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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 the 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.

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I loved working in accident and emergency, or casualty as we called it. The terms are interchangeable but A and E is probably more modern. You really have no idea what is going to roll in. Sometimes literally as drink is a major player. Of course when I was working in them Casualties were often very busy, but we didn’t seem to be troubled by the shit minor stuff that comes in nowadays. Stuff that should be sorted out by a wash and a plaster, or perhaps a visit to a chemist shop. Or a visit to the GP on Monday. I mean there were time wasters, but nowhere near the level there are today. People seem to have lost the ability to sort themselves out and will call out an ambulance because they have a splinter in their thumb.

But I digress. The first time I was attached to Casualty was as a student, and I blogged here about the Hoover Dustette incident and here about the fireworks. But there were plenty of other stories. It really is a place to see all of life and we did. Sometimes in eye-watering ways.

And so it was that I was asked to see a young woman who had “Got something stuck”. I think we all know where this is going. And sure enough behind the curtain was a fairly dishevelled looking girl of about 19. Looking a bit embarrassed but more worried than anything else. I asked her what the problem seemed to be and she told me she’d got a Coca Cola bottle stuck up inside her. And sure enough, when she lay down I could clearly see the bottom of one of those nice shaped glass Coca Cola bottles between her legs. “How did it happen?” I asked, waiting for the “I was walking nude around the house and tripped over and it just went up there,” usual guff  But no. She was unperturbed to tell me she’d been masturbating frantically with the Coke bottle and suddenly she’d been unable to pull it out altogether. She’d no idea why not. She’d been pulling and pulling but it just wouldn’t come. (no pun intended).

I examined her more closely and could see that her vaginal wall had been sucked inside the coke bottle and was now swollen and unable to come back out of the top of the bottle. It was well and truly plugged in. I thought I’d better call the Gynae Reg to come and see her. This was their department after all. But of course in the mean time I was discussing her with other colleagues on the floor. I mean, these kind of cases brighten the day and raise a smile. So often we are dealing with tragedy and loss it is fun when something like this comes in. And during the conversations someone came up with the obvious solution which I hadn’t thought of. The frantic up and down, in and out motion had created a vaccuum and sucked the vaginal wall inside the bottle so all that was needed was to break the vaccuum and it would release the pressure. Brilliant.

So now we had to work out how to break the bottle without injuring her further. The colleague who’d thought of the answer came over and we thought about wrapping the bottle and hammering it but there wasn’t actually much bottle protruding so it was pretty impossible to get enough leeway to try to smash it without also risking crunching her pelvis instead. In the end we got an orthopaedic drill and drilled a hole in the bottom of the bottle and hey presto the vaginal wall was gradually and gently released and although a bit sore and swollen, she was able to go home even before the Gynae Reg had made it down to see her.

She was in and out in no time.

I am not a great housekeeper. I would love to be, and I admire those who are. I don’t mean those who have houses you daren’t sit down in, but those whose houses are clean, tidy enough that you don’t trip over everything, have food in the fridge and ironed clothes.

I kind of know where stuff is….

I am not bad, just not great. And luckily we earn enough to have a cleaner who comes in and keeps on top of it for us. The joy of freshly hoovered stairs! The sparkling worktop! The sitting room without newspapers strewn everywhere. Unfortunately I can’t let her loose in my office as it looks like a chaotic mess, but it is a mess that I kind of know my way round.

But I digress.

As a medical student some attachments are more interesting than others. Depends what lights your fire I suppose, but straightforward medicine never really did it for me. I loved the sheer variety of A & E (or Casualty as we called it then), the cut and thrust of surgery and the intensity of oncology. But it was always through A & E that we got the most surprises. The things that made your eyes water at the thought, or made it hard to maintain an air of professionalism.

And so it was one day when I was with the registrar, we were called to review a male patient who had come in with a lacerated penis. And lacerated it was. Nasty nasty nasty. Blood everywhere. How on earth had it happened? An angry wife? A startled  blow job? No. Doing housework.

Apparently he had been hoovering in his dressing gown (as you do)  and had gone to switch it off at the plug. But as he leant over, his dressing gown became unfastened and his penis ‘”was sucked in to the nozzle”. Allegedly. Honestly, that is what he said. And who was I to disbelieve him? Unfortunately for him the particular model of vacuum cleaner he was using had blades inside the nozzle at 15cm. Yeeeeowwww!

And so dear reader, think twice before you get out your Hoover Dustette. It might bite back!

Searching the British Medical Journal for something else I just happened to find the paper the Registrar must have written. Great memories!

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