Monday, June 27, 2016
Saturday, June 25, 2016
Name That Old School Object
These gizmos were few and far between but it was always good to find one. If they ever clogged up, close the lid and flush away to your heart's content. Here are some possible answers. Just pick one of the answers or enlighten me with one of your own.
It's a science project gone awry. It was designed to be a tornado replicator. Just add some water and you can experience all the fury of a typhoon.
It's actually a horizontal hopper. Just invert the bedpan, close the lid and let it work it's magic.
This is actually a distilling device for custom making irrigation fluid.
It's actually an old school public address system. The nurse just bellows into the megaphone like device and everyone on the floor can hear her. "I need help with a lift in 221 bed 1 or visiting hours are now over."
I promise to reveal the correct answer real soon.
I promise to reveal the correct answer real soon.
Tuesday, June 21, 2016
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.
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.
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.
|
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.
Sunday, June 12, 2016
Sleeping Pills: A Hypnotics History From 1960-1990
Sleeping pills always reminded me of the organized crime situation in Chicago; widespread, old players withdrawn (or jailed), new players or pills on the scene every decade, claims to be safe and acceptable, but very dangerous, and often fatal with long term use.
In the 1960's the big time hypnotic players were barbiturates such as the alluring red/pink Seconal. These little capsules were like a knock out punch in a medicine cup. After witnessing their power, I used to get sleepy just looking at the potent pill. Give one of these little 100mg capsules to a patient and it was guaranteed that in 30 minutes they would be sawing logs. I used to speculate that in a pinch these gems could be used for light anesthesia in minor cases. I discovered that notion was not far from the truth. Dr. Bustoff, our plastic surgeon, used to order Seconal prior to performing local cases with Lidocaine. I vividly recall one case involving the excision of multiple sebaceous cysts where Dr. Bustoff underestimated the length of the procedure and the patient began to arouse. "Tell him to stop screaming and give him 100mg of seconal STAT," was the order from the good doctor. Sure enough, 5 minutes later the patient was sound asleep and business went on as usual in the OR. Maybe open heart surgery could be done with a double dose!
Seconal was a drug that was carefully accounted for even before the Controlled Substances Act of 1970. The drug was sold by Eli Lilly and was packaged in small numbered cellophane ( a plastics precursor) packets that were reverse numbered and rolled into strips and packaged 25 in a memorable green box with the Lilly logo plastered all over it. The company must have really been proud of this product. Nurses had a tremendous amount of respect for this powerful drug and I was never aware of diversion or abuse issues with nurses, although I have heard stories about health care workers becoming addicted. This drug was like penicillin in that fancy marketing campaigns and drug salesmen were unnecessary. The end results speak for themselves and did not really require promotions.
Occasionally, Iresearch google something before I write (if you could call it that) about it. It was shocking to me that a pharmaceutical company recently acquired the right to market Seconal and was currently selling it for $3,000 per 100 capsules because the drug had been found useful in physician assisted suicides. Kind of sad, but then I realized that I must have handled over a million dollars worth of this drug. It seemed like almost every hospital patient was on Seconal. As a nurse it always seemed like big money was flowing right through me or around me, but I can't complain, I've always had everything I could want with the wealth accumulated from being a scrub nurse. Life is good and most mornings I couldn't wait to get going in the OR which was probably a lot more important than the money. All of my old colleagues who have gone onto their great reward ran out of health long before they ran out of money.
Around 1970 or so, Seconal began to fall out of favor as it's addictive potential was recognized. A patient experiencing symptoms of barbiturate withdraw was not pleasant and the only way to combat the problem was with reintroducing the drug and tapering off it. Sometimes old school detox treatments were probably not too smart. Abbott labs actually made a D5W solution containing ethyl alcohol to prevent DTs while alcoholics underwent medical treatment. As a young nurse, I noticed a disproportionate number of alcoholics coming from suburbs around Ohare airport. I figured the jet noise must have driven them to the bottle.
In 1970 the shift to "safe" alternatives to Seconal was in full swing. The two I remember best were Doriden and Pacidyl. The most popular of these at our hospital was by far Placidyl. It came in 3 memorable doses; big, green jelly bean 750 mg cartoonish looking gelatin capsules, red gelatin jelly bean capsules which were 500mg and round gelatin 200mg capsules. The 200mg strength was intended to induce sleep if a patient aroused (not likely) from the heavy duty jelly bean capsules. Placidyl was not counted and there were huge stock bottles of it in every med room. Some nurses claimed the 500mg capsules were an effective way to deal with working an occasional night as a daytime sleep aid, but I never really wanted to try it after seeing what it did to patients.
