Sunday, May 24, 2009

lights, knife, action

i was reading a post by a really good medblogger i follow. it reminded me of an incident years ago when i was rotating through neurosurgery.

now neurosurgery lends itself to tracheostomies (long intubations in people who tend to not want to breathe on their own). i soon became pretty good at an icu unassisted trache (that was the way we did them then). then the new guy arrived.

the new guy was a rotating orthopod. the neurosurgeons knew i would be leaving soon and their reprise from doing all their own traches would come to a sudden end. when the orthopod expressed interest in learning the procedure they saw an opportunity and quickly appointed me his teacher. as usual there were a couple to do that day. i'd do the first and he'd do the second. then he would be on his own.

the demonstration trache went well. i tried to point out all the tricks i'd learned with the thirty or so tracheostomies i'd done. he watched in silence, occasionally nodding his head in acknowledgement. and then it was his turn.

we walked together to the outlying icu where our next patient was. there were quite a few icu units in that hospital. when the neurosurgical icu was full any new neurosurgery patients could find themselves landing in one of any number of outlying icu units. generally these weren't quite as geared for neurosurgical patients but they were good enough.

finally my young apprentice put steel to skin. immediately i realised this guy had a natural acumen for surgery. he seemed to intrinsically know what to do. his movements were precise and achieved exactly what was intended. he definitely didn't need any advice from me. there was only one thing not right.
"sister, please call the anaesthetist on call." the orthopod stopped dead in his tracks. his head shot around to look at the monitor. as soon as he confirmed the patient was stable his head swivelled back to stare at me almost accusingly. then he got back to work. he knew there was basically no way an anaesthetist in that hospital would actually come out of theater, much less to make the long trek up to this out of the way icu. and if he did come all the way, it better be to miraculously raise someone from the dead. anything less would be beneath the gas monkeys of that hospital.
"sister, please call the anaesthetist on call!" i repeated. she also could not believe me, but dutifully moved towards the phone.
"why?" she asked as she lifted the receiver.
"the lights are not right. tell him to come and position them for us please."

again the orthopod stopped operating, but this time it was because his body was convulsing with waves of laughter.


Jabulani said...


rlbates said...


anne said...

careful! or you'll find yourself listening to whatever music you hate the most next time you're in theatre. They can take revenge if they want to.

The Hippocratic Oaf said...

Haha! Surely the theatre nurses would oblige.

Are tracheostomies routinely performed by neurosurgeons? Over here it's the ENTs forte.

Bongi said...

oaf, in the end the icu nurse did adjust the light. suppose it seemed like less effort.

generally the neurosurgeons do their own thracheostomies and pharyngostomies. there is one in these parts who asks me to do them for him.
no self respecting general surgeon here would call an ent guy for a mere trache.
even the physicians here often ask the general surgeons and not the ent people.

The Hippocratic Oaf said...

Ah, the tracheostomies I saw were performed by the ENT reg and SHO, not the consultant. He probably did have more to attend to!