The Disappearance of Needle Stylets

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A thing of beauty is a joy forever. A stylet at home in the bevel of a needle

New fangled disposable injection needles with their cheap looking plastic syringes were just beginning to show up on wards at the beginning of my nursing journey. I just love that "journey" vernacular so common in today's healthcare lingo. See, I can talk just like a whippersnappern if I try really hard.  Anyhow, old school nurses had lots of laments about disposable equipment of any permutation because it  went against the grain. We were taught to reuse just about everything. Throwing away Monoject disposable syringes was bad, but the elimination of stylets was even worse.

Reusable injection needles always had a stylet running the length of the needle bore that terminated at the beveled business end of the needle. Whippersnapperns might start out their day by logging on to a computer, but their predecessors started out by sharpening injection needles. The stylet was a vital component to reusable needle maintenance and sharpening. Ramrodding a stylet through the needle served to clean the bore of any residual debris. When sharpening was completed the stylet served to clear the needle bore of any residual micro shards from the grinding process.

Stylets also served as a template to maintain the appropriate angle of the needle bevel during the sharpening operation. Minimalist minded nurses could sharpen a dulled needle on an ever present match book striker. Needle sharpening was one of those rare instances when a nurse was off her feet and the matchbook was a cue for a quick smoke. Smoking and sharpening needles went together like peanut butter and jelly. Mechanical devices for needle sharpening were most commonly hand cranked gizmos where the bevel of the needle was rocked back and forth by a cam while pressed against a rotating wheel all the while an indwelling stylet maintained the bevel angle.

Every nurse's station needs a needle sharpener

Biopsy needles with their very shallow bevel always have a stylet as a stiffening mechanism and as a control over the cored tissue sample. When sampling liver tissue from an obese patient the stylet is left fully engaged during it's journey (oops..here I go again with that "J" word) through the subcutaneous tissue. When the final liver destination is reached the stylus is withdrawn to snatch a core of tissue. Stylets are also needed to expel the cored tissue from the biopsy needle.

When performing spinal taps or removing fluid from a body cavity, the stylet is also necessary to control the flow of fluid. No stop cock can halt the flow of fluid through the lumen of a needle like a trusty stylet.

Inventive nurses discovered that stylets have  unintended uses that have loads of utility. When the hinge screw mysteriously disappeared  from my ever present eyeglasses a quick fix was needed. I discovered that a stylet from an 18 gauge needle was the perfect diameter to fit the void left by the missing screw. With the stylet in place, it was a simple matter to bend it in the shape of a horseshoe with a needle holder. A perfect fix. It was also common knowledge that a stylet was the perfect instrument to pierce ear lobes for those nurses that liked to decorate themselves with earrings.

It's nice to know that stylets have survived into the present age with spinal tap and biopsy needles, but once upon a time every needle worth it's jab had a stylet.

John R. Brinkley - A Pioneering Transplant Surgeon

Dr. Brinkley in action. Just say BAA

The recent outbreak of Corona virus piqued my interest in past outbreaks so I began reviewing the events underlying the great influenza outbreak of 1918-19 and lo and behold the strange career of Dr. John Brinkley came to light. This man was no ordinary surgeon, in fact his only medical credential was a $500 phony diploma he purchased from the Eclectic University of Kansas. His skills as a pitchman exceeded his surgical skills by huge margin.

Dr. Brinkley, a physician of questionable  competence, to say the least, began his career treating victims of the great influenza outbreak. On  a house call to a farmer named Stittsworth, he found the hapless patient  complaining of impotence, Brinkley had an epiphany that would make him a millionaire. Eyeing the proud testicles of a nearby penned up Toggenburg goat he remarked, "You wouldn't have any tumescence troubles down there with one of those goat glands in you."

The troubled farmer replied, "Well why don't you just put one of them goat balls in me?" To an eager surgeon, the external anatomic character of male genitalia is like dangling the keys to a Pontiac Trans Am before the eyes of a hot rodder. All that exposed  anatomy is just begging to be incised, dilatated, or ram-rodded with a scope.

In 1920, the eager surgeon went to work on the readily accessible scrotum and implanted a goat testicle in the impotent Farmer Stittsworth. There was no neurovascular connection or fancy anastomosis to the vas deferens; the transplanted gland was popped in and left to hang there like a drunk dangling from a bar stool. A rubber crutch would be more functional.

