Sunday, August 06, 2006

My (Nearly) Short Career

First time I laid a scalpel on a patient as a fully-trained practicing surgeon, he nearly died.

Well, actually, I never laid a knife on him. Having moved to Oregon and set up shop after seven years of grueling training, including a couple of military years, fully competent to handle the most major of major operations, my first case was the in-office removal of a cyst on a young man's face. The man, in his twenties as I recall, lay comfortably on my operating table; my nurse -- a throwback, in her starchy white dress and perfectly-placed nurse's cap -- was standing attentively by while I prepared to begin a simple five-minute job. I'd explained to the man that this was a plugged up oil gland (sebaceous cyst), given him the pros and cons of removal, and the routine game-plan.

He'd seemed perfectly comfortable. Already having prepped the area with a germ-killer and draped some sterile material onto the field, I began a gentle injection of local anesthetic, using a very small needle. I prided myself on gentle locals. Midway through the injection, the man announced that he felt like he might faint, at which point I realized I had no idea how to adjust the table into head-down position -- the first reaction for a vaso-vagal episode. In seconds, the man stopped breathing, turned bluish, and had a grand-mal seizure. Where's the crash cart, where's the oxygen, do we even have oxygen?

Greenhorn surgeon kills first patient in office,
 the headlines read in tall letters in my mind. Looking stricken, my nurse raced around the room and came up with a mask and an oxygen tank, from where I couldn't tell. I managed to find the pedal that controlled tilt. My patient began to blink, looked around, asked what happened. You're fine, I told him. You fainted, but you're fine. Yeah, he said. I tend to do that. Having had quite enough for the day, I told the man that he'd also had a seizure and that while such a thing wasn't necessarily a sign of anything, I wanted him to see his doctor and have a checkup before we tried again.

Not long thereafter I was doing a vasectomy on another young man, once again in my office OR. (I'd done a lot of vasectomies -- in Vietnam, many soldiers seem to have figured that since they weren't getting any, it was a good time to take care of business. I was halfway through the procedure, with the guy's vas looped out of his scrotum, pinched between my fingers. I think I'm going to faint, he croaked (bad choice of words. May have to edit that.) Like lightning, hard and fast, I stomped on the tilt pedal, enough so the table went nearly vertical. As the man slid off the table like a frozen fish, I followed him down, trying futilely to maintain a grip on his vas (losing it could mean a tough time relocating the exact spot on which I'd been working.) He ended up with head and torso on the floor, feet and legs still on the table, pointing to heaven (perfect position for recovery, actually.) He woke quickly, wondering what happened. Oh nothing, I said, maintaining my shaky grip on the south parts of his manhood. You just fainted so I laid you down. After a somewhat clumsy re-mounting of the table, during which I, of necessity, loosened my scrotal death-grip, we made it through the operation eventually; I was left sweating bullets, while he was left shooting blanks.

Hard not to wonder what I was doing wrong. Was I so young that people didn't trust me? Were my patient communication skills lacking? Were the gods against me? Was it too late to apply to law school? I'll be fine. I know how to talk to people, I'll get some grey hair; sooner rather than later, evidently.

At this stage I wasn't getting many referrals for major cases. So I was pleased one day within shouting distance of the previous events to see my office schedule included a lady with gallstones. Working though the patients preceding her -- lumps and bumps -- I looked forward to the upcoming visit. She was still sitting in my waiting room when, according to the receptionist, she began slowly to lean forward and rolled onto the carpet, dead. As the EMTs wheeled the body away, I thought I could see lettering on their backs: Stay away from Schwab....Stay away from Schwab....Stay away from Schwab.

It occurred to me later it could have been worse. The lady had had a workup before she was referred: a healthy 70 year-old. I might well have scheduled her operation and watched the event occur in the OR. Fragile as I was, it could have been the last straw. The gods, I decided, didn't have it in for me after all: they let me go on with my career. But I'm not sure how they felt about that poor lady.

11 comments:

Jordan said...

One of my first patients in residency had cellulitis...simple right? Ended up being necrotizing fascitis......first one are always a doozy!

d said...

I went to a podiatrist once for an ingrown toenail. I was about 11 or 12, so my mother came in with me. Just like with your first case, I felt like I was going to pass out, told the doctor and my mother, then proceded to have a grand mal seizure.

I had my gallbladder out last Thursday, and of course everyone who saw my "lidocaine" allergy asked me about it, and I repeated the story about 12 times. Every single one of them acted like I was some kind of freak. Good to know I wasn't the only person to have a reaction like that! :)

Alice said...

This is scary; all my worst nightmares apparently do come true. I'm amazed that you continued tempting providence after those three patients. . . :)

Sid Schwab said...

Alice: well, at that point I had too much invested to bolt. For some reason every new surgeon I've seen open up shop seemed to have some weird thing happen early in practice. Probably all docs. Or maybe it's that the weird and scary happen throughout practice (they do!) but the first ones make the biggest impression...

Surgeon in my dreams said...

I absolutely LOVE reading your material! Even my dog is sitting here wondering why "mother" is laughing tears. I can picture the guy and the handful of Vas Deferens so clearly.

kim said...

I've noticed that men tend to vaso-vagal more than women.

That's not an insult, just an observation I've noted with injections.

Women just die, I guess! LOL!

Dr. W. said...

"SCROTAL DEATH-GRIP"!! I love it! That was very entertaining.

beajerry said...

"sweating bullets", "shooting blanks"?

Ok doc, you're having too much fun here.

Moof said...

Oh! Help! I can't stop laughing! >;o)

That was really, really good! Thank you!

And by the way, I'm truly enjoying your book!

Sid Schwab said...

Moof!

I'm honored that you bought the book, and delighted that you like it. (Tell your friends)

Nurse Practitioners Save Lives said...

I am so glad that I stopped by to read your blog today. I needed some laughs after taking my Pharm final. Keep up the great stories!