One of the perks of being a senior student nurse was a class bus trip to Abbott Labs in North Chicago, Illinois. This drug company treated us like royalty (so different from our instructors.) We were treated to a really good lunch and a tour of the facility. The Placidyl production line was very memorable with 1000's of those red Placidyl capsules and gelatin waste everywhere from molding the capsules. The excess gelatin was not really wasted, the drug company reused it as backing for the little paper memo tablets they gave away to medical personnel to promote their products. One of the tag lines printed on the Placidyl gelatin bound notepads was; "PLACIDYL...and softly,gentle slumber comes. Rest assured." When I saw this clever slogan the first thing that came to mind was "take one Placidyl too many and rest in peace." How different from the pharmaceutical industry of today that just raises prices to whatever level they please. I don't think that any drug company of today would worry about wasting gelatin or taking the trouble to use it as paper tablet binding material. It was very clever to convert a waste product (gelatin) into a marketing promotion for the product that created the waste. A profit circle of sorts.
Despite an alluring, peaceful sounding name there were big time problems with Placidyl. There was a very narrow margin between therapeutic and toxic levels of the drug which resulted in overdose. I did not have much experience with Doriden, but I think it was so addictive that the FDA banned the manufacture of it. Both Placidyl and Doriden were on the way out in the late 1970's and the new decade ushered in the benzodiazepine era.
Dalmane was a biggie and widely used sleeping pill in the 1980's. Patients used to complain of a funny taste in their mouth in the morning after awakening from a Dalmane induced sleep. To me, it did not seem to have the potent knockout ability of Seconal or Placidyl. In the mid 1980's there was some discussion that perhaps Dalmane had too long of a half life and a short acting benzodiazepine, Halcion was used. From my observation, this did not seem to be effective and there was much patient dissatisfaction. Lots of patients complained from feeling hung over the day after taking Dalmane.
I don't really know what came next in the hypnotic arena, but judging from the direct to consumer advertising, this must be a fertile market. Direct consumer advertising of toxic prescription drugs is one of the dumbest things that I have ever witnessed, but that's a contemporary issue and beyond the scope of my old time foolishness.
Foolishness and science are about as dangerous of a combination as guns and alcohol so don't take anything here as being factually accurate. There is probably enough misinformation in some of my posts to launch a Donald Trump speech. Oopsie, I should not have said that, but at least I have a good excuse. These are old memories sifted through an ancient nervous system.
In the 1960's the big time hypnotic players were barbiturates such as the alluring red/pink Seconal. These little capsules were like a knock out punch in a medicine cup. After witnessing their power, I used to get sleepy just looking at the potent pill. Give one of these little 100mg capsules to a patient and it was guaranteed that in 30 minutes they would be sawing logs. I used to speculate that in a pinch these gems could be used for light anesthesia in minor cases. I discovered that notion was not far from the truth. Dr. Bustoff, our plastic surgeon, used to order Seconal prior to performing local cases with Lidocaine. I vividly recall one case involving the excision of multiple sebaceous cysts where Dr. Bustoff underestimated the length of the procedure and the patient began to arouse. "Tell him to stop screaming and give him 100mg of seconal STAT," was the order from the good doctor. Sure enough, 5 minutes later the patient was sound asleep and business went on as usual in the OR. Maybe open heart surgery could be done with a double dose!
Seconal was a drug that was carefully accounted for even before the Controlled Substances Act of 1970. The drug was sold by Eli Lilly and was packaged in small numbered cellophane ( a plastics precursor) packets that were reverse numbered and rolled into strips and packaged 25 in a memorable green box with the Lilly logo plastered all over it. The company must have really been proud of this product. Nurses had a tremendous amount of respect for this powerful drug and I was never aware of diversion or abuse issues with nurses, although I have heard stories about health care workers becoming addicted. This drug was like penicillin in that fancy marketing campaigns and drug salesmen were unnecessary. The end results speak for themselves and did not really require promotions.
Occasionally, I
Around 1970 or so, Seconal began to fall out of favor as it's addictive potential was recognized. A patient experiencing symptoms of barbiturate withdraw was not pleasant and the only way to combat the problem was with reintroducing the drug and tapering off it. Sometimes old school detox treatments were probably not too smart. Abbott labs actually made a D5W solution containing ethyl alcohol to prevent DTs while alcoholics underwent medical treatment. As a young nurse, I noticed a disproportionate number of alcoholics coming from suburbs around Ohare airport. I figured the jet noise must have driven them to the bottle.
