Saturday, February 24, 2007
It happens sometimes: finished with a suture, you pass it back to the scrub-nurse, the needle contained in the jaws of the instrument, less than carefully locked. In placing it down on the sterile tray (the Mayo stand), you might see the needle spring up as if alive, arcing across the table to land an impressive distance away, on the floor. Or they get laid down momentarily on the drapes; or transferred by hand, holding the thread, only to have it slip away. Needles, in other words, sometimes find their way out of the field and into the ethers. Incorrect needle counts being anathema, adding precious (and expensive) minutes to operating time, forcing several people to devote annoying amounts of time in the search, occasionally even requiring reopening of incisions, you'd think thought would be given to making the hunt as easy as possible. So why do the designers of operating rooms so often come up with Jackson Pollack patterns on the linoleum; and why do hospitals buy it?
Only a few days ago I was reminded of it again, as I was asked where the needle was that I'd just instrument-laid in front of the nurse. As I've done many hundreds of times, I'd pulled it out of a laparoscopy port without giving it any particular thought. Automatic move. But somehow she hadn't received it. Could I say for sure I'd watched it all the way to the point of release? Well, no. Yet there was no reason to think I'd fluffed it, left it inside, and I was sure I hadn't. (If you grasp a suture in the wrong part of the jaws of some instruments, the grip is flimsy, and withdrawing it through the port provides enough resistance to brush it off.) I looked at the floor near me, and noticed that ridiculous surface, designed, I guess, to allow people to ignore sweeping their kitchens too often: hides dirt like a miracle. Leave the lettuce, Lucy. Won't show till it blots out the whole damn pattern.
Going through the litany of look-sees, finding no needle, we had no choice but to re-scope the entire abdomen, and, finding nothing while continuously updated on the fruitless search around the room, we called for Xray to be sure that needle was nowhere within our patient. As certain as I was, I couldn't be certain. No needle. Satisfied as we could be, we returned to sewing up, the meter running. At some point, an eagle-eyed nurse found the needle, lying invisibly within the curled and multi-colored linoleum lines. It couldn't have been harder to see if the pattern were of millions of surgical needles.
So tell me: what would be wrong with a single-color floor, chosen specifically for its ability to highlight a wayward needle? It's a damn operating room, ferchrissakes! Doesn't a dirt-hiding floor seem a little out of place?