matter-what a euphemism-required a sluicing in the dirty utility room. A lovely, white 6 foot porcelain slab lined one of the walls of the dirty utility room. It was not for napping. At the elevated end of the sluice there was a massive faucet capable of unleashing a Niagra Falls torrent of water flow. The depressed end of the slab terminated at a slop sink which had a massive drain. This drain could accommodate a bolus biomass of stool the size of a bowling ball. Don't ask how I came to know that  little factoid. Someone had the foresight to install a trap on this sink which seemed to me comparable to the diameter of a subway tunnel. At least once the fetid fecal foosball facsimiles were beyond the trap they were gone for good and you could breath again.

To properly sluice a sheet place the origin of the offending substance at the lowest point of the sluice nearest the slop sink. If you enjoy inhaling aerosolized particulate matter simply reverse this procedure. Now for the fun part; turn that mighty faucet to full blast and watch that mass of olfactory offensive material sliding away on it's merry way to the waiting slop sink. Some types of residue affectionately referred to as smears, mucilaginous masses messes,  or pasty blobs require some encouragement from the intrepid sluicer and for this unsavory task a squeegee borrowed from housekeeping acted s a pusher. I always found it strange that the housekeeping personnel never asked for nursing to return their squeeges.

Suddenly, like a bolt out of the blue in the very early 1970s a memo from the nursing director came out stating that sluicing was no longer required due to improvements in the hospital laundry system and we could simply toss soiled sheets into the hamper. Sluicing like the lobotomy was gone for good and nurses were ecstatic.

This really piqued my curiosity and called for a personal visit to one of my favorite places which was our on site laundry operation. The Hispanic staff working the laundry were among the most content of all hospital staff despite working in a place that reminded me of Dante's inferno. This place was hotter than a brick oven, louder than a Pittsburgh steel mill and to top it off, smelled funny and that's putting it nicely. These folks made $2.20 an hour and were overjoyed with their pay (minimum wage was $1.65 an hour.) They were some of the nicest people in the hospital and even helped me with my lackluster Spanish skills.

When I asked about the new sluice free linen policy they happily showed me their brand new washers that had a built in sluice cycle. The washers had huge outlets that opened before the start of the wash cycle that permitted a huge flow of water through the batch of linen before the wash was initiated.

I was invited to observe a mechanical sluice cycle and it was very impressive. The mighty roar of the water being injected through the linen sounded like a 747 on take off roll in the midst of a rain storm. These giant sluice/washing machines had to be one of the greatest engineering accomplishments in healthcare history-and you thought anesthesia was an impressive invention. An open drip ether drip mask is nothing compared to these sluicing behemoths.

A few years ago nurses from my alma matter were invited to a homecoming. Changes made in the use of space at the hospital were depressing. The old OR suite, home to much drama and lifesaving (I hate that "L" word with a passion.) had been remuddled remodeled to fancy administrative offices. The beautiful terrazzo floors had been covered with Karastan carpet and pretty pictures hung on the walls. The sluice room on one ward had been converted to a data processing room filled with computer doo dads with blinking LED lights.

Crude rooms that were vital and offered maximum utility for patients  were converted to an office sitters paradise and an electronic wasteland. A depressing commentary on contemporary healthcare.

Operating Room Nurse Skills - Door Opening 101

Open sesame or perhaps it was "open says me"  are the magical words in the tale of Ali Baba and the Forty Thieves by which the door to the robbers' cave was made to pop open. Old school scrub nurses were masters of open sesame too, and could open any OR  door with any body part excluding the upper extremities. Specific skill sets like this are in the same class as other neat tricks like learning how to recycle your own snot when scrubbed in surgery with a bad cold, but that's  a tale for another post so let's get back to the doors.

There were no self opening or side sliding  doors in old time OR's. The doors were hung on self-closing hinges that came in two different varieties. My favorite hinge type allowed the door to swing both ways and return to the closed center position by the force of gravity. The hinges had a cam mechanism that raised the heavy door about an inch or so when opened. The weight of the door dropping downward pulled it closed by the action of the hinge cam sliding down an inclined plane. This was a very reliable system because gravity never fails.

