Surgical theatre, not the other kind, darlings.
I’ve just written about my first experience in the surgical theatre and talking of things that didn’t make me squeamish made me think about the one procedure that did leave me feeling a little queasy. I was now about 30, I remember I had recently had a tattoo for my 30th birthday, so this is 10 years after my first memory, and up until this point with many excursions into theatre, often lengthy hip or tibia internal fixations, I had not found myself to be squeamish about anything nor had an episode of feeling faint other than through personal illness. In fact in common with most theatre staff I usually found it was a great appetiser and often left theatre and headed straight for the canteen.
I had seen this patient in the accident and emergency section of our x-ray department (for those of you who don’t know from previous writing I am a radiographer which means I am the person who puts you into uncomfortable positions on a table, puts heavy lead shields over your gonads or other radio-sensitive areas and then rushes to the bomb shelter screen in the corner of the room when you have an x-ray). I had the pleasure of assisting another radiographer to perform the examination on this particular lady and I read the history of how she came to be in hospital. She had been on a school trip or similar as a parent assistant or something like that. The group had been walking along a wet grassy area in a park or similar and she had taken a tumble. When I say a tumble she had basically slipped and skidded a short distance along the grass. The result was that one of her legs was almost amputated at the mid tibia level. It was a gross open wound with a simple fracture of the tibia, technically an open fracture but the bone was not visible through the wound. The wound was quite horrendous for the simple way it had come about. The skin and flesh was torn in a spiral around most of the mid portion of the lower leg. The x-ray images showed the fracture to be clean, straight, mid shaft of the tibia with a small contra-coup spiral fracture to the fibula. I was on a 2-10pm shift that day and as such was the radiographer on call for orthopaedic theatre. And this was where I next saw her.
The image below is a generic image of a tibia following a tibial nail procedure which is what comes next. So the patient is put onto the emergency orthopaedic list and scheduled for debridement and tibial nail. I have attended many tibial nail procedures and been fine. This one made my stomach flip however as I arrived at the start of the procedure in order to line up the C-arm for the surgeon to work around and assess the fracture in real time prior to starting the nailing procedure. What made me feel queasy this time? Well it was the debridement. The wound was open and had been contaminated with soil, grass and small stones or grit.. and the surgeon cleaned it out with a surgeon’s nail brush. It didn’t bother me at first but the cleaner the wound got the more the brush brushed away loose tissue.. and the lumps of adipose tissue (or fat cells) being scrubbed away made me realise just how deep the wound was and how it would have hurt had the patient not been anaesthetised. So I suppose my queasiness came from my empathy of what the patient might have felt.