In 1970 the shift to "safe" alternatives to Seconal was in full swing. The two I remember best were Doriden and Pacidyl. The most popular of these at our hospital was by far Placidyl. It came in 3 memorable doses; big, green jelly bean 750 mg cartoonish looking gelatin capsules, red gelatin jelly bean capsules which were 500mg and round gelatin 200mg capsules. The 200mg strength was intended to induce sleep if a patient aroused (not likely) from the heavy duty jelly bean capsules. Placidyl was not counted and there were huge stock bottles of it in every med room. Some nurses claimed the 500mg capsules were an effective way to deal with working an occasional night as a daytime sleep aid, but I never really wanted to try it after seeing what it did to patients.
One of the perks of being a senior student nurse was a class bus trip to Abbott Labs in North Chicago, Illinois. This drug company treated us like royalty (so different from our instructors.) We were treated to a really good lunch and a tour of the facility. The Placidyl production line was very memorable with 1000's of those red Placidyl capsules and gelatin waste everywhere from molding the capsules. The excess gelatin was not really wasted, the drug company reused it as backing for the little paper memo tablets they gave away to medical personnel to promote their products. One of the tag lines printed on the Placidyl gelatin bound notepads was; "PLACIDYL...and softly,gentle slumber comes. Rest assured." When I saw this clever slogan the first thing that came to mind was "take one Placidyl too many and rest in peace." How different from the pharmaceutical industry of today that just raises prices to whatever level they please. I don't think that any drug company of today would worry about wasting gelatin or taking the trouble to use it as paper tablet binding material. It was very clever to convert a waste product (gelatin) into a marketing promotion for the product that created the waste. A profit circle of sorts.
Despite an alluring, peaceful sounding name there were big time problems with Placidyl. There was a very narrow margin between therapeutic and toxic levels of the drug which resulted in overdose. I did not have much experience with Doriden, but I think it was so addictive that the FDA banned the manufacture of it. Both Placidyl and Doriden were on the way out in the late 1970's and the new decade ushered in the benzodiazepine era.
Dalmane was a biggie and widely used sleeping pill in the 1980's. Patients used to complain of a funny taste in their mouth in the morning after awakening from a Dalmane induced sleep. To me, it did not seem to have the potent knockout ability of Seconal or Placidyl. In the mid 1980's there was some discussion that perhaps Dalmane had too long of a half life and a short acting benzodiazepine, Halcion was used. From my observation, this did not seem to be effective and there was much patient dissatisfaction. Lots of patients complained from feeling hung over the day after taking Dalmane.
I don't really know what came next in the hypnotic arena, but judging from the direct to consumer advertising, this must be a fertile market. Direct consumer advertising of toxic prescription drugs is one of the dumbest things that I have ever witnessed, but that's a contemporary issue and beyond the scope of my old time foolishness.
Foolishness and science are about as dangerous of a combination as guns and alcohol so don't take anything here as being factually accurate. There is probably enough misinformation in some of my posts to launch a Donald Trump speech. Oopsie, I should not have said that, but at least I have a good excuse. These are old memories sifted through an ancient nervous system.
Wednesday, June 1, 2016
Self Portrait
Saturday, May 28, 2016
What Happened to Operating Room Sponge Racks?
Here is how that functional piece of gleaming furniture worked. There are usually two flavors of sponges that we carefully kept track of. Laparotomy or "lap" sponges and smaller 4X4s or in our old time vernacular "stick sponges" because they were always used on a ring forceps or sponge stick. Fold the 4X4 in half and then fold in half again snap it into a sponge ring forceps and PRESTO, you just made a sponge stick. I always thought of sponge sticks as the kindling to launch a very nasty diatribe from Dr. Slambow. If a hapless resident mopped up blood from the wound with a windshield wiper like motion the fireworks began. Dr. Slambow would bellow, "You just wiped away all the clots, Are you training to be a barber surgeon? Next time dab the blood, never wipe."
Lap sponges came in groups of 5 and 4X4s always came in groups of 10. The sponge rack had several rows of vertical spike like rods on the top and more rows underneath with the rods much closer together. There were 5 spikes in each row on the top and 10 spikes in each bottom row. The laps get hung on the top spikes via a loop on the corner of each sponge and the 4X4s get skewered on the spikes below. The more timid nurses wore gloves during this procedure but were at risk of being accused of trying to bankrupt the hospital by overconsumption of valued resources like gloves. When the case is over, check to make sure each row of the sponge rack is complete or you have the sponges necessary to complete a row left over on your Mayo stand. Your sponge count is correct and you may advise the surgeon that it's OK to close up.
In real life, surgeons did not pay a whole lot of attention to the circulating nurse announcing that the count was correct. If the surgeon was told the sponge count was incorrect, the standard response was, "It's not in here, I'm closing."