Soon the farmer was singing the good doctors praises albeit a few ovtaves higher about his new found libido. (The placebo effect of sham surgery is even greater than it's pharmaceutical counterpart.)  When the farmer's wife gave birth to a healthy baby boy who was named after the good doctor, word spread far and wide. Large groups of forlorn men showed up at Brinkley's office eager to pony up with the surgeons goat gland  implant fee of  $750 ( equivalent of $10,000 in today's money.)  Exploiting desperate patients like this was a foul ball of the highest order, but Dr. Brinkley was a master of self promotion with little regard for the welfare of his patients.

What he lacked in respect from the medical community he made up with acquisition of material goods which included a fleet of Cadillacs, an airplane, a yacht and an opulent mansion. Before his medical license was revoked in 1923 on the grounds of unprofessional conduct he performed nearly 16,000 goat/human xenographs.

The man who fittingly sported a goatee throughout his career developed a deep vein thrombus necessitating the amputation of his leg in the early 1940s. His handicaps did little to slow down his huckstering spirit. Perhaps the inspiration of sacrificing goats on the surgical alter led him to the study of theology. His dreams of launching a mega church died with him.

Karma seems to catch up with just about everyone. This gland grafting gooofus died penniless.

A Heminephrectomy and a Stock Tip

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

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

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

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

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

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

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

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

Were You Ever Afraid of Contracting Somthing From a Patient?

  I was almost infected with greed fever

Someone on Quora asked me if I was ever afraid of  contracting something from a patient and a plague of answers began swirling around  in what's left of my ancient cognitive vault. Hmm...was it Hepatitis C, influenza, or step throat? Well, no, something else suddenly came to mind and it did not involve a bacterium or virus. It was pure unadulterated greed. Something all too ubiquitous in today's healthcare world and as contagious as the most virulent virus.

As a novice nurse one of my patients was confined to a self imposed isolation in a private room on one of the nicer hospital units. He had a high forehead with bushy eyebrows and  a prominent jaw line that did not betray a hint of weakness or doubt. He had a definite presence about himself.  His name was Ray Kroc and the McDonalds restaurant empire was his brainchild. Billions and billions of burgers meant big bucks and a lifestyle ordinary folks could only dream about.

 The reason for his hospitalization was weight loss. One too many BigMacs had taken a toll on his waistline and rather than purchase a bigger belt he checked into the hospital for a carefully supervised dietary regimen. Rich people do strange things and a  huge monetary donation reserved his hospital bed. Money can buy anything.

He was very friendly and interested in the workings of a big city hospital. After hearing a few of my tales about hospital experiences he came up with a grand  proposition for me. His business sense told him there was a pent up demand for male nurses and not all that many nurses carried XY chromosomes. According to him, a nursing agency for male nurses could be quite lucrative with careful marketing.

I looked down at my lowly Timex watch and compared it to the gleaming Rolex on his fat wrist. Hmm, I thought, maybe I could swap my Raleigh Super Course bicycle for a motor vehicle. I was just about to contract a very bad case of greed as dollar signs danced in my head.

Then I came to my senses. Greed suppression was an integral component of nursing education. Nurses weren't supposed to have much of anything. The ANA code of ethics even prohibited RNs from endorsing any commercial products. All the nurse influencers of today would be in big trouble as money making was definitely not in the cards for a nurse. Nurses were supposed to be selfless caregivers often at their own expense.

I began to think of all the experiences I would miss if I were worried about my balance sheet instead of the names on a Kardex. Being well off financially disconnects you from the day to day activities  that define the experience of everyday folks. I would have missed out on the warmth and caring shown to me by a homeless person in the ER  when he taught me how to keep warm in a Chicago winter by wrapping layers of newspaper around my extremities. I hoped I would never need the skill, but the kindly way it was explained to me stayed with me. I can still see his warm smile.

When nurses leave a  patient's room after a failed code they seldom look back. Somehow I managed to corral my greed impulse and never looked back. An agency for male nurses sounded like a dubious proposition and, besides,  I always thought of myself just as a plain old nurse. No gender qualification needed.

Nursing School Probies Had a Rough Initiation

Right this way to the swimming pool!

First year hospital   diploma nursing students were affectionately referred to as "probies" which was short hand for probationer. Probies had a rough life and were at the mercy of junior and senior nursing students for their first 6 weeks. Some of the more benign pranks inflicted on the  hapless probies were scavenger hunts to central supply for things like fallopian tubes or enema nozzles and  getting doused with water blasted from an asepto syringe.

