Monday, April 19, 2010

15 years

Today I'm going to eat at Sonic.

Fifteen years ago was lying in bed reading when there was a loud noise and the house shook. I initially thought that a car had hit the house. I lived in Oklahoma City and I was three and half miles away from the Murrah Federal Building.

Within a couple of hours I was scrubbed in surgery at St. Anthony's. I was no longer an employee, having parted ways with the hospital almost a year earlier. I was part of three separate teams working at the same time on the most seriously wounded patient. I've been scrubbing for almost twenty years. I remember two patient names. This woman is one of them. (The other was named David Stapleton.)

At one point I went to see if I could help in instrument processing. St Anthony's was the nearest hospital to the federal building. (Close enough that the hospital building itself had minor damage.) Hundreds of walking wounded had found their way to the St. Anthony ER. Almost all of them had severe lacerations. The average hospital stocks maybe thirty suture trays. Luanna, the scrub in charge of processing, had her staff opening every tray we wouldn't being using that day, the GYN instrument and the like, and reassembling them into suture trays: Two hemostats, a needle holder, a pair of scissors and some forceps.

When I came out of surgery, I was surprised to find bags full of Sonic hamburgers. Someone at Sonic had figured that there would be a lot of people working a lot of hours at the hospitals who would not have much chance to eat. They made and sent thousands of burgers to every hospital in town without being asked.

Today I will say a prayer for the souls of the departed and a prayer for the continued health of the survivors and families. And I'll eat at Sonic.

Wednesday, April 7, 2010

The Sound of Surgery

I've mentioned elsewhere that the smell can be the grossest thing about surgery. Smell is not the most nerve wracking thing, though. Sound is. Not the sound of surgeons bellowing, but rather what is normally a quite normal sound, the pulse oximeter. For those not familiar with it, the pulse oximeter is a machine that measures the amount of oxygen carried by the blood. It does this by shining a specific wavelength of red light through a relatively thin body part, usually a finger. It then measures how much of that light is absorbed. From this it is able to calculate what percentage of the red blood cells are oxygenated. The best possible "score" is 100 (unless you are a member of Spinal Tap). Numbers above 96 are considered normal. Numbers below 90 are worrisome. The machine is also able to measure the pulse by measuring the time between each wave of freshly oxygenated blood. It has become one of the basic tools of anesthesia.

It has also has the best designed sound I have ever heard. It is the modern version of Monty Python's "machine that goes ping". Every time the curve peaks the machine makes an electronic "ping". Its the background noise of every OR. Most of the time it doesn't register on our consciousness. The genius in this sound is one feature: as the oxygen saturation decreases, the the tone of the "ping" lowers. A drop of 10 points will drop the tone over an octave. Since a decrease in saturation is often accompanied by a slowing of the pulse, the machine begins to sound like its battery is dying, which is the perfect metaphor, because that's what the patient is doing.

Believe me, a serious drop in the tone of a pulse ox will get everyone in the rooms attention.

This video shows the tone change in minor way. These tone changes wouldn't grab anyone's attention but they give an idea of what I am talking about. (Tone changes about 0:27 and 1:25)