On Surgical Experiences

I was in the doctors lounge at Harborside Hospital in St. Petersburg Fla, waiting to do a case.  The story was that a guy came to the ER thru the night and had a piece of chicken caught in his esophagus.  The ER doc, thought it a good idea to try putting meat tenderizer down to soften the chicken and get it to pass.  Wrong thing to do.  I was a bit perturbed that they had invited an ENT specialist with a rigid scope to take care of the patient.  I have experienced rigid scopes in my early years and this was quite a while later and flexible scopes were (at least in my mind) more logical.  I was there about half an hour when an OR nurse came running to me, hurry get cap mask and gown on, they need you in the OR.  I went in and the surgeon said “I think I have a problem”…and motioned for me to look thru the rigid scope.  I looked in and there in quite plain view was a collapsed lung, the beating heart and the nicely evident inside of the rib cage.  He had perforated the esophagus…a very serious problem.  I agreed, spoke to the referring doctor who was right there and we agreed that the patient had to be opened emergently.  I changed clothes, scrubbed for surgery and cap, masked and gowned.  They had to remove the scope to safely turn the patient onto his right side, he was prepped and draped.  I made in incision along the border of a rib and quickly got into his chest, with a rib spreader holding the ribs apart.  I could not find the perforation, there was no bleeding and no evidence of the perforation beyond the collapsed lung.  I had to break scrub and pass a flexible  gastroscope.  It immediately popped into the perforated path and I would even Now, pay big money for this following scene.  I look thru the scope…I see the collapsed lung, the beating heart the rack of ribs…spread wide and held open by the rib spreader, and the assisting surgeon (the one with the rigid scope) looking into the wound from the outside.  JUST IMAGINE that scene!!  Well, I did major irrigation and layered closing and appropriate drainage, and a chest tube and the patient went to recovery with no problem.  He was transferred to another hospital at the request of the referring doctor but I know he survived.  It’s a very serious complication.  I enjoyed every bit of it!  I loved my job!

Upon leaving Cleveland after my residency, I was married to Fran and Chris was a baby.  I worked in an office with Dr. McNeal in New Bethlehem while I lived in Clarion not far from the hospital.  One winter night, I was travelling the 18 miles to Clarion when I saw car lights where there should not have been any.  It was a horrible winter night with blizzard conditions.  A lady with 2 young sons had gone off the road and rolled her car.  This was long before seat belts and child protective auto accessories.  One little boy was unconscious with a nose that was split vertically right down the middle, and both his eyes were already starting to get black and blue.  Mom and the other boy were ok.  I hustled them into my car and drove straight to the hospital while I supported the other boy the best way possible.  They would have frozen to death before EMS could have reached them and I was safer and quicker.  Dr. Tom Polatty came in for anesthesia but he only needed intubation.  I opened the deep laceration of the nose which went up partly into the forehead.  Beneath that was a skull fracture…I lifted a piece of bone and there was the brain.  Ok…deep breath….and then he, the boy, took a deep breath, and then Tom…took a deep breath.  We watched to be secure there was no evidence of bleeding and I meticulously cleaned and closed everything.  He spent a few days in the hospital and went home.  I saw him to take the sutures out and the wound looked good despite it literally dividing the nose in half.  A couple months later, on Christmas day, the mom came to my home with him and gave me a hug and crying showed me his nose.  There was no sign of a scar whatsoever.   He was about 7 yrs old.  I know who to thank.

Another fun experience was with Gene Kundick.  He was originally from New Bethlehem, but this time I was in my office in Tampa when Gene walked in and asked for me.  I knew he was in the area as I had seen his sister Connie who was a high school classmate of mine.  Gene had been fishing out in the Gulf of Mexico off Tarpon Springs which was an easy hour or more north of Tampa.  He was also out a good hour off shore with a friend, standing at opposite ends of an outboard boat, fishing by casting for tarpon.  If you’ve ever seen a tarpon hook…they are in a word, huge.  Would easily fit inside the curl between your thumb and index finger with your hand extended.  His buddy was casting when the hook caught Gene….in the nose.  With the point of the hook sticking right out of his nose in the front.  They had driven all that way to shore and then packed up the boat and trailered it and then to Tampa to see me.  Damn.  I took a photo of it but it didn’t come out.  No big effort removing it, after a little lidocaine but the photo didn’t come out.  sigh

Another rarity….I was in the hospital in Clarion when I was called to the E.R..  The patient was a coal man, standing talking to his friend out on a strip job.  A couple hundred feet away was a guy driving a bulldozer.  Suddenly, the patient felt a sharp pain in his nose and lip, felt with his hand and showed blood on his fingers.  His buddy looked and broke out in disbelief….as did I when I looked.  This man thought the dozer had chipped a stone which flew over and hit the guy in the face.  Instead…someone somewhere, shot a 22 rifle into the air and the bullet came vertically down, down thru the mans nasal flare, down and out that nostril, down and into the upper lip and was protruding down out from the upper lip.  I have that image…somewhere. sigh  Was nothing to remove but a couple inches off vertical could have been fatal.

