The bits I didn’t like
September 23, 2013
The only bits of medicine I didn’t like, and in fact was quite squeamish about, was eyes. There were things I didn’t enjoy as much as others, like filing, but eyes did my head in. There was a girl at school who could put her finger under her eyelid and basically wipe her eyeball with her finger. Used to make me feel physically sick. And as a doctor it’s pretty tricky to just say “Yeuk, no don’t show me that stye/conjunctivitis/contact lens!” so I had to brace myself and swallow hard when I did anything involving eyes. Funnily enough I rather enjoyed incising and draining Meibomian cysts which are little cysts in the eyelid and you have a special circular little clamp to use once you have flicked the eyelid inside out. Sounds gross but actually rather fun. But that’s about the only time I haven’t minded eyes.
The worst time was when I was covering Accident and Emergency and two men came in having been involved in a stabbing. The guy I was resuscitating had been stabbed in the chest,, the neck and the face. The knife in the chest had pierced his ventricle – the pumping chamber of the heart. The neck one had missed the major artery but looked like it had pierced the top of the lung. The one in the face was through the cheek bone and up through the bottom of his left eye. His eye was pushed forward out of its socket and resting on his cheek.
As the anaesthetist my job was to secure his airway so that air could come in and out. Basically to keep him alive whilst the rest of trauma team worked on him. He had arrested and had no signs of life so I needed to put a tube down in to his trachea (windpipe) so I could help him breathe and some lines in to give him fluids and drugs. Someone else was on his chest doing compressions whilst trying not to squirt all the blood out of the hole in his chest and heart itself.
The cardiac surgeons arrived. We are still in casualty but they decide they need to open him up and sew up the hole in his heart. This meant getting all the sterile drapes on and making sure the field they were going to operate in was clear of any of my unsterile equipment. No tubes or bits and bobs in the way that they might accidentally touch once they had scrubbed up.
So I had to wrap his head in a sterile green drape to keep all my tubes and stuff well clear of the surgical area as all my equipment is not sterile. But obviously I still have to be able to access them all and check he is still breathing OK and still unconscious. Wouldn’t want him to wake up and start coughing or pulling at his tubes.
Thus I have a green drape about a metre square and I lift his head up to shuffle the drape underneath. I then take the corners furthest away from me (I am standing behind his head) and pull them up and across his face, trying to ensure I capture all the tubing. (It’s a bit like putting a towel turban on after you’ve washed your hair except I’m wrapping his face in it too). And as i bring my hand up my finger catches his eyeball resting on his cheek. I am nearly physically sick as it blobs around. I have to clip the drape with forceps to hold it in place and I am terrified I will accidentally puncture the offending eyeball but I don’t.
It’s fairly crammed in the resus room in A and E but it’s all we can do and the surgeons have split his sternum (breast bone) open and have rib spreaders in place to hold the rib cage apart whilst they sew up the ventricle. They have managed to restart his heart and they put in a chest drain to reinflate the lung that has been punctured. It’s all going on and I am keeping him alive whilst they build him back together. I’ve had to be very mindful of this eye that is now hidden under the green drapes as it is not uncommon to rest ones hands on top of them, or a piece of equipment if it were light and obviously I can’t do that as I might damage it.
And soon the cardiac surgeons leave – all flying surgical gowns and blood stained boots. And I am left with this poor guy. And his eye. It is still there staring at me from under the drape that I have now loosened but not revealed the offending globe.
We are waiting for the ophthalmic consult. The eye guys have been called but obviously couldn’t do anything whilst the cardio-thoracics are ongoing. So I wait for them. They have been called from the specialist eye hospital Moorfields which is not far away in city. I am dreading the eye surgeons wanting to take him to theatre and then I will have to anaesthetise him for that and sit through the whole gruesome procedure. And eyes are so close the head where I sit, I can’t get away with not looking.
And then the door opens and two guys sweep in. In shades and black crombie coats. As cool as fuck. Seriously it was like Men In Black but 20 years before it. I removed the drape. They took one look and said “He’ll have to come back with us.” What a result. The surgery was too complex for them to do at our hospital, They wanted to take him back to the highly specialised theatre in Moorfields.
“So how did it happen?” asked one of them. “It was an argument about a parking space outside a curry house.” I said. We all looked around the room at the aftermath of a senseless altercation over something as trivial as a parking space. He was lucky to be alive and may well have lost the sight in one eye. The other guy had been whisked away to theatre with an abdominal stab wound. At various points there had probably been in excess of seven or eight people working on each victim, numerous pieces of equipment, drugs, and blood being used, It will have cost the NHS thousands and thousands. All for a sodding parking space.