Some of the initiation shenanigans were a bit shocking and proved to me that estrogen could be just as potent as testosterone when it came to fueling hijinks aimed at demeaning innocent victims. Groups of hospital hardened young women possessed a mystical herd strength fueled by their clinical nursing experiences and were eager to share the misery with novices. Somehow, the girls who were the most faint-hearted became the most aggressive tormentors.

 Nursing was emotionally and physically challenging and the initiation was designed to weed out the more faint of heart. Steel plating was a prerequisite for the rigors of vintage hospital nursing.

Many hospital nursing schools in Chicago  had beautiful indoor swimming pools. Cook County Hospital had one of the fanciest which  resembled a Roman bath complete with marble columns. What a contrast to the stark Nightengale wards packed to the gills with suffering, impoverished patients. Luxury in the midst of poverty always rankled my hackles.

Unbeknownst to probies, our hospital lacked a swimming pool but did have an old fashioned exterior  fire escape tube connected to the second floor freshman dormitory on one end and the great outdoors on the other. In the event of a fire, the fleeing victims opened the double doors to the tube and flung themselves into the awaiting platform that quickly transitioned into a steep descent. Gravity did the rest as the victim flew through the tortuous tube at breakneck velocity landing, hopefully, safely on the outside.

Junior and senior students knew how to grease the skids, so to speak, by applying pilfered bone wax to the inclined tube's interior with ABD dressing pads. This made the descent even more terrifying, especially to the unexpecting probies.

The probie trap was baited by covering the EMERGENCY FIRE EXIT sign on the escape tube's entrance with an ordinary sheet and substituting it with a sign clearly stating: SWIMMING POOL OPEN. The deception was further enhanced by soaking a washcloth with Clorox and tossing it just inside the opening to the tortuous tube. The tortuous tube even smelled like a swimming pool.

"O.K. probbies it's time for a group swim," was the battle cry as the doors to the cleverly disguised fire escape were gleefully swung open. As the probies made their sudden descent a satisfying ( at least to the juniors and senior students,) cacophony of shrieks and screams emerged from the tortuous tubes. Any probbie further back in the line up was advised the screams were in good fun and initiatd by the cold water in the pool.

Merry Christmas

Merry Christmas to all. I can identify with that Christmas tree shown above because although I'm worn out and a bit scraggly, I'm still vertical. I spent a good number of holidays working in the hospital and like my colleagues above always found something to be joyful about even in the most dire of circumstances. There is always a silver lining, especially at Christmas.

Before my brain freeze set in, I came up with this a few years back. My readership was no where near what it is now, so if you need a chuckle, here's the link:    https://oldfoolrn.blogspot.com/search?q=twas+the+night

Nursing Diploma Schools Were Providers With a Price

Diploma schools provided "free" textbooks

It was the crack of dawn on the very first day of a new class and we were seated at our hard wooden chair/desk hybrids. Those  old hardwood seating devices had a writing surface that resembled a bent canoe paddle that followed a serpentine course until it was right in front of you. This clever design averted a hasty exit because you had to swing out laterally before standing up. Scanty student seats like this were scorned by those unfortunate enough to be left-handed as there was no upper extremity support while writing.

Miss Bruiser, my favorite instructor was doing her gestapo waltz around the classroom depositing a brand new text book smack dab in the middle of the business end of the canoe paddle desk. We all knew what was coming next and dutifully treated our new books as if they were a hot branding iron. Like all "gifts" from the school, books came with a harsh admonishment. Everything from uniforms to housing had a price and I'm not referring to dollar signs.

"Before you students put your grubby little lunch hooks on these brand new textbooks, I have a little paper for you to read and sign," Miss Bruiser bellowed as she dolded out the pungent scented mimeographed documents. We were conditioned just like Pavlov's dogs to the scent of mimeograph ink. That unique smell spelled trouble in the form of a test, written admonishment, or stern warning from a rigid authoritarian instructor or senior nurse.

Here is what the nursing school party line was on handling our sacred nursing textbooks. Hold the book  with it's back resting on the surface of your desk; let the front cover down, then the other, holding the leaves in one hand while you open a few leaves at the back, then a few at the front, and so on, alternately opening back and front, gently pressing open the sections until you reach the center of the book. Do this several times for the best result. Open the volume violently or carelessly in any one place and you will break the back and cause a start in the leaves. Never, ever force the back of a book.

I let loose with a muted chuckle before endorsing the mimeographed missive and paid a heavy price; I had to "volunteer" as a patient while the sophomores practiced their phlebotomy skills on my prominent veins.