The glamor of surgery

i-e7a12c3d2598161273c9ed31d61fe694-ClassicInsolence.jpgAs I mentioned, I was on the road over the weekend. Unfortunately, that means I didn’t manage to come up with a new post for this morning. That’s OK, though. Off to the archives we go. This post originally appeared on February 7, 2006. Holy crap! That’s over two years ago!

Enjoy (I hope). Fear not, new stuff will appear this afternoon or tomorrow. I just didn’t manage to have time to finish today’s intended post and bring it up to the high standards I demand. If I have time I’ll tune it and post it this afternoon.

Nonmedical people always seem to have a conception of surgery as being a particularly glamorous profession. So did I to some extent before I entered medical school, although my surgical rotations quickly disabused me of that impression. Somehow, working from 5 AM to 11 PM every day and several hours each day on the weekends, combined with the grunt work that had to be done, just didn’t seem as all those medical shows. All one has to do is to spend a night in the emergency room draining perirectal abscesses to know how unglamorous surgery can be. Not that it mattered. Something about surgery hooked me, and even all of the abuse that I endured failed to deter me. I have to wonder how it is now, given the 80 hour work week. That takes away one of the biggest downsides of a surgical residency, the five years of every other or every third night call that I endured, aside from the occasional respite rotating at the VA Hospital, where call was only every fourth night and usually fairly benign.

The “glamor” of surgery was driven home to me in a rather spectacular way one night back when I was a second year resident on the trauma service. It had been a particularly busy weekend night (Friday or Saturday, I don’t remember). It was the dark hours between 3 and 6 AM, when things usually shut down (or at least quiet down enough to allow those of us on call to lie down for an hour or two), and we had tucked in the last trauma victim. It’s the lowest ebb of the night and a resident’s energy. The trauma team and I collapsed in our respective beds in the cramped trauma call room. Blissful sleep seemed moments away.

That is, until the screech of four pagers going off simultaneously ripped through the silence.

We all moaned, and, ever so reluctantly, threw off our covers and trudged down the hall to the trauma bay, looking not unlike the characters in Shaun of the Dead pretending to be zombies, except that we weren’t really pretending.

The scene that greeted us was the usual controlled chaos of a multiple trauma, with nurses and ER docs running around doing physicals, drawing blood and inserting IVs, and barking orders. What also greeted me was the horrific smell of body odor mixed with alcohol, through which cut the drunken screeches of two middle-aged men yelling at each other, at the paramedics, and at the doctors and nurses trying to evaluate them.

Yes, the victims were the usual trauma victim variety, but even worse than usual. It was two winos, and the story was actually rather amusing–or would have been if it hadn’t been around 4 AM. Apparently, the two of them had been fighting over a bottle of booze on a railroad overpass when, in a mutual death grip on each other and their favored poison, they had both fallen to the gully below, approximately 20 feet, according to the paramedics. Our chief resident ordered the junior residents to split up, each taking one patient. I took the louder and smellier of the two, trying to protect my interns from what would almost certainly be a more annoying patient to take care of.

There he was, strapped securely to the backboard, neck immobilizer in place. The radiology techs had just finished taking the chest and pelvis X-rays and it was time for the C-spine films, which meant it was time for me to suit up and pull. I explained to the patient what I was going to do (pull on his arms to pull his shoulders down and out of the way, so that–hopefully–we could visualize the C7 vertebrae and the top of T1). He actually cooperated, but leaning over this guy only reinforced the obvious: This guy clearly hadn’t bathed or showered in many days, if not weeks.

It was now time for the fun part.

Time for the Foley catheter.

I once again tried to explain to the patient what I was going to do, namely put a catheter through his urethra and into his bladder.

“You ain’t puttin’ no tube in my dick!” he yelled.

I tried to reassure him over and over that it was necessary. No go. He just kept yelling, “You ain’t puttin’ no tube in my dick!” It’s at this point that the experienced resident knows that a doc’s gotta do what a doc’s gotta do.

Just do it.

So I began. I gloved up, got the head cleaned off with iodine, tested the balloon, and lubed up the catheter. Time to get started. I grabbed the object of the procedure and began.

And got blasted in the face with what had to be the most impressive urine stream I had ever seen in my life.

Maybe he didn’t need the tube in his dick after all.

“Ack!” I yelled, jumping back more athletically than I would have thought my skinny body, pasty white like a mole from months without significant exposure to the sun, could move, particularly given the lethargy I had been laboring under until this point. Fortunately, I was wearing protective eyeware and a mask, but, sadly, those masks are designed to protect from blood spatters. They aren’t water-tight for a high-velocity, high volume splash right in the face. Gagging, I ripped off the mask before more of the foul liquid soaked through, but too late to prevent the taste of urine from reaching my mouth.

“Go wash your face,” my chief resident told me.

No shit, Sherlock, I thought. He didn’t have to tell me twice. Fortunately, neither patient was unstable, and their injuries appeared relatively minor; so the team could function without me for a while. I headed for the nearest bathroom and scrubbed my face raw. Even after I was done, I couldn’t shake the feeling that I was unclean. Unfortunately, there was no time to go back to the call room to brush my teeth.

I headed back to the trauma bay, cursing myself for not being more careful. I had had some near misses before. It had to be the exhaustion that led me to an intern mistake like that.

I headed back to the trauma bay to finish what I had started. Fortunately, another member of the team had taken care of it for me. Later, he confided in me that he hadn’t been particularly gentle about it, although he had taken care to make sure he was nowhere near the line of fire as he put the Foley in.

“Ha, got you good!” A drunken laugh greeted me, as I took over the patient’s management again.

Why was it again that I wanted to be a surgeon? I asked myself.

I couldn’t provide myself with an answer.

And I never did find out who got the bottle of booze.