Gag-O-Meter

I have rejoined the living after the busy day at clinicals, thanks to my three hour power nap. I still have much to do and its already rounding on midnight, so instead of getting started on all that...of course I'll blog.

First of all, I kind of smirk when I type: "busy day at clinicals." At this point, I really think the words "busy day at" should just be implied. I think I have a really high tolerance for change on the fly. Heck, I ran a design studio for years, full of creative and brilliant lunatics. There existed no linear process of A to B. I honestly don't know how folks could enter the medical profession if they were wired to expect to make a "plan" and then "follow it" to the letter. Still, even I am constantly adjusting to the whole new world of crazy that is the hospital floor.  As we are learning in school, there is the "ideal outcome" for any given situation, and then...there's what really happens. Reconciling how far apart those two things really are is always surprising for me. And I'm a Type B! Lord help all those Type A nurses out there!

One incident today (among several less interesting things) shot my best laid plans all to hell. It also makes for an interesting story, although those of you with a delicate constitution may like to skip it and go back to whatever it was you were doing.

THE HEMOVAC.

Sometimes when you have surgery you'll wake up attached to a circular accordion-like vessel which is about the size of a saucer. The surgeon will squish down this plastic device, which is attached to a tube inside your surgical site, and which will then provide a bit of suction and a place for that nasty stuff to collect outside your body. This is a Hemovac, and today my knee-surgery patient had that snaking out of his tidy full-leg bandages on his first morning post-op. Of course I was excited to see it, since it would be something new for me to experience. He also had a couple of wires sticking out of his tush, a nerve block that kept his whole leg blessedly numb. In other words, he had a lot of lines which could potentially detach from him and ruin both of our days.

Of course that's exactly what happened...and how I discovered the presence of my Gag-O-Meter.

Man, we were SO close to the end of my time with him and everything before that had gone swimmingly well. I even got to give him his mid-day IV push medication. Afterwards my instructor had gone over how I would empty his drain, as it was now expanded about two inches full of blood, and courtesy suggests we don't leave these messy tasks for the next shift...we take care of them before we go. She trustingly left me to do this solo and went to deal with another patient. However, for moral support, I snagged another student who had just completed this task and was willing to talk me through it. Since it was essentially a bag of blood, I figured a mistake could easily ruin both my stark white outfit, AND my reputation!

So my patient was tucked neatly into the freshly made bed (which I had just finished making up while he was at PT) and was starting on his lunch of rubber turkey and powdered mashed potatoes when we approached to deal with the Hemovac. I flipped back the crisp white covers and instead of the cleanly bandaged leg resting on clean white sheets -- he was laying in a bed of gore! Bright red blood was leaking through his thick bandages, beneath him on the bed pad and all over the covers! (My bed!) His drain, and its now detached tube were lying impotently beside him. Since his leg was fully numb, he couldn't even sense the wetness he was lying on.

Rather calmly, the other student and I began to deal with the situation. She went to get a nurse, while I remained with the patient. The male nurse came in, glanced at the bed full of gore and diagnosed blandly, "Drain's out."  (Clearly this was a "no-DUH" moment, but I repressed it.) The patient stated that he felt a little tug about 30 minutes ago, and we deduced that shifting around in bed had pulled the tube out. (I realize this isn't exactly rocket science.)

The nurse and I then emptied the drain out of the patient's line of sight, thankfully. I held the measuring cup and he squeezed. The thing is, it's blood. It doesn't just drain right out when you open the valve (say, like urine would.) I hadn't really thought about that fact ahead of time and I was already somewhat steeled to participate in this gross task. (You just never know what event is going to cause you to toss your cookies.)

If you can picture me on a television screen this whole time, down at the bottom of my screen would pop an animated meter - my Gag-O-Meter, which goes from zero to ten.

It was at zero when I entered the room. And I am proud to report that it didn't really twitch when we flipped back the covers to see the bloody mess. When I held the cup and felt the warmth of the blood filling it, the meter moved up to a 1. No big deal. But it wasn't until the nurse began to squeeze the drain, and this long, dark clot just hung there suspended, and then slowly began to snake, quiver and coil its way into my warm cup that the Gag-O