Sunday, August 05, 2007

Close Encounter

Disclaimer: My spousal consultant, in the interest of retaining my current place of employment, has insisted that I take a moment to note that this case occurred at a previous location, that will go unnamed, although I suspect it has happened elsewhere.
It was a case like every other Friday afternoon - a lady in her 80's who needed a permanent pacemaker after falling at home and arriving to the Emergency Room with a heart rate of 30.

After a careful evaluation of her situation and agreeing that a pacemaker made sense, I discussed the risks, benefits and alternatives to a permanent pacemaker implantation with her, and she agreed.

She was brought to the pre-operative holding area and her left upper chest was prepped with an antiseptic solution for 5 minutes. She was pre-medicated with an antibiotic to avoid infection, and after wheeling her into the electrophysiology laboratory, her chest area was prepped twice more with antiseptic solution.

Great care was used to drape her first in sterile towels, then this was covered with an antiseptic-impregnated plastic film that was draped over the surgical site. Next the sterile final drape was carefully exposed over the operative field to shield all other contaminated areas from affecting the surgical site. A plastic cover was placed over the image intensifier of the x-ray tube, and finally, her face exposed to the nurses on the other side of the bed.

A local anesthetic was infiltrated beneath the skin:

"You'll going to feel a pinch and a bit of burning as we numb up the area here, Mrs. Smith."

She jerked slightly, but soon tolerated the anesthetic. After all, this was the necessary step to avoid the discomfort of the pacemaker implantation. She tolerated the anesthetic administration remarkably well.

A bright light shown from my forehead, an operative light strapped there to permit the light to move where my visual field traveled. It illuminated the surgical area remarkably well, causing the patient to question, "What it that light I see flashing?" she asked.

"Oh, it's just a bright light I use to see into the surgical area, Mrs. Smith." She silenced as the sedation took effect.

A small silver scalpel blade was then pressed against the skin and passed to the subcutaneous tissue in one smooth stroke. Bleeding was managed with gentle pressure and a cauterization unit stopped the flow of significant bleeding.

Suddenly, a small flurry of activity occurred in the back of the laboratory. I was unaware at first. It was just a minor scuffle. But soon one of my technicians could be seen standing on a chair waving a towel.

"What the...? Can I help you guys?"

"No, thanks. Just keep working."

"How the hell can I keep working when you guys are dancing on chairs around the EP lab?"

"Well, it just... well... this...."


"... this... this... fly."

"What the hell are you talking about? You mean we have a fly in here?"

"Yes, sir."

"Turn off my headlight, guys! I don't want that sucker over here!"

The light was dimmed. We stood motionless, waiting for any hint of motion from the little tiny black contaminated object.


We waited.

My technicians had a vague idea where they had seen it last. They approached one corner of the operating suite. Suddenly, like a Komikaze pilot aiming for the sterile surgical drape, the fly turned perilously close to the surgical field but veered off at the last moment toward the room light above. My technician, armed with a medium sided towel, hurled himself toward the critter, but as he turned to address the flying foreign body, his head collided with the xray monitors dropping him to the ground like a giant sequoia. He rose quickly, determined to capture the maggot with wings, blood dripping from his brow. The fly, impervious to the damage below, circled above. I stood scrubbed, helpless.

By now, the nurses, too, had joined the chase. The fly had become Public Enemy Number One. Nothing could proceed until we were assured of its demise. The contol room technician and industry rep, too, helped identify the location and trajectory of the defiled detritus with wings.

"In-coming," I said as the fly approached the surgical field.

A maze of hands attached to towels swooped in to prevent the flying refuse residue from entering our "no-fly" zone. But his velocity exceeded their swipes. As he approached the surical field, they withdrew. The fly made a close pass, but hurried past to the corner of the operating room. There, it made one critical error: it landed briefly.

By now, my blood-stained technician, fire burning from his eyes, descended on the critter with such might, it looked like a scene from Apocalypse Now, and the fly was flattened. He raised his hands, victorious.

We all breathed a collective sigh of relief but stood stunned at what had just transpired. Soon, my headlight was illuminated once more.

"Well alrighty then... Anybody got some valium for the doctor?"


Photo credit.


Margaret Polaneczky, MD (aka TBTAM) said...

Reminds me of the Junior Mint episode of Seinfeld....

Anonymous said...

i've seen flies and even a mouse in various labs that i have worked in.
haven't had anyone bloody themselves working to get the bugger though.

Anonymous said...

Hilarious. Err, scary.