At festive Christmas celebrations these doors could also function as efficient nutcrackers. Just position the walnut or brazil nut under the door or  even in the jamb with the door wide open and quickly swing it shut. VIOLA a delicious, nutty  treat awaits, just don't try this trick when a case is in progress or you will rankle the hackles of that overly nasty supervisor named Alice. She nearly cooked my goose when a tattle tale ratted me out for cooking a turkey in an autoclave on Thanksgiving while on call.

The other type of OR door was spring loaded and would swing in  both directions and return to a closed position when the spring tension released.  The hinge springs were wound up tighter than an eight day clock when the door was pushed open  and were entwined around the  center of the mechanism. Late one night, the cacaphonus sounds of emergency surgery (hissing suction, buzzing  Bovies, chugging Airshield ventilators  and hollering surgeons) was interrupted by the loud report of a door hinge spring suddenly breaking in a most spectacular  manner. The sudden, unexpected  noise definitely resembled the report of a high powered firearm.  We nearly jumped out of our skin and the irony of this occurrence during a gunshot emergency surgery rattled our composure. Strange things happen in the middle of the night during trauma cases.

After the typical 10 minute  surgical scrub a nurse had to pass through the doors while holding their hands out from the body at chest level. A sterile consciousness dictated that the scrubbed hands touched absolutely nothing except a sterile towel after entrance to the room was accomplished.

This mandated opening the door with any body part except the hands. There were several methods to accomplish this amazing feat. My personal favorite was the "flying buttress" maneuver which involved approaching the  closed door backwards while bending over at the waist and at the proper moment exploding through the door by flexing your  backside into the closed door. I used to amuse my fellow nurses by telling them, "They don't call that thing a boomer for nothing." I have previously mentioned when discussing patient positioning that once the mid section of the body is set in motion the rest is sure to follow. It's simple physics and applies to both patients and nurses.

  It was most efficient to deliver this blow on the opposite side of the hinges.  Unfortunately, this position blocked the view through the  door window which could have unfortunate consequences. One time,  I exploded through the door and my flying buttress connected with a hapless student who was observing. The circulating nurse joked that I should be charged with assault with a deadly weapon. The student was not amused and I made a mental note to carefully judge for obstructions before opening a door to prevent mishaps like this.

Another effective door opener is the Kung phooey  Fu technique. This is a good one for scrub nurses that like to show off or exert their authority. The nurse approached the door facing forward and at the correct distance popped the door open with a thundering forward kick. I would not have believed it unless I actually witnessed it, but it was possible for a scrub nurse to perform a door kick while wearing a scrub dress. Simply amazing.

The side -  swammy  sashay was perhaps the most refined and elegant of the door opening techniques. The nurse side-stepped  her way to the door and lightly pushed it open with a slight  lateral hip movement  just wide enough to slither through. Not too flashy, but effective and stealthy when the need for discretion occurred. On very long cases we would give each other breaks and sometimes the surgeon would be so engrossed in his ministrations that he was totally unaware of the scrub nurse switcheroo and that was our intention.

Once a nurse has adopted a particular door opening technique, they are usually very loyal to it. There are very few switch hitters in this business. However, I have seen some nurses alter their technique in mid-swing so to speak. The most frequent switcheroo would be an ineffective side-swammy to a full blast flying buttress. I always figured, why waste your time and simply initiate with the big guns of the flying buttress. Think big!

If I was circulating and had a good working relationship with the attending surgeon, I would keep a lookout and when he approached after his scrub,  open the door from the inside and greet him in a friendly welcoming tone of voice. A little bonhomie can go a long way in an operating room. I always tried to do the door opening/greeting routine for Dr. Slambow, but he frequently questioned my sincerity by gruffly ordering, "Cut the crap Fool...It's time to hit it." I always knew things were right with the world when he responded like that. It was going to be another day in surgical paradise.

The Disappearance of Darkness

Before PACUs there were recovery rooms and yes they were nocturnally

illuminated by 15 watt nightlights and nurses penlights

Over countless millennia,  human behavior has been influenced by the 24 hour cycle of sunlight and darkness. Evolution has imprinted our nervous systems with the notion that daylight is for vigilance and night is for peaceful rest. Fooling around with nature's rhythms produces an unpleasant emotional response. Just ask any night nurse how they feel leaving the hospital when all the daylight personnel file in all bright eyed and bushy tailed. I used to feel nauseated after working nights and the bright sun provoked a throbbing headache. Hospital patients don't feel well to begin with and keeping them up all night with bright lights adds fuel to their emotional distress.