Most of my life has involved Emergency Room visits on frequent occasions.  A couple quick ones that started identically and I hope I can put images up soon.  I was called to the E.R. at Tampa Osteopathic Hospital on S. Manhattan and when I walked into the room, I saw this young college age boy sitting on the gurney with a large barb sticking down out of his heel.  I said, ‘Oh wow, does that hurt”, and he said, “You just wouldn’t believe”.  I would.  Stingray barbs have a sheath over them that carries a toxin and more.  It causes extreme pain but unusually, the toxin is heat labile and to stop the pain, you immerse the site in water as hot as the patient can stand.  It’s almost magical the way the patient responds.  Seeing this, and it happened in this following case almost in the same manner, I grabbed at my pockets and found my car keys and said, “Someone take my car home and get my camera”!   Both victims responded with “WHERE do you Live”.  I told them I would take care of the pain immediately, I wouldn’t charge for the experience, and I’d give them a copy of the image.  And so it happened.   The boy with the stingray barb, was playing football on a beach and stepped on the tail of a large dead stingray.  Because the barbs angle backwards, I expected difficulty in removing this one which was almost 6 inches long and 1/2 inch wide.  I grabbed it with a pair of heavy pliers and someone held him onto the gurney and after a while, the teeth filled up with the dense connective tissue in the heel and the barb came out intact.  A dose of tetanus antitoxin and some antibiotic after serious flushing and the boy had no complications at all as I followed him for some weeks afterward.

Barb of dead stingray in mans heel.

Stingray barb

The other case…I was called to the E.R., and when I walked in I said “Well, what are you doing for excitement?” as he’d obviously done something to get himself to come to the E.R..  The nurse said “Just take a look”…and the college age boy was half sitting, half lying on the gurney absolutely frozen to the tops of his open blue jeans.  He had been wearing a scrotal support which is like a jock strap with a hole for the penis.  He had jumped up and not paying attention, quickly grabbed his zipper and pulled hard.  His foreskin was trapped for a full inch within the zipper.  I clutched at my pants and asked someone to run get my camera just like before and his response was the same.  I instilled some lidocaine and we took the zipper apart and saved his life (sic).  I had taken lots of foreskins off but I never put one back on and I was not sure what the outcome of this would be.  I told him circumcision might be necessary as the tissue was quite crushed but in a weeks time, one could not even see a scar.

Trapped

Don't be in such a hurry

 

4/4/12

I have indeed had some incredible experiences and slowly as my mind permits, I hope to get some of them to print.   Sometime after 1971 when I had moved to Tampa, I met a black gentleman who had an unusual problem with his right (dominant) hand.  It was gangrenous and avascular from mid forearm distally, for a time period long enough that surgery was mandatory.  Usually the need for an amputation of mid-forearm is traumatic in origin, and then possibly an embolic phenomenon which can happen but to a single site is uncommon.   I talked to the patient at length and explained the surgery.   He was understanding and tolerated the surgery very well.  Following the surgery and discharge he went to therapy and prosthesis.  I saw him for removal of sutures and wound followup.  A few months later, he came to my office with a big smile on his face.  I even met him in the waiting room at his request.  With a big smile…he showed me the prosthesis and asked me to stand back.  He took his hat off his head with the hook that opened like a grasping device…and with that, he threw his hat and landed it on my coat/hat hanger in the waiting room.  It was simply wonderful.  But then…he told me to watch, and with that prosthesis, he pulled a bag of rolling tobacco out and rolled himself a cigarette with his left hand, and then, using the prosthesis, lit the cigarette with a lighter.  With my profound feelings, he thanked me and hugged me and left.  I could have cried with emotion.

Many years later now, I am in Pennington Gap, Virginia and I get one of these “Come now, we need you” Click! from the emergency room at the hospital.  Dewey Dougherty had been on the phone to his girlfriend demanding she bring him some drugs.  She refused, and he said to her “Ok…I’ll fix you”…and shot himself with a 22 caliber pistol in the right flank.  He was in shock but awake when I saw him but I knew that emergency surgery is mandatory.  So, to the O.R. we go in a bit of a hurry.  I made what is called a Chevron incision, which is below the rib cage from one side of the abdomen to the other in an arched “chevron” shape.  Naturally we encountered lots of blood, but we found that the bullet went thru the right lobe of the liver…thru the gallbladder, thru the duodenum at the level of the Common Bile Duct, thru the length of the pancreas, thru 2 different sites of jejenum, thru one site of colon and thru the lower pole of the left kidney.  After a LOT of work…10 hrs later, I left the kidney to drain out of a drain placed into the capsule and out the left flank.  There’s a story behind this part that I may or may not spell out later.  His post surgical time was uncommonly good and he left the hospital after about a week as I recall.  I was chastised that I had not taken out the left kidney…he was fine except urine was coming out the drain as I planned if it was severe enough.  It was only the lower pole of the kidney and I could have fixed it at a later date..but he was sent to the V.A. hospital and they removed his left kidney.   I found this out some time later.  Then a few years later…with Dewey in one of his drug rampages…got into an argument with his father and it got so severe that his father shot him and killed him.  Such is the life of surgery in the environment of Appalachia, the mountains of Virginia.

4/7/12  Isn’t this fun getting some memories back.  Could it be the Coconut Oil? 🙂

I was in Tampa in my office when I got a call from Zephyr Hills Hospital, about 30-40 minutes drive north of Tampa.  They couldn’t reach their surgeon and they needed on emergently.  I had my secretary call the state police and tell them I’d be driving high speed and I was on my way.  When I got there (btw…I never saw any police), The man was in surgery, unconscious with his abdomen prepped for surgery.  Not sure how they counted on me so strongly but my close friend Tommy Baptiste was my assistant that day.  He showed me an x-ray…a NG tube (naso-gastric) was in and the distal tip of the tube was just under his left clavicle.  He had perforated his diaphragm and his stomach was displaced that much.  When I got in, I also saw that his spleen and transverse colon were also up there.  I effected a repair after putting anatomy where it belonged.  Had to be reminded (can you imagine) to put in a chest tube so his left lung could re-expand, and everything else checked out ok.  But, closer look at an x-ray showed him to have collapsed vertebra in the lumbar spine.  A few weeks later, I re-operated him and took care of that.  The patient, in explaining his accident that he was so fortunate to survive…”all I can remember is sneezing and looking up and seeing the 18 wheeler coming at me.”  Life was good.

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