I should have taken a clue about how my day was going to go from the very first patient of the morning. We were consulted for a tibia fracture in the ER. We went down to check it out before our first surgery of the day, at 7:30. Waiting for us was a middle aged train wreck of a woman. She was on 3 very strong psych meds and had a fifth of jack for breakfast. We learned some other "fun" facts about her while we took her history. She was an alcoholic, had liver failure, kidney failure, Hep C, and was an IV drug user. Perfect...This is just the patient part. The ER was slacking too. This lady had a displaced tibia fracture that clearly needed to be surgically corrected. They hadn't done their side of things and prepared for us to get there. This delayed us and was not in the patients best interest. My attending let the head ER doc have it and the guy never yells at anyone!
The 4 shoulder surgeries we had during the rest of the day had a few problems. One guy had really soft bone and every time we put an anchor in his humeral head it would pull out and leave a giant hole in his bone. Another case was missing pieces of equipment and another the scrub tech dropped like 5 things so we kept having to wait for more tools. It just was not going well. We still had one more case though, the tibia fracture from the ER early that morning.
This was a bigger case requiring lots of hands so there were four of us scrubbed in on this one. Everything was going smoothly and we were making good time. We were at the part when you put one of the supporting cross pins in the tibia. The doctor was drilling a hole through the tibia to place the screw through. He had one hand on the drill and the other on the other side of the leg supporting it as he drilled. Somehow he ended up drilling straight through her leg and directly into the end of his finger!! Let me put this into perspective for you, he drilled a hole straight through her hepatitis C infected bone marrow/blood and straight into his finger! His face went immediately white when he realized what he had done. I watched him do it and even saw both layers of his rubber glove get ripped right off. Anytime you accidentally stick or cut yourself in surgery it's a big deal. You have to go to employee health and go through a battery of tests and sometimes prophylactic medications. If you remember from earlier in this post I said that this woman was an IV drug user, hepatitis C positive, and unknown HIV status. This is the WRONG patient to accidentally cut yourself with. I felt so bad for this guy! He handled it pretty well considering. We paused the surgery and properly cleaned out his finger, then he gloved up again and finished the surgery. The only difference was he was now asking us all of the statistics on blood-borne pathogens. Guess everyone copes with thing differently.
I have been in on a lot of surgeries with high risks like hep C or HIV. The first few times you do them it's a little unnerving but you learn to be a little extra careful and wear a few extra layers and it's not big deal. I had almost lost my fear of these types of cases until today. This accident put that healthy respect back into me. I will remember that case every time I go into a high risk surgery for the rest of my life.
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