Modern hospitals are brilliantly illuminated inside and out at night. The brightness of the helipad can be seen from miles away. Florescent lights bombard halls and patient rooms with artificial daylight 24/7. This photon bombardment is definitely NOT patient centered.

One local hospital here in Pittsburgh actually had signage (don't get me started on hospital signs) offering eye masks to patients. Just ask your local friendly nurse for one if the bright lights prevent you from sleeping. Maybe they should be also be in the ear plug dispensing business. There is certainly minimal resources contributed to promoting restful sleep. I guess this is one more attempt to force patient participation in their care. "No.. we cannot dim the lights at night so here is an eye mask to cover your face with." said the caring nurse.

From personal experience, I can tell you hospitals do not promote restful nights for their patients. I don't know which was worse, the bright overhead lights or the nurses clip clopping around in their noise producing clog footwear. I believe they are called Danskos, but a more accurate name would be Decibels for all the racket they produce. Old nurses valued quiet footwear. There  was nothing like a well broken in pair of Clinic nursing shoes for stealthy moving around at night.

Old school hospitals were serious about patients getting their rest. Sleep was actually recognized as an important element for the patient's recovery. At night the hall lights were dimmed by a switch at the nurse's station so they were barely on. All areas occupied by patients contained one tiny night light that was louvered and close to the floor. Nursing personnel all carried flashlights or tiny penlights and these were only switched on at the bedside when providing care. There was a cache of tiny 15 watt bulbs at every nursing station. Darkness was an important commodity.

I have been attempting to write about something other than operating room tales, but it's difficult to shift gears at my age. So here I go again with a story about lights out in the OR.

There was an unusual, but very good vascular neurosurgeon that I occasionally worked with. After clipping and removing a potentially life threatening aneurysm from cerebral circulation his routine orders were for the circulator to turn off all overhead lighting for a full 2 minutes. He asked the nurse to carefully time the lights out interval, but by instinct, he could tell exactly when 2 minutes were up.

His explanation for this practice was that the brain was housed in the light tight cranium. He wanted assurance that there would be no occult bleeding in the dark intracranial cavity after he closed everything up. If anyone questioned this practice he always said in a haughty, judgmental voice that he was doing this based on empirical evidence. I guess his point was that this trick seemed to work, but there was no science to back it up.

I always thought that after having a brief lights out interval, the surgeon's eyesight was more acute and sensitive to any bleeding after the lights were fired back on. Anyhow, his trick seemed to work. Nurses see some whacky things!

Thanks for reading my foolishness.

Why Did Operating Rooms Have Green Ceramic Walls?

A modern white washed abomination of an operating room that

has all the ambience of a  waiting room at the bus station. What

happened to the green ceramic tiled temples with terrazzo floors?

Much thought and deliberation was dedicated to the design of old time operating rooms. There was sound reasoning behind the selection of green ceramic tile walls and dark terrazzo floors.  These were not meant to be places where health care personnel fiddle around with computers, jaw - jack and mouth flap to one another, or gaze at flat screened monitors in a washed out colorless environment. This was  where the surgeons practiced their profession in a serious and sometimes somber environment. Where the rubber met the road. No monkey business was tolerated in this sacred green tiled environment.

These green ceramic  tiled temples were indeed sacred places where the patient was always at  the center  of a planned anatomical alteration to expeditiously eliminate pathology or repair traumatic injury. The room communicated this objective by the single-mindedness of it's stern ambience. Green was also thought to promote relaxation in patients prior to induction.  No one would mistake an operating room for a waiting room at the Greyhound station.

The color scheme was developed in response to the most important color present in the OR which is obviously the redness of blood and tissue. Green is the complimentary color to red and this was selected as the optimal background color  for surgery.

A surgeon who looks up from the dark red wound and glances at the bright,  illuminated  white-washed wall will find himself momentarily blinded by constricted pupils and it will take precious seconds for his eye to adjust back to the less well illuminated wound. This problem is averted with the eyeball friendly green walls. I suspect the architects of these white wannabe ORs have never lifted a scalpel or tied off  a bleeder. The lack of input from workers in the trenches has been a problem in hospitals since the times of Florence Nightengale.

