what is the point of even having surgical principles if you can't finish them off with a light hearted one.
general surgery is roughly divided into two categories. ie. blood and guts. the guts side of things involves feces, stomach content, bowel content, bad smells and the like. the blood side of things is often high drama and adrenaline and is the stuff that the medical tv shows are made of. most of the general public don't really want to hear about the time i did a rectal examination and my glove broke or the fact that the smell of a septic abdomen somehow seeps through the gloves and it can't be washed off your hands afterwards leaving a most unpleasant stench. i considered trying to market whatever it is in abdominal puss that causes that stench as a deterrent for fingernail biting, but it seemed too much effort.
but if you talk about someone bleeding to death and you intervene, this causes an entirely different reaction. it makes school children who watch these tv programms think that they would love to become surgeons. i just hope they don't bite their nails. so, bearing in mind we can only really be glamorous in half of our work, it is sometimes nice when one can get a bit of this glory.
it was post intermediates and i tended to stroll around casualties as i have mentioned before. a good friend of mine and i were in the same firm, so the night in question, we were both together checking out what was happening there. we had nothing better to do for a change.
as we casually walked through casualties (why can't more people be casual in casualties i wonder) we heard a bit of commotion in resus. we walked over and glanced in. what a sight.
there was a guy lying on the table. he had a large gash in his chest just left of the sternum. out of this hole bright red blood was gushing out in torrents. there were two casualty officers poking away with artery forceps but in that amount of blood it was clear they were losing the battle badly. the patient was still moving but his movements lacked conviction and were getting weaker as we watched. obviously they had called the thoracic guy but just as obviously, unless he was just around the corner the patient would be dead when he arrived. i thought that the heart was probably lacerated.
i turned to my friend.
"shall we?" i asked.
"why not?" he replied. and we walked in.
the casualty officers acknowledged our presence with nervous smiles. i asked for a knife. there were only loose blades. i took one and extended the wound. the patient didn't flinch. he was on his way out. i shoved a swab in. my friend hooked the edge of the wound with a retractor, but because of the ribs we couldn't really open too wide.
"i see it , i see it!!" he shouted. he reached for an artery clamp and grabbed the upper end of the transected internal thoracic artery (also known as the internal mammary artery, but because this guy was a guy i've decided to go with internal thoracic). immediately the amount of blood was less. i shifted my retractor and quickly identified the lower end of the transected artery. it's a lot easier when you know what you are looking for. i clamped it. soon we were tying the bleeders off.
we spent a bit more time to put up acceptable lines and call theater to book the thoracotomy for when the thoracic guy actually did turn up.
in just moments we had turned a hopeless situation into at least a salvageable one. when the thoracic guy finally did turn up all he had to do was wait for theater and fix up the hole in the guy's chest (which admittedly we were more than partly responsible for).
then my friend turned to me.
"have you seen outside resus?"
"what do you mean?" i asked.
i walked outside. there were about five nursing students, all wide eyed and all looking at us as if we were absolute heroes. being a surgeon and already being under the influences of an over active ego, i felt pretty good. i did not want to be the one to tell them we had just been lucky with the injury and that a true stab to the heart would most likely not have turned out quite so rose coloured (except maybe a blood red rose of course).