|
|
These stories are true, but the names may be For the first seven months of my year at the 71st, brain surgeries were done by Percy (can't remember his last name), another tech. He had the most experience and was always assigned to scrub in with the neurosurgeon. I was sometimes scheduled to circulate on the cases, which meant that I also got to prep the patient. In the military medical mind, hair is equated with "contamination". One part of my training (91 Delta...Operating Room Specialist) related to how to prepare the patient for surgery. The rule of thumb was no hair within a foot in any direction from the incision/wound. When doing any type of belly surgery, the patient would be shaved from nipples to knees...EVERY hair had to go! This led to some rather amusing stories during my OJT (on-the-job-training) at Fort Sill, OK. One involved a General, me and a 4" straight razor...I'll let you figure that one out. It's amazing how humble a general officer can be when presented with 4" of cold, sharp steel being waved around something he values highly. With combat head wounds, there was some leniency given with regard to hair removal. An operating area of 2-3" around the wound was acceptable. Our mission was to get the patient stable, then Evac him to one of the bigger hospitals along the coast, or possibly to Japan. The prepping procedure we used was to remove as much hair as needed with electric clippers then shave with a straight razor to get down to the skin. Then we'd perform a two-minute scrub of the skin with antiseptic soap. On one occasion, I was called on to prep a patient with a serious head wound. After placing him face down on the OR table, with an extension on the table to cradle his face (can't remember what it was called), I got ready to prep him. His hair was full of blood and there was a 3" exit hole in the crown of his head. He was dripping blood and brains onto the floor, so I placed a waste bucket under his head. The entrance wound was high on his forehead. There was a considerable amount of brain tissue extruding from the exit wound. I asked the surgeon what I should do about it. He remarked that I should just remove it. This made sense because the tissue was grossly contaminated and damaged beyond repair. We couldn't just stuff it back in the guys' head and close him up, so I lopped off the brain tissue that was hanging out with my prep razor. It fell with a dull "plop" into the waste bucket. Someone said, "There goes the third grade." I proceeded to scrub the area and the surgery continued. I don't remember how that patient did, but have often wondered how he did, or if he even survived. We never saw our patients again after we'd operated on them. We had no connection with them and didn't really want to have one. It was only their anonymity that made it possible for us to work on them dispassionately. If we had known them, our work would have been unbearable. As it was, we buried our emotions and covered our horror with expressions of gallows humor. The more horrible the situation, the more we covered up by being "tough". Tears would have been logical, even reasonable, but totally unacceptable. The emotion that couldn't be expressed in the OR or ER came out in often bizarre and inappropriate behavior when off duty. Some abused drugs or alcohol or indulged themselves in other ways. Today there would have been a whole team of skrinks, working full-time, to counsel and help us deal with it . At that time, though, everyone just dealt with it however we could and went on. We had a job to do and we did it. Those who couldn't hack it didn't last long and weren't missed when they left. We had zero-tolerance for anyone who couldn't do their job. After Percy left, as senior OR Tech, I was grabbed one busy night to scrub in on a head case. There were a couple of other ORs going, so we were very short-handed. Usually three people scrubbed in on most cases...surgeon, first assistant and scrub (nurse or tech). The surgeon would do the cutting, first assistant would assist, holding retractors, suturing, etc., and the scrub would thread needles, pass instruments and try to keep things organized. For this case, only the surgeon and I would be scrubbed in. That meant that I would get to retract tissue, thread sutures, pass instruments, cut off tied knots, and EVERYTHING else! Not a good situation going in. Aside from the fact that our team would be one person short...it was my first neuro case as scrub. After the head was prepped and we got the patient draped, Tony (the surgeon) made the inital incision and we clamped and tied off the bleeders, then retracted the scalp, exposing the skull, which had a 1/4" entrance wound, but no exit wound. In neurosurgery, as opposed to general surgery, we used little, tiny sponges about 1/4-1/2" square to soak up blood, so I had a lot of those cut and ready on the instrument stand. After a few minutes' work, we had cut away enough of the skull to expose about a 1" circle of dura mater, the membrane that covers the brain. There was a very small hole in the dura, into which, I had no doubt, a bullet had gone. There was almost no bleeding, but the dura was bulging upward, indicating increased intracranial pressure. Tony looked at me and said, "Let's go in." and made a small incision in the dura. Instantly a jet of blood under pressure shot from the hole, hitting the ceiling and showering us with blood. Without thinking, I stuck my finger in the hole, shutting off the shower, but also tying up my right hand. This, I thought, was NOT GOOD!! With wide eyes, I looked at my surgeon. His eyes were also pretty wide. "Good move!", he said, "Now, don't move that finger and give me a big sponge on a stick". (surg talk for a neuro sponge clamped in a hemostat...you'll just have to endure the surg talk...no time to explain everything. If you really want to know...join the Army and sign up for 91D training...they'll clue you in).
The rest of that case is pretty much a blur, but I remember being really
scared for the first time on a case, and I'd done hundreds by that point. The
fact that I was in unfamiliar territory and had no previous experience only
added to the stress. I
don't even remember if the patient lived or died, but it seems like he was
alive when we sent him to post-op. Somehow I managed to hand Doc the instruments
he needed, working one-handed for a while. We worked our way into the patients'
brain, finally locating the source of the bleeding, a small hole in the superior
sagital sinus (not a good thing in which to have a hole!). I don't know if we
found the frag or bullet that caused the damage. As I said, what I remember
are the details of going in and having the eruption of blood, then just the
terror I felt. My fear was that I would screw up and the patient would die as
a result. In all of my other cases, the team was large enough to overcome a
mistake made by a team member. In this one, it was just me and Doc. Neither
one of us had any margin for error. Comments: E-mail me Thanks for visiting ...SP5 Steven Streeper
|