Surgeons were always apex predators in the hospital food chain. If they wanted to keep their patient in the hospital for a week or two post-op; no problem. If they wanted to hand pick a favorite scrub nurse so be it, (This is how I became Dr. Slambow and Dr. Oddo's scrub nurse.) I kept my foolish mouth shut, my eyes open and tried to deliver the correct instrument at the appropriate time. If the surgeon preferred a green tiled operating room, that's what they got. Office sitting hospital administrators and architects rolled over surgical tradition like a well oiled power mower when white became their  color of choice for ORs. It's just plain wrong.

Mans' creations are sometimes at odds with nature and in the long run, nature always has the final say. Dr. Slambow always backed up his arguments by citing principles of Darwinian Evolution. According to him, man evolved in an environment of fields and green bushes that were the same shade as green ceramic tiles in the OR walls. And up above the illumination from the sky mimicked the overhead OR lights. The dark earth floor was replicated with beautiful terrazzo floors. Over millennia, natural selection adapted man to work under these optical conditions. It's simple common sense to reproduce these time proven optical conditions for the exacting work of surgery.

Another serious deficit  of these new fangled ORs is the absence of windows to establish a connection to the natural world. Surgeons of yesteryear would often stroll over to gaze out the window for the  view of  distant Lake Michigan to give their weary eyes a break  from close-up work and return to their surgery with a newly refreshed vigor.

Maybe an Eskimo operating in an igloo at the North Pole has the correct genetic make up to perform surgery in one of the modern white washed room, but I don't think white ORs would be optimal for most of the human gene pool.

There might be hope for a return to the time tested green tiled Operating Rooms. I remember when electronic components like VCRs (yes, I still use one) were produced in a silver coloration for a couple of years and then switched to black. This color change cycled back and forth (black- silver, black-silver)  over the years. Maybe we are into a white OR cycle and someone will wisely return to green.

A Fine Art Operating Room

This is the plastic surgery OR at Barnes Hospital in St. Louis MO circa mid 1930's. I have worked with many plastic surgeons and they were a zany lot. This surgeon even commissioned an artist named Gisella Loefler to decorate his room.

A number of sights grabbed my attention here. Why are there 2 scrub nurses? I suspect one must be a student. That instrument trolley is actually a precursor to what is a modern Mayo stand. Modern that is to Old Fools like me. In the 1930's operating rooms had a common back table which was loaded up with instruments for a full day of cases. The nurse selected instruments for the current case from the common supply on the back table. The back table was always covered between cases. Nurses and surgeons stayed put in the room until the day's caseload was done. None of that traipsing in and out of the room between cases like you whippersnapperns are so accustomed to. This eliminated extensive room turnover times and there was minimal delay between cases.

One of the scrub nurses has committed one of the 7 deadly sins of OR nursing; her gloved hands have been dropped below the waist band of her gown. For punishment, may I suggest damp dusting that overhead Operay multibeam shadowless light. This was difficult to do with traditional lighting, but imagine the fun in cleaning the nooks and crannies in that Operay

I have always been fascinated with OR lighting devices and I immediately recognized that Operay shadowless lighting system. Our very old unused (except for Dr. Slambow's office) operating room had one of these devices. I spent many happy hours fooling around with it and will post about it soon.

Why Are Operating Rooms Always on the Top Floor of Old Hospitals?

Old hospitals were the source of many mysterious questions; What is that funny smell?.. How tight should a scultetus binder be applied?..How many hospital beds can you fit into a 600 square foot room?..Where is that blood curdling scream coming from?.. and finally, Why are the operating rooms always on the top floor of a hospital building?

In virtually any mid 20th century hospital patients were always being sent UP to surgery. The first time I heard that a patient was coming down to the operating room, I thought that either the ambient nitrous oxide in the room or sleep deprivation was getting the best of me. When I googled the question about operating rooms always being on the top floor of old hospitals very little came up. I just love obscure or overlooked questions that I can answer with my vast accumulation of foolishness so here I go again.

Cook County Hospital, Chicago, Illinois. Operating Rooms

on the top, morgue in the basement. Just like it should be.

