It was an accident. Honest.

September 9, 2012

The training to become an anaesthetist is second to none. Expert one on one tuition from more experienced doctors. You start with simple cases and work up to more complex.

Open heart surgery is ‘more complex’ and the first time I was assisting the more senior anaesthetist, one of the very very senior surgeons was operating. Very old school. No real banter or craic with this guy, he was serious.

I would be the person in blue on far left – this side of the barrier at the head end of the patient

It’s the kind of operation where the patient is put on the bypass machine at various points so that the blood doesn’t circulate through the heart, but is pumped by an external machine (the bypass machine). It’s all very hitech and serious stuff. The patient has lots of different drips and lines in, and throughout the operation I would be putting up new lines and replacing bags. You’ll all know you have to get the air bubbles out of any tubing before it gets to the patient – don’t want an airbubble in the bloodstream. And a standard way of getting rid of them in tubing is to tap the tubing with side of a pen and the bubble will rise upwards until it gets to a chamber where it can stay.

Exactly like this

I had a classic clear Bic biro. We had to fill in charts throughout the operation to monitor the patient’s vital signs and record what we had done.  I was standing behind the green sheet that we make as a barrier bewteen us (at the anaesthetic, non-sterile, head end of the table) and the surgeon, who works in a sterile environment. Informally it was known as the Blood Brain Barrier, dividing the surgeons (with the blood) and us (with the brains).

The operation was progressing. The sternum had been sawn open and the rib spreaders put in place to hold the chest cage open. The heart was pumping away.

One of the intravenous lines had a bubble in it. I held the line straight with one hand and  tapped it sharply with my pen. The bubble didn’t shift. I tapped again, harder this time.

Whereupon the pen top flew off, over the green barrier and straight in to the gaping chest wound. A perfect hit. I couldn’t have done it if I’d tried.

But this was awful. A chewed pen top is about as far from sterile as you can get. Dropping it in to the operating field was an error so gross I can hardly bear to think about it. I was in serious shit and I knew it. I was going to get torn off a strip for this, and rightly so. I had put the patient at risk of an infection by being so careless.

The whole theatre had gone silent. My senior anaesthetic colleague muttered something like “Oh God, you’ve done it now”. The surgeon is staring at the pen top, bobbing on the beating heart. My own heart is hammering in my chest. Theatre sister is staring at me in incredulity.

I did the only thing that came naturally to me.

I peered over the top of my green barrier, put my hand straight up in the air and, in my best imitation of a child, asked, “Please Sir, can I have my pen top back?”

Luckily for me the place erupted in laughter. Well, nervous sniggers really, but it broke the ice and we were able to get on with the operation. It also averted the full on, public dressing down that had no doubt  been coming way way. The surgeon removed the pen top, irrigated the area and I stayed well away from the drip lines for the rest of the operation .

I did check on the patient a few days later and no infection had developed so I’d got away with it this time. But lesson learnt. I went out and bought a papermate pen that had a button to press on the top so that never again would I need to use a pen with a detachable top.


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