Sponge racks were an efficient way to maintain an accurate sponge count, but they also had secondary benefits. In a previous post "What's the Prognosis Doc," I neglected to mention the sponge rack drip sign. If a sponge from an upper rack drips blood onto a lower rack, things are not going well. This sign was most common in trauma surgeries and was a grave prognostic indicator.
Men really are more sensitive to visual stimuli and the sight of a sponge rack loaded with blood soaked sponges got more attention than a girlie pin up photo in a soldier's barracks. The sponge rack was a graphic visual display of blood loss. This could be a real boon to the nurses in the classic anesthesia vs. surgeon transfusion argument. The sponge rack told the story of blood loss and usually left the nurses out of the classic transfusion argument.
When anesthesia attempted to use the volume of blood in the OR suction bottle to bolster their argument for blood replacement, I knew what to say. Dr. Slambow would insist that the volume of irrigant was huge and the suction bottle was not a reliable indicator of blood loss. He would then nod to me and I would nonchalantly reply, "Oh yes, I have used a couple of bottles of irrigant." It was a classic reply just like the drunk who told the cop he had consumed just two beers.
Sponge racks also spurred my contemplative thoughts. Looking at he blood soaked sponges,I marveled at where all this blood had been as it constantly coursed through someone's body. It had been batted about by heart valves, squeezed through tiny openings, exchanged gas in the alveoli, and absorbed nutrients from the gut. It seemed strange to see something that had been in constant motion just sitting there. The pattern of the bright red blood on the sponge was the operating room equivalent of a Rorschak ink blot test. I have personally seen lots of angels and crosses etched in brilliant red on the hanging lap sponges. I usually tried to only see good or encouraging images in the blood stains, but I swear once on a gunshot trauma victim there was an accurate image of a pistol. YIKES.. I better just stick to counting the sponges.
Part of my daily routine after coming home from working in the OR was to sit down and watch "Andy's Nickelodeon Theater on WGN (channel 9) TV. My favorite part of this show was watching Three Stooges Shorts. I became convinced that a sponge rack would be a perfect prop for one of their routines. Dr. Slambow was always hollering at new scrub nurses about their casual handing off of surgical instruments. He relished a very hearty slap of the instrument into his waitng hand. If a novice scrub nurse passed an instrument without the slap, he would bellow, "Let me have it so I can feel it!" I imagined that this would have been the perfect time to lob a blood soaked lap in his direction. The sponge had that gooey, sticky feel to it just like one of the Stooges pies. "Here is blood in your eye." I would holler back as I lobbed the sponge.
Like many other elegant objects made of durable metal, sponge racks were killed of by the widespread use of plastics. In 1970, give or take a year someone came up with an alternative to sponge racks. The kick basin was lined with a plastic bag and the overwrap from an instrument tray was draped over the plastic bag. The scrub nurse tossed sponges into the kick basin and when there were 5 laps or ten 4X4s in the basin, the circulator grouped them together and tossed them under the overwrap. This newfangled method worked well, but the visual impact of a loaded sponge rack was gone forever.
Friday, May 20, 2016
Derifil - Nose Plugs in a Bottle
Before the advent of air conditioning and ventilation systems, hospitals were a virtual cafeteria of disgusting olfactory stimulation. The various offensive smells would just hang in the halls of the hospitals. Often times you could tell which ward you were on just by the character of the different smells. I think the worst was probably the detox ward. Combine the pungent stink of paraldehyde with every effluent a body could expel and you get the picture.
I remember a job interview where the meticulously attired supervisor asked me what my priorities would be if hired. The response popped into my head and I spouted out without much thought, "The ward smells just terrible. I would do something to mitigate the stink." The boss looked somewhat bemused, but offered me the job.
Traditional odor control involved opening as many windows as possible, using fans, dumping soiled linen as quickly as possible, and cover-ups like Airwick sticks positioned on door transoms. These odor camouflaging sticks looked like large green candles and did manage to add another olfactory flavor to the mix. I hated the smell of these green monsters as much as the scent from expelled lactulose enemas. I know it sounds paradoxical but those Airwick sticks had the nastiest "clean" smell that I have ever inhaled.
There was a revolutionary pharmaceutical product that was introduced at our hospital in the early 1980's. It was called Derifil and the product insert with this drug made some spectacular claims that had nurses enthralled.
This stuff was a chlorophyll derived medication administered orally in a beautifully colored greenish/black pill. We were totally fascinated by this pills color. Some said that it was the greenest black color they had ever seen and others insisted that it was blackest green color. Anyhow, it was very unique.