I think that the notion of placing the OR on the top floor came about as an idea to isolate the area from the septic environment found on hospital wards. Nasty conditions like advanced syphilis, TB, pneumonia, and every contagious disease known to man was ever present in the hospital.  Setting up the OR and isolating it from general hospital traffic was a good idea. A sort of institutional inertia was set into motion and all hospitals adopted the notion of the top floor is where to place the OR.

There were other benefits to this top floor set up. Surgeons quickly learned that being on the top added another valuable tool to their pre-op evaluation armamentarium. The general surgery floor at our hospital was on the 6th floor directly below the OR. It was common hospital knowledge that the stairwell leading up to the OR was the perfect arena for pulmonary function testing. Instruct your patient that all he has to do to prove his lung capacity is to climb the flight of steps from the 6th floor to the 7th floor OR. Anesthesia residents would even write orders to hold the pre-op med until pulmonary function tests were completed. We all knew what that meant. It was not unusual to see a cachectic little old man wheezing and expectorating green mucous gobs while attempting his ascent. A resident holding his IV bottle and offering encouragement by pushing from behind was not unusual. I always remembered to watch out for slick, green spots when running up the operating room  stairs for an emergency call.

A couple of the older operating rooms actually had large skylights for natural lighting. Overhead lights had been added later in a modernization move, but those light rays beaming in were really a boon to surgery. Everyone really liked the naturally lit rooms and this was another good reason to locate the ORs on the top. After a heavy Chicago snow storm one of the first things to be cleared were the rooftop skylights.

Operating rooms on the top offered the opportunity to vent anesthetic agents which had the propensity to rise skyward when released. Today, I suspect all anesthesia is administered by a closed rebreathing circuit. In my time, it was not unusual to have an open system where exhaled gases from the patient were vented right out an open window via a clever device known as a "blow hose." Had the operating rooms been located on a lower floor of the hospital, the vented anesthetic agents could have anesthetized a captive audience, the patients on the wards. Whenever maintenance workers discovered deceased avian creatures on the roof we all suspected that it was the anesthetics.

The penthouse location of the operating rooms afforded some fantastic views of Chicago. We had several beautiful, huge, white ceramic scrub sinks located in an alcove with a splendid view of Lake Michigan. (If you would like to read what I think about  those rotten, no good, modern stainless steel scrub sinks, please see my scrub sinks post.)  Those new-fangled metal sinks look like they would be more suitable as livestock feeders and look out of place in a dignified OR. I despise them!  Ooops sorry about getting off topic.  It was a delight to watch the sailboats on the lake while scrubbing up for a difficult case. From time to time, surgeons would take a break from a case to refocus and gaze out the windows for a second or two.  Everyone appreciated the view from the top.

As a youngster, I always dashed up the stairs to reach the operating room suites. A bit of aerobic exercise served to clear the mind and the alternative was unpleasant. There was one old manually operated elevator to the surgical suites and it was manned by a cranky (that's putting it nicely) old man named Tony. He had an obvious, crippling orthopedic problem which he blamed on the entire medical world.  He must have had a series of orthopedic surgeries with a suboptimal outcome. When transporting attendings, he always kept his mouth zippered, but with nurses or residents he let the venom fly. He would begin by accelerating the elevator car up like a rocket and aggressively slamming on the brakes at the last minute leaving a gap to climb up to the 7th floor operating rooms. Upon arrival he would announce "butcher shop..everybody out."  I tried to avoid this at all cost. I suspect someone gave him the job out of kindness or because they felt sorry for his plight.

The other nice thing about being on the top floor was the relative peace and silence. Despite the posting of QUIET..HOSPITAL ZONE signs, the din of city traffic could always be heard on the lower hospital floors. I remember when James Taylor sang that old Drifters song "Up On the Roof." The lyrics "On the roof it's peaceful as can be. And the world below can't bother me."  It sounded to me he must have been singing about the location of the operating rooms.

Another feature of top floor operating rooms was a hybrid climate control system. Insects could not fly very well above about the 3rd floor so in the Spring and Summer we could open our windows. Winter meant that it was time to fire up the radiators and if they put out too much heat we could always open the windows. Whippersapperns think hybrid operating rooms are a new thing, but we had them back in the good old days of big open surgeries.

When our old penthouse operating rooms were finally retired, the area was redone at great expense to house the offices of our esteemed hospital director. What a great testimony to the value of the top floor location. Our brand new operating rooms were smack dab in the middle of a brand new building. Something always seemed like it was missing.

