by Mister Schnell
We admitted this patient at three in the morning. She was an emergent open Abdominal Aortic Aneurysm repair; in hospital jargon “a triple A”. The procedure went fine. In and out of the operating room in record time. The decision was made to extubate then ship to the ICU.
They slice and dice, manhandle the bowel to get to the abdominal aortic aneurysm, put the scrambled gut back in place when done, close, allow the patient to wake up then extubate and transport!!! That has got to hurt and cold blooded if you ask me. At 3 AM there is no recovery room. The ICU is the recovery room.
The patient arrives in the unit screaming. Open aneurysm repairs are painful. She is hurting, agitated, combative and pulls out her radial art line. Apparently it wasn’t sutured in place. Art lines are nice to have to monitor and manage blood pressure when recovering aortic aneurysm repairs in the first 24 hours. High blood pressure can mess with the surgeon’s fine stitch work so I politely request of the surgeon, “Would you mind putting in another arterial line? The patient inadvertently pulled out the one she had placed in the operating room. It wasn’t sutured in.”
Oh was he pissed! He grudgingly put in a new line and while suturing this one he snarled at me, “If this comes out I’ll be back with a gun!“
I was speechless. Did I hear what I thought I heard? I looked around the room, which was dead silent now. Yeah. We all heard it.
I looked at the surgeon. He is maybe 5’6″ at best. Pigeon legs. Weighs maybe 135 pounds. Bald with a few strands of comb over. Mid 50s I’d guess and threatening us with hand gestures indicating his high powered imaginary firearm. Bang Bang.
I am in my early 40s, 5’11”, 225 pounds, broad shoulders, full, thick head of hair, bushy beard (Charlie Manson style), stocky build. Hunted wild game all my life. Pretty good shot too, if I say so myself (but got my last deer with a bow a few years back). I am also a military veteran and on that day I have this scrawny, little, baldheaded twit threatening me with an imaginary gun at 3 am.
Next to me is another male nurse in his late 20s who was an Army ranger. A paratrooper. He used to shoot .50 caliber machine guns and throw hand grenades. Part of his training involved hand-to-hand combat and living off the land in alligator filled Georgia swamps. Did I mention he is a body builder too?
The only thought I had was, “What caliber gun, doc?”
I mean, honestly, he’s runt size even for an aging gnome, with smaller hands than Donald Trump. The kick from anything bigger than a BB gun would easily snap his hobbit size, tooth pick wrists.
Staff were staring at me. It was obvious they could read my mind and their eyes were pleading, BEGGING, “Don’t, please, PLEASE DON’T ASK THAT?”
Bowing to majority mental telepathy pressure and ignoring everything I ever learned in “The Bedside Jokester Book Of Clever Retorts” I suppressed the urge to engage and remained silent.
The sigh of relief was felt all the way to the hospital parking garage a bus shuttle away.
Why does this highly trained, talented surgeon have to be such a moody asshole? What he does for a living is amazing, prestigious, respected and rewarded. Could it be he is some how intimidated? Nah, surgeons are never intimidated. Maybe just tired? But that is a human quality uncharacteristic of his immortal stature. Does mentioning “a gun” win some kind of convoluted pissing contest for him? All of the above? Me thinks that be the case (pardon my grammar). Typical and expected. Something nurses deal with all the time.
We are an open heart, catch all surgery recovery unit. We deal with intubated patients, temperamental surgeons, and apparently, now, “gunslingers” around the clock. Leaving an abdominal aortic aneurysm intubated and sedated through the remainder of the night would have been nice and even humane. We would have allowed her to emerge from the anesthesia slowly, controlling her discomfort gently along the way. We would get her extubated like we do everyday with our post operative heart patients. But not tonight. Our sleep deprived munchkin is calling the shots (pun intended) and probably doesn’t want calls later (no one does).
Neither of us has ever worked with “Little Rambo” before and this is the middle of a night shift. Generally he is only around from 9 to 5. Must have been the on call surgeon tonight.
Anyway, we get this lady’s pain under control, make her comfortable, and settle her in. The new arterial line works wonderfully. We keep her blood pressure within parameters and use the line to draw blood work without disturbing her. The surgical stitch work is never stressed or compromised.
To our relief the arterial line stayed in and “little gnome Rambo” didn’t have to “come back with a gun”. The patient recovered without further incident and later that day I got a hair cut and trimmed my Charlie Manson beard while my Ranger coworker wrestled alligators at the local zoo.