The medication was touted as an internal deodorant that actually quashed odors within the patients body before the stink could be expelled. It was said to quench the odor of stool, emesis, and even wounds draining purulent goo. I never figured out how a patient with vomiting could retain an oral dose, but the product insert did indeed specify that Derifil would destink an emeisis. We thought the hospital should obtain candy dishes to dispense this miracle drug. Just fill the dish to the brim and pass out the green/black miracle pills to every patient in sight with double doses on the detox ward especially prior to administering Lactulose enemas.
The Derifil era at our hospital only lasted for a couple of years and was quickly forgotten. This stuff was definitely effective at mitigating the odor of stool and doctors would order it for some patients that were squeamish about their new colostomies and were preoccupied with the odor.
Derifil was introduced before pharmaceutical companies were clever enough to medicalize and come up with a pathological sounding name for the disorder and physicians did not recognize odor control as a serious medical issue. Maybe if the drug companies marketed Derifil to combat OOD (offensive odor disorder) the odor control game could have been propelled to a new paradigm. Without clever marketing, Derifil came to be regarded as a lifestyle drug before anyone even heard of lifestyle drugs. Physicians and patients alike failed to see odor control as a significant medical problem.
I also think that lack of compliance with the odor control regimen may have been an issue. Who wants to acknowledge that they stink so bad they have to take a pill? People have evolved through the years an ability to tolerate their own body smells no matter how bad. I have been in attendance at many code browns (a great new term I picked up from you whippersnapperrns) where the nurses and aides are gagging and resisting the urge to run away while the patient lies there without batting an eyelash. People are basically immune to their own bad smells and not keen on taking a drug like Derifil.
Derifil seemed like a good idea at the time, but it quickly fell out of favor. I wonder, with new pharmaceutical marketing techniques this medication could be resurrected and become a commercial success.
I remember a job interview where the meticulously attired supervisor asked me what my priorities would be if hired. The response popped into my head and I spouted out without much thought, "The ward smells just terrible. I would do something to mitigate the stink." The boss looked somewhat bemused, but offered me the job.
Traditional odor control involved opening as many windows as possible, using fans, dumping soiled linen as quickly as possible, and cover-ups like Airwick sticks positioned on door transoms. These odor camouflaging sticks looked like large green candles and did manage to add another olfactory flavor to the mix. I hated the smell of these green monsters as much as the scent from expelled lactulose enemas. I know it sounds paradoxical but those Airwick sticks had the nastiest "clean" smell that I have ever inhaled.
There was a revolutionary pharmaceutical product that was introduced at our hospital in the early 1980's. It was called Derifil and the product insert with this drug made some spectacular claims that had nurses enthralled.
This stuff was a chlorophyll derived medication administered orally in a beautifully colored greenish/black pill. We were totally fascinated by this pills color. Some said that it was the greenest black color they had ever seen and others insisted that it was blackest green color. Anyhow, it was very unique.
The medication was touted as an internal deodorant that actually quashed odors within the patients body before the stink could be expelled. It was said to quench the odor of stool, emesis, and even wounds draining purulent goo. I never figured out how a patient with vomiting could retain an oral dose, but the product insert did indeed specify that Derifil would destink an emeisis. We thought the hospital should obtain candy dishes to dispense this miracle drug. Just fill the dish to the brim and pass out the green/black miracle pills to every patient in sight with double doses on the detox ward especially prior to administering Lactulose enemas.
The Derifil era at our hospital only lasted for a couple of years and was quickly forgotten. This stuff was definitely effective at mitigating the odor of stool and doctors would order it for some patients that were squeamish about their new colostomies and were preoccupied with the odor.
Derifil was introduced before pharmaceutical companies were clever enough to medicalize and come up with a pathological sounding name for the disorder and physicians did not recognize odor control as a serious medical issue. Maybe if the drug companies marketed Derifil to combat OOD (offensive odor disorder) the odor control game could have been propelled to a new paradigm. Without clever marketing, Derifil came to be regarded as a lifestyle drug before anyone even heard of lifestyle drugs. Physicians and patients alike failed to see odor control as a significant medical problem.
I also think that lack of compliance with the odor control regimen may have been an issue. Who wants to acknowledge that they stink so bad they have to take a pill? People have evolved through the years an ability to tolerate their own body smells no matter how bad. I have been in attendance at many code browns (a great new term I picked up from you whippersnapperrns) where the nurses and aides are gagging and resisting the urge to run away while the patient lies there without batting an eyelash. People are basically immune to their own bad smells and not keen on taking a drug like Derifil.
Derifil seemed like a good idea at the time, but it quickly fell out of favor. I wonder, with new pharmaceutical marketing techniques this medication could be resurrected and become a commercial success.
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