Of Mops, abdomens and lessons

“An anesthetist has hours of leisure, minutes of horror and seconds of terror”. - Unknown

“A professional is one, who does the thing he knows best, on the day when he does not have the mood to do so.”

The operating facility in the centenary building is nestled in the second floor. Set up exclusively for women and children, this place can be an anesthetists’ nightmare. Unlike its elder cousin, the main operating complex, that resembles the British TV show, the crystal maze, it is well built and technically advanced. Only that her virtues are compensated by its appalling emergencies. Its walls of glinted marble have seen it all and the medical personnel within it have done it all. With Women rushed in with babies stuck in their pelvises and naughty kids aspirating a peanut or two, the moments for the duty-on- call are no less than a Hollywood suspense thriller.

It was one of those days when I was on call, during those hours of leisure that the obstetrician rolled in a gurney with a young woman lying restless on it. A 22 year old lady gave birth to a healthy male child by caesarean section 10 days ago in a neighboring state. A week later developed severe abdominal pain and fever. Her blood pressure began to drop and the fever would not relent. The lady was transferred to this higher centre for management.

The obstetrician with the supercilious look foisted the plan of general anesthesia on us to save time. A surgeon deciding what mode of anesthesia benefits a patient is like a passenger on board instructing the pilot on deck about flying. He only knows the destination but has no clue about maneuvering a plane in the air.

The obstetrician was visibly worried. If she had had a fitness band it would have displayed a heart rate of 150. I did not want to add to her woes further. I decided to administer general anesthesia which was apt for a patient with a dropping blood pressure.

IV access was secured, drugs were given and intubation performed. There was no further drop of blood pressure with anesthesia. As the surgeon frantically cut through layers of antiseptic painted abdomen, a putrid smell filled the air. The air cooling that was stopped till then to prevent patient from loosing temperature, had to be switched on.  As the gloved hands deftly probed through multiple loops of intestine like an officer chasing a criminal, the patient on the other side of ether screen was stabilized with drugs to maintain blood pressure, pain killers, anesthetics and fluids. Ten minutes later, the culprit was caught. A huge mop of cloth was pulled out amidst the young mother’s bowels.

There was a lull of silence. The feelings that pus filled, stinking cloth evoked in me ranged from pity to anger. How can any surgeon do this? What level of negligence can result in acts like these?  What trauma this young family is made to suffer?

for representative purpose only

Thankfully this surgery was uneventful. The patient was shifted to ICU for further care and discharged in good health eventually.

Two months later, I was posted in urology theater- the place where urine and fluid flow in streams; where kidneys and everything attached to it, are cut, restructured, transplanted, joined and dilated. It was 3 pm and I was calculating if I can see the sun before it sets. The registrar was scratching the abdominal wall for an hour already to perform a procedure called pyeloplasty. I was waiting for the senior surgeon to scrub and technically start the surgery like a drought hit farmer looking at summer sky for the first shower of monsoon.

The scrub nurse was not helping matters. From sutures to instruments, she would ask me to open up, teaching me multi tasking to be a floor nurse also at the same instance. After 120 grueling minutes of stable surgery, the procedure was finished and the abdomen was almost closed, when the staff exclaimed that a mop was missing.

I began to curse the nurse for wasting my time. The stupid mop would have been dropped by the surgeon. May be the staff has poor math skills unable to count from 1 to 5. Half an hour passed and I began feeling distressed for losing another evening.  The surgeon was too tempted to start closure but had to heed the adamant staff’s call.

What I saw next was incredulous. The mop was behind the kidney that was operated upon.

Suddenly the daily procedures of safety seemed angelic to me. One of the things I hate as a registrar of anesthesia is the time spent on formalities. As the clock ticks, we run against time to finish the ambitious OR lists, which the surgeons themselves are convinced, can never finish. Added to the slothful pace of operations, is the time taken to do a boring and ever pervading job of checking for patient details and counting of mops used in the procedure. But it is these small but essential formalities that prevent calamities from happening. It is the obstinate embrace of these rules that will prevent us from causing immense pain and reoperations for our patients.

Monotony and protocol are nobody’s friends. We don’t realize the use of helmets, seat belts, statutory warnings and health advisories until tragedy strikes. The collective wisdom of safety protocols emerge victorious when an accident occurs, planes crash, cancers and liver diseases are diagnosed. That’s why we avoid them with precaution. That’s why we check machines every day before giving anesthesia. That’s why we load up emergency drugs well in advance before the emergency itself. From the hours of leisure, can seconds of terror emerge stealthily. The best response is of course preparedness that comes by safe practices and protocols.

A Whatsapp message from my friend stands up for my experience aptly- “The sense of achievement does not come from dealing with critically ill patients, but from doing the most ordinary thing thousands of times, each time with out mistake.”