Terrific Terrazo Floors

Terrazo floors were common place in old hospitals, found in halls and heavy foot traffic areas like operating rooms. They were created by mixing small stones, usually of different sizes, in a dyed concrete mix. The mixture was then  poured into forms that were cross-hatched with metal dividers spaced a couple of feet apart.

After the concrete set, the floor was ground down with progressively finer discs on a big grinding machine that resembled a super heavy duty rotary floor polisher. The end result was a very beautiful floor surface that resisted stains such as betadine or blood and lasted practically forever.

As a youngster I had the opportunity to talk with workers installing a new terrazzo floor in an operating room. They were Italian (Terazzo means terrace in Italian) and they were a proud, hard working group of men. The process was very loud and dusty from the grinding down of the concrete stone matrix, but they actually seemed to enjoy their work. The end result was truly a work of art. I am sure the cost of doing this today would be astronomical and I suspect this is the reason terrazzo floors disappeared.

These are two beautiful examples of a terrazzo floor with a silver metal dividing strip down the middle. Our operating room had much darker terrazzo floors with a greater diversity in size of the stones and beautiful gold dividing strips.

In the foreground is a very nice illustration of a terrazzo floor in an older operating room. Notice  how the ceramic tiled walls and terrazzo floors combine to create a certain ambience.  Important things are going to be happening here. These are hallowed halls.

I have seen plain white flooring in contemporary operating rooms heavily stained a yucky yellow color from the prep. A dirty looking floor in the OR does not inspire confidence. Plain looking flooring looks like it belongs in an airport or school, certainly not in a sacred place like the tiled temple of an operating room.

Now for some foolishness. A typical scenario for a scrub nurse on call would be to awaken to a call in the middle of the night stating,"There has been a multi vehicle accident on Lake Shore Drive we need you in the operating room ASAP." I would jump up out of the call room and run to the scrub sink and begin my scrub and  about 10 minutes later I was ready for showtime with my mayo stand set up and my back table loaded for bear. I was chomping at the bit and ready for any thing. Let me at 'em.

Now for the fun part. Sometimes we had to wait up to an hour before the patient arrived in the OR. I really don't know all the reasons for the hold up, but suspect it had to do with stabilizing vital signs and establishing an airway or further diagnostic studies. Peritoneal taps to evaluate internal bleeding were common before CT scans became available. Sometimes the poor soul died in the ER before even making it to the OR.

Dr. Oddo, my favorite neurosurgeon, frequently reminded us that in our line of work it was important to have diversions and relax when you have the chance. He was a really affable, pleasant man  outside the OR with lots of good friendly advice. His diversion was a sailboat docked at Montrose Harbor where he spent much of his spare time.

One of the most important times to stay loose and relaxed was during that wait for the trauma patient to arrive. I would stand between my Mayo stand and back table, guarding their sterility, then begin meditating on the beautiful terrazzo floors. It was a lot cheaper than a sailboat. Once Dr. Oddo observed me deep in my meditative trance and said "How nice, Old Fool was praying." I didn't say anything to contradict him, but I was really exploring cosmic frontiers in the terrazzo floor.

These  floors could be like exploring the solar system if you studied them closely. You could easily identify the planets from the different sized stones imbedded in the floor. For more visual props, distant galaxies like anesthesia can contribute things like yellow tops from KCl multi dose vials to represent the sun. Does Mars have water that could support life? According to that pool of I.V. fluid that was just dripped onto the floor, it does.  Wow is that a meteor shower? Nope, just the lights being reflected through anesthesia's IV bottles.

Staring at the straight gold dividing lines and comparing them to random round stones always made me wonder why there are no straight lines in the natural world. Those straight metal dividers always reminded me of the big straight incisions and what a contrast they were to soft round organs and tissue. Were we doing the right thing here?  I also sometimes wondered if all those little stones in the floor were symbolic of the rocky recovery faced by some of the unfortunate victims of trauma. Life can change in the blink of an eye.

Wow things are getting out of hand here, it sounds like a catastrophic meteor shower out in the hall. Nope, it's the arrival of our patient attended by a band of frenzied care givers. As Dr. Oddo would say, "Let's hit it!"

Scrub Sinks

I've been meaning to write a post comparing modern scrub sinks to those of yesteryear, but I haven't been able to get Cherry Ames off my mind since that last post. It's an addiction of sorts that rears it's ugly head from time to time.

A 12 step approach is probably in order here. I've been practicing that opening line, "My name is Oldfoolrn and I'm a Cherry Amesohloic." Oh well, I could give her up anytime, maybe next week. I'll get some help. She is interfering with my blogging, but I'll just have to try harder to put those Cherry Ames books down.

How is this one for a classic? "Cherry Ames, Rest Home Nurse."  Cherry  even avoids the pejorative connotations of using that nursing home terminology in the title. I bet there is nary a mention of decubitus ulcers or manually removing a fecal impaction. Just look how delighted that cheerful oldster beams as Cherry greets him. I like how that head gear tells a story. Cherry in her nursing cap and the oldster tipping his stylish hat to Cherry. There was nothing like a cap to establish a nurse's identity.


Well that's enough of Cherry. Recently a whippersnapperrn invited me to view a new operating room suite at the local hospital healthcare system. Wow! the first thing I noticed were the scrub sinks. They looked like something out of my grandchild's toy kitchen. Stainless steel might look nice in a gourmet  kitchen. But from my perspective completely unsuited for a surgical environment.

The noise made by the cascading water striking the stainless steel sink sounded vaguely familiar. Then suddenly like an epiphany, it came to me. The sound was an exact replication of a drunk voiding on a garbage can lid. This used to happen constantly in the alley behind my Chicago apartment.

The willy-nilly placement of these modern scrub sinks is another issue. Just hang them on a wall near the OR. Back in the day of huge porcelain sinks, placement was an important consideration. I have seen old time scrub sinks positioned with a beautiful view of the Chicago skyline or with a view into the OR. It was nice to be able to fix your gaze on pleasant distant scenery before all that close up work ahead in the OR. It was also fun gazing into that tiled temple of an operating room imagining how you were going to set up your Mayo stand.

That puny little foot activated faucet head is pathetic. It puts out as much water as  an octogenarian with an enlarged prostate. It's probably energy star approved, but we never worried about that. Our sinks had a length of perforated pipe running above and parallel to the sink. Water could be toggled from a trickle to Niagara Falls level with a knee operated valve. Nothing makes a lowly scrub nurse feel more powerful than knowing you have the capability of replicating a natural wonder like Niagra Falls by just a wiggle of your knee.

These new fangled  little sinks don't have the depth of yesteryears sinks. We never had to worry about contaminating ourselves on the back of the sink because it was a mile away. Likewise, the bottom of the sink was also a mile away. You never had to worry about contacting it with your arms.

Now this is a scrub sink. Proudly emblazoned with a name like AMERICAN STANDARD or SPEAKMAN. I can close my eyes and still see that proud name printed in blue on that brilliant white porcelain sink. When you were called in on a late night trauma, it was a real pleasure standing before this sink scrubbing. The brilliant white finish waking you up and preparing you to face those bright overhead lights in the OR.

We were required to scrub a full 10 minutes before each case usually with Phisohex which was later found to be a neurotoxin. I guess I could blame some of my dementia fueled foolishness on the scrub soap. We were also required to scrape out that subungal area under our nails before the first case. Your nails were required to be trimmed 1mm. and we actually had a supervisor that measured fingernails. Who knew that area under your nails had a fancy name like subungal? We never learned that one in anatomy class!

These scrub sinks were so big that they had another use. When a surgeon removed a questionable specimen, pathology would come up to the OR and dissect it in the sink. That white porcelain offering a beautiful neutral background for the specimen. I recall one instance when a pre op patient was parked in the hall and started to witness one of these intraoperative dissections. "Yecch! what's that?"  she shrieked. I sheepishly informed her it was a portion of a stomach and quickly relocated her down the hall. I felt really bad for her and stayed at her side until her room was ready for her. I guess she was more curious about what was going on than any thing else.

Comparing old and new scrub sinks is like comparing a modern Mini Cooper to an old Cadillac Eldorado. Sure. The Mini Cooper is far advanced and sophisticated, but it still feels like something is missing. Well I have to get back to reading Cherry Ames: Department Store Nurse oops I mean watching TV.