04 Mar A Day in the Life of an Anesthesiologist-Part Three-Swallowed Razor Blades and other O.R. Bizarreness
People do crazy things.
We had a patient from the local prison who was regularly brought in by ambulance after swallowing anything from forks to writing pens, syringes, toothbrushes, even razor blades. At which point we’d be called to provide anesthesia so the endoscopist could go down with their scopes and retrieve the sundry objects.
The thought of swallowing a razon blade brings tears to my eyes. How a prisoner gets ahold of a razor blade is a good question. I’ve never been incarcerated so I don’t know. You’d think swallowing a razor blade would be a quick way to die as it slices and dices its way down the esophagus to your stomach. And maybe, if you or I tried it, we would bleed to death. But regardless of what objects this particular patient swallowed, there never seemed to be much residual damage.
When she was asked why she kept swallowing anything she could get her hands on, she replied, “I want the judge to think I’m crazy so they’ll let me go.” See what I mean.
One Friday night, payday for our next patient, he came into the ED drooling and choking. He’d gone out for a steak dinner after a hard week and eaten too fast. We knocked him out and the endoscopist pulled out a foot-long piece of gristle and fat which had coiled up in his esophagus like a worm, unable to wiggle its way down into his stomach. That piece of meat might have looked appetizing on his plate, but it was gross coming back up. I couldn’t imagine how ravenous he must have been to devour a twelve-inch piece of steak in one bite.
Or the cantankerous, heavy smoking, obese, sixty-year-old woman who came to the operating room for abdominal surgery, gallbladder, I think. We gave a little Versed to help her relax as is our routine as we headed into the OR and she revealed that she’d still been smoking in her hospital room bathroom, even as recently as an hour ago. She had been taking her oxygen off, smoking, then putting her cannula back on. She acted unapologetic, even proud of her antics. As she lay flat on her back, waiting to be induced, she kept feeling around, like she was searching for something lost, but never said what. After she was unconscious and intubated, the scrub nurse started prepping her abdomen. She lifted one of the patient’s breasts and discovered a half-smoked cigarette trapped in the fold beneath. As we dropped the patient off in the recovery room after surgery, she was happy to learn that we’d found her lost ciggy. And no, we didn’t give it back.
Getting a pre-op history and physical is a requirement before any patient is allowed to go to surgery. It’s inconvenient I know, but it’s for your own good. You want your anesthesia care team to know who you are, on the inside as well as the outside. People use all kinds of excuses to get out of it. But forging your own H&P and writing in doctor’s summary section, “Joe Blow is ready for surgery,” and faxing it in from a hotel chain’s fax machine with the hotel’s header on top is not too smart. The patient had a history of a craniotomy, two hip replacements and a seizure disorder, but he was forging his way into spine surgery, not a hangnail removal. Thank goodness the pre-op nurses picked up on it. Case cancelled.
Through the grace of God, instead of bleeding to death or dying of sepsis from perforating her own bowels with swallowed objects, or setting the hospital ablaze because she was smoking too close to her oxygen mask, or getting into the middle of a major spine surgery and discovering the patient has a life-threatening ailment that we weren’t aware of because he forged his own H&P, none of those terrible things happened.
In anesthesia and surgery, you have to be on your toes. With all the smart and caring people who work in our hospitals, miracles are being performed daily to help people and save lives. But sometimes, even with all of that going for them, the not-so-well-intentioned patient still needs a little luck and a pardon from the almighty to survive to see another day.
Next Thursday: So, You Think You’re Having a Bad Day