Since this small dysfunctional corner of the internet has made it to sixty that's right folks 60 entries I decided to relate one story of a distant past. Plus crusty is a few strong beers in on a late weekend night. Forgive the typos and hold on to the popcorn cause this folks is a true doozy.
I was working a trauma shift in one of the trauma centers I had worked in my past. One of the responsibilities of this area that night was taking inventory of the equipment on hand vs needed for the night. The preference is for every trauma bed that there be a thoracotomy tray.
Before I go any further let me state a few things:
1) I know precious little about surgery
2) Although exciting it still to this day well over a decade later as a dumbass ER tech that surgery on a major scale terrifies me.
3) I have a LARGE amount of respect for anyone who takes knife to skin in hopes of healing
4) I am NOT an OR tech nor do I have any OR experience. I could not tell you the components of a thoracotomy tray but I can tell you once you get to that point that GODDAMN EVERYTHING IS IMPORTANT. I am an old EMS type who has seen a thing or two with a keen sense for shit really going sideways and figurung (drinking here remember) out how to dig out of the proverbial hole.
5) Many apologies to those of you who work OR who know what is going on.
6) I am terrified of surgery...did I say that already?! That is whether it's being done on me or not.
7) PLEASE understand I am talking out of my ass and way out of my comfort zone here.
So I do my inventory and find that for the night and for all our trauma beds I have exactly ONE thoracotomy tray on hand which perplexes me but I am told that "it's a week night nothing REALLY happens on weeknights' Cue foreshadowing music. I am working at a poor hospital and really we are lucky to have this tray on hand usually we have to beg one from the OR.
Now up until this point I've seen a few chests cracked. Been there when we needed to internally defib a patient and not have the paddles on hand. (how do you fix that? well open up another tray or grab a spare set if you are in a well funded hospital) So I know a little bit which is to say when the surgical team decides to crack a chest in a trauma room the pucker factor goes up a shit ton and the shit has hit the fan in a very major way. Which is to say when I hear the surgical types say "We're cracking a chest" I need to know where everything is at and then where to find things if shit ain't there another words when old murphy of murphy's law makes a very unwanted appearance.
Long story short and you dear readers saw it coming that night we crack a chest.
The tray is opened and lo and behold the tray has everything we need except for:
THE FUCKING RIB SPREADERS
For those of you not in the know rib spreaders (eg, Finochietto) are one of those essential pieces of equipment you cannot get to the heart without them. This vital piece of equipment opens the rib cage enough for the surgeon to reach their hands in to do repairs to very vital organs, defib a patient or do a heart massage. These like most parts of this particular tray are important. Unlike most everything else in an ER you cannot just cobble together something that works you gotta have THAT piece of equipment.
Now I am sure there are folks out there way smarter than ol' crusty ER tech who know how to do shit like this. To them i will say in a situation like this I am by far the dumbest person in the room. I am not a trained surgical type. I will say that even surgical folks may not know how to over come this deficit of essential surgical equipment. I don't know I do not work in an OR.
So there are no rib spreaders. Since I slapped the tray down on the table and i'm standing there and fuck there are no rib spreaders all eyes rest on me. Now double fuck me. I should have insisted earlier on getting a second tray up ther just in case but i was waved off that thought for what ever reason. At that point the surgeon says "Fuck open another tray" Which the charge nurse and trauma nurse say "That's all we got" A silence falls over the room. We all know the surgeon wants to crack the chest in fact in the hurry to do it the rest of his team has already cut into the appropriate land marks and fuck blood is pouring out. The level one is going and suction canisters are filling up. Lots of blood in the chest cavity.
I look up and say "I'm going to run over to sterile supply and get another tray" I get told more than once before i leave the room to "Hurry the fuck up"
I am sprinting down the hall way. I am confident in those moments that the charge nurse is on the phone to sterile supply telling them someone is headed over there to pick up another tray. I know there is probably a resident calling the OR telling them of our predicament. Sterile supply is closer in a round trip than OR is one way. So I know if it's no dice at sterile supply I gotta call the ER and let them know I got fuck all. It's a monumental cluster fuck.
I make it to sterile supply, instead of seeing a rattled person standing outside the doors with the tray in hand I arrive at the door hearing their phone ringing. I start pounding on the doors with both fists screaming. I am having a controlled shit fit. The doors fling open and there stand a bewildered sterile tech looking at me all pissed off.
This is understandable. I can imagine the life of a night shift sterile tech being almost zen like. Night in and night out you listen to your music and clean surgical tools. You do the same thing night in and night out you may think "this is awesome, I'm all by myself and I don't have anyone hardly ever bothering me." Again I don't know I am not a sterile tech I can only guess.
I have disturbed this dude's zen and fuck now the damn phone is ringing off the hook, shit every line is ringing off the hook. I would guess that this dude has never seen this much action going on at his job ever. He's answering the door & picking up the phone. He's got me screaming at him for a thoracotomy tray and some other person on the other end of the line screaming for the same thing. This dude is in the eye of a horrible shit storm and he ain't use to it. I know it's the charge nurse asking for what i'm asking for because she ain't leaving anything to chance cause I could have dropped over dead running over to get the thoracotomy tray. In fact i'm a little surprised a surgical resident or another tech is not running up right after me.
Needless to say I am sweaty and wild eyed.
The sterile tech is able to focus enough through this abrupt cacophony of noise that I need a thoracotomy tray. He has no clue I need it NOW!!! He tells me all our thoracotomy trays are being cleaned at the moment, that we'll have to wait until later to get them.
Clearly there is a misunderstanding here.
To his credit he hangs up the phone before I speak. The phone begins to ring again. He looks annoyed. I am one breath from pushing him aside and just grabbing whatever i need which would be a mistake since i have no clue where anything is in the sterile cleaning area. I calm down enough to tell him that we are cracking a chest up in the ER and that I need a thoracotomy tray ASAP, Yesterday, NOW!!!! If I ask for rib spreaders alone it will be a fuck up. Better to ask for the tray in fact in my paranoia I ask for two thoracotomy trays. He snatches up two quick that belong to the OR . I tell him if I have to come back for another tray that physical violence will occur. I mean it because what we need aint on these trays then I am fired, he is fired and other people are fired so why not kick someone's ass over this damn mess. I'll take the charge fuck it.
I make it back to the ER in just a few minutes (literally, yes LITERALLY!!!) The chest is cracked the rest of the way and surgical things happen. I won't go past that.
I don't know who fucked up the thoracotomy tray so badly that there were no rib spreaders in it. I was told rather sternly that I knew better and to have a back up tray in the future. I learned a powerful lesson there. The charge and trauma nurses were told the same thing. We all got angry glares from the surgical teams for months after that. A lot of memos and emails were exchanged over this very gross oversite. For as long as I was at this hospital that never happened again.
I had a triple extra large whiskey after that shift. It makes for a nice story but I've had a lot of sleepless nights over that one. So goes the life of the ol' crusty one.
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