Wednesday, May 09, 2007

Hair's the Deal




Among my duties as an intern, back in those dark days and nights, was to order (and, not rarely, to do) the pre-op shave on patients. "Nipples to knees" was the typical order for vascular surgery patients. (Might be a good name for my next book, or for a rock group.) In addition to shaving hyper-extensively, we also generally did it the night before surgery -- now shown to be a bad idea, because the inevitable nicks became little soup bowls for bugs. The closer to the time of an operation the shave is done, the lower the incidence of wound infection from skin organisms. In fact, evidence suggests shaving not at all might be the best idea, even in the Tony Sopranoesque. Once in a while, in my practice, I had a guy (always a guy) show up for a hernia repair having hacked himself way more extensively than necessary, even into the, uh, saccular parts, leaving terrible tracks. Claiming only the wish to help, I guessed it was a matter of not wanting just anybody mucking about "down there."

But the most compelling argument against shaving is it itches like crazy when growing back. Having more complaints about that than about pain when I'd see people post-op, I came to shave less and less over the years. More than that, I generally shaved my own patients, because I could rarely get others to do it as minimally as I did. My aim was to keep hairs out of my way when working and to leave room for a (small as possible) bandage.

I think some OR nurses thought I had some sort of fetish for shaving. Not so. If others shaved people as minimally as I did, I was fine with it. Once I came in to shave my sleeping patient, heading toward the pubes for a groin hernia. To my surprise they fell away en mass; a well-intentioned aide had shaved already, and when the anesthesiologist noticed, he said "Oh no, you shaved Sid's patient!! Put it back! Put it back!!!"

13 comments:

Raveen said...

lol "put it back"

Xavier Emmanuelle said...

ahahahahaha "put it back"

scalpel said...

One of our well-meaning ER techs completely shaved the eyebrow of a man with a simple laceration of that area in triage. The patient requested a plastic surgeon to suture his wound, and the doc totally freaked when he saw that.

The shaved eyebrow was far more cosmetically disturbing than the laceration repair itself. Eek.

Lisa said...

rofl!

SeaSpray said...

SERIOUSLY Dr. Schwab? They REALLY did THAT? OMG! If I was drinking my water that is sitting right next to me - I would have either choked or spewed it all over! Too funny - Thanks for the laugh! :) Did you laugh? Did they? Bet the aide was holding his/her breath. LOL!

Scalpel - the same thing happened in our ER. A well intentioned aide did a partial shave of an eyebrow and the ER doc went ballistic on her.

So if you do decide to shave how far do you shave if someone is going to have a vertical ABD incision?

I was really bummed a few posts back when you had written about veterans. My husband was a Vietnam vet and I had written you a long comment and I was just about to publish it when my computer suddenly ended the session. I elected to restore everything but my comment was lost. I poured my heart out-maybe it wasn't meant to be.

I am getting the renal scan next Wednesday and this is the one that will determine whether or not I will have to have the surgery. I am believing for good things. Can't blame a girl for hoping! :)

Lynn Price said...

Eyebrows and hair...I'm laughing myself silly. I think I'm going to have to put Sid and Scalpel in my acknowledgments on Book 3...such ripe material.

Sid Schwab said...

Lynn: stay tuned. I have a series of posts coming up that could give you enough "good stuff" (well, I think so anyway) that I could make a case for a share of royalties...

Lynn Price said...

Geez, Sid, that means I'll have to list you as co-author. Hey, we just got nominated for an IPPY award. Wish us both luck. I get to keep the trophy if we win, okay?

Judy said...

Either the dog is going deaf, or she's just gotten used to the way I react to stories like this. She used to wake up and run out of the room.

What a hoot! Put it back!

L O said...

Was that Larry???

Sid Schwab said...

yes

wfr said...

Question: if the nicks and such become a problem why isn't a "Nair" (Sodium Hydorxide) type solution used to clear out the exact area of interest? I imagine this would kill most bacteria, but I guess irritation could be a problem?

Sid Schwab said...

I think Nair takes a while to work, so in the OR it would be a time-waster, compared to doing the shave right then and there. The nicks aren't a problem when they are immediate: it's when the shave is done in advance that they have a chance to brew. I have had people use dipilatories in certain situations, though: like keeping the area around a pilonidal wound clean, or women who have bothersome numbness under their arm after a node dissection...