flame thrower

it's funny where one sometimes finds useful pieces of information. i mean the story of the flame thrower i think was maybe told with a slight embellishment, and yet i have found it useful quite a few times.

in the old days us registrars quite often were left in deep water. it was the theory of survival of the fittest being put to the test. and it also worked on the registrars. the less fit didn't make it.

one of my friends opened up an abdomen late in the afternoon that was the sort of abdomen you actually should open early in the morning. you see after four it was pretty difficult to get a consultant back onto the hospital premises at kalafong. quite soon he realised he was in trouble. the patient had a massive inflamed brittle friable kidney on the one side that looked like it needed to be removed. yet every time he poked it it would bristle in rage and threaten to bleed. he simply didn't know what to do. he called his consultant whose name appeared on the call list. the consultant told him there was no way he was coming back and wished him the best for the rest of his call. they then phoned the consultant of the other firm who wasn't on call. this man started out in a bad mood on any given day but was also not the type to leave someone who didn't need leaving. after the obligatory frothing at the mouth he said he would come in and help.

while my friend waited he tried a few more times to tease the kidney out but when the anaesthetist started making noises about the fact that the swabs were becoming redder seemed to somehow coincide with the fact that the patient was becoming more unstable he decided to just compress and wait.

the consultant arrived, his eyes glazed over with anger. as he entered the theater everyone went silent. the urgent bleeping of the pulse oximeter suddenly sounded deafening in comparison to the sound of all the held breaths of all the people in theater. he walked up to the patient and glanced at the kidney with disdain. even the kidney went silent. it seemed to know better than to mess with this man. then without a word he walked off to the scrub room. there was an almost audible sound of everyone exhaling together.

moments later the consultant once again approached the table. the registrar gave way as he started explaining his dilemma. the consultant mumbled something, either to himself or maybe a warning to the delinquent kidney. he then reached into the abdomen and with one smooth motion ripped the kidney out. he then turned to the floor nurse and spoke for the first time.

"set the cautery to flame thrower!" with that he systematically controlled the more than liberal ooze from where the kidney had been. it was the sort of thing you could laugh about afterwards. at the time no one was so foolish.

many years later i discovered that the flame thrower setting was actually quite useful in liver and even spleen oozes when nothing else helped. and, yes, each time i would turn to the floor nurse and with the driest voice possible would bellow,

"set the cautery to flame thrower!"