Safety First

As I got ready to clock out for the night, I was paged by the surgeon to assess an emergent case in the surgical ward. A plan was set: we would rendez-vous upstairs to speak with the patient and review the chart.

The polaroid snapshot of the injury slowly faded into view as the patient told his story: a high impact trauma to the upper leg…non-weight-bearing…decreased mechanical function…swelling…pain…

Emergency physicians had already ordered x-rays an hour before; the scans and the radiologist’s report would be available on the computer by this time. However, when a picture is worth a thousand words, a radiologist’s report really does not do it justice.

In one word, it was “bad.”

A comminuted, displaced fracture of the femur filled the screen. We would have our work cut out for us. A second surgeon was brought in to consult on the safest and best approach towards putting the shattered pieces together again, not merely because the femur was severely comminuted but also because we had another factor we could not neglect.

This patient was HIV positive.

As we worried about what we would do for this patient, with compartment syndrome and other complications creeping up as time passed us by, our safety was equally important on this case. An approach was agreed upon, and the surgeons moved swiftly to brief the team and get the operating room online.

I followed close behind, nervous and scared. “You do exactly as I tell you to when we start. You keep your visor on, you watch the sharps. Safety first.” He looked stern and on edge, something uncharacteristic for his usually quiet demeanour. I nodded.

After what seemed like an eternity of waiting in the OR lounge, we got the call from the nurses that the patient was ready. It was time.

We wasted no time getting the patient ready. Our first task was to control the bleeding once we opened up. The plan was to apply a tourniquet cuff around the leg but we quickly realized that it would overlap with the area of injury and prevent us from finishing the proximal end of our repairs. After much frustration it was, much to our fear and disappointment, abandoned. We would just have to deal with the blood as it happened.

As the doctors made the first incision and sliced his way towards the bone, there was blood. Lots of blood. I watched as the red liquid oozed from every corner and every sinew, a thick pool that betrayed its potentially serious and infectious payload.

Spurt! Spurt! Spurt! Every now and then a gush of blood would spray out and take us off guard. It was guerrilla warfare, an ambush. A hit and run. We dealt with these bleeders quickly.

In the end, despite the soiled and bloodied gowns, we successfully repaired the damage. As I ungowned, I checked my hands and face thoroughly. No cuts. No blood. I was safe. On the report, it would write that “the patient tolerated the procedure” and that the blood loss was significant but manageable.

How little do those words convey the full picture.