Excerpt - Surgical Heights

Jim Smythe's early days as a medical student:

At four o’clock, Jim and Steve approached Mr. Lorenzo, who was smiling, nodding and saying, “Yes, yes,” as he had earlier. Jim again explained how they were going to remove his catheter. Neither Jim nor Steve had even seen one of these catheters removed before. The procedure’s complexity was considered minimal, and therefore no formal teaching was required. Strangely, nurses who had worked with these lines for years were not allowed to remove the catheters, so the task fell to medical students, who were always delighted to enhance their experiences by doing new procedures.

With the head of the bed elevated at forty-five degrees, Mr. Lorenzo was lying with his left side down, trying to cooperate as best he could. Mask now in place and dressed in his crisp surgical gown and sterile gloves, Jim carefully cleansed Mr. Lorenzo’s neck with iodine solution. Then he covered the area around the catheter with sterile disposable paper drapes. Steve also wore a sterile gown and gloves as he hovered over Mr. Lorenzo’s neck. Using sterile scissors, Jim decisively cut the stitch, the only obvious attachment between Mr. Lorenzo and his central line.

“Do you want to pull it out, or should I?” Jim politely asked.

“Hey, you’re the one who has half a chance of going into surgery. Go for it.”

Jim gently pulled the catheter towards the ceiling. Mr. Lorenzo’s skin tented up with the catheter at the insertion site, on the right side of his neck. Jim hesitated. He then pulled a little more firmly; again the skin seemed adherent to the catheter. There was no reason why it simply shouldn’t slide out, thought Jim. He looked over at Steve. Jim could tell that Steve was smiling confidently under his surgical mask.

“Go for it,” Steve said again.

As Jim tugged harder, the catheter snapped just above the skin. For one helpless half-second, Jim and Steve watched as the remaining one-quarter inch of visible catheter disappeared under the skin of Mr. Lorenzo’s neck. Jim quickly placed his hand on the skin where the catheter still made a visible impression, remaining evident from the entry point for about three or four inches down Mr. Lorenzo’s neck. While still holding onto the catheter with his left hand, Jim stared in disbelief at the broken plastic end. Redirecting his attention to his patient, Jim was reassured that if he could at least feel the piece of the catheter under Mr. Lorenzo’s skin, he would know it was not making its short journey into the right side of the patient’s heart. But what if that happened? Jim feared that Mr. Lorenzo’s life might be in danger. He looked across at Steve’s serene eyes above his mask. Steve was probably feeling both lucky and happy that he wasn’t the one who had just pulled on Mr. Lorenzo’s central line.

Steve took a moment to reassure Mr. Lorenzo that this was all routine—all part of the plan—and that they would be done in a few minutes, after he made a quick phone call. With Jim’s right hand still gently palpating Mr. Lorenzo’s neck, Steve was off to call Dr. David Coulter, the junior resident.

“Dr. Coulter, it’s Steve,” he said sheepishly. “We have a bit of a problem up here on 5-West. That central line broke off and most of it is still inside Mr. Lorenzo. What? No, I’m not kidding.”

© Paul E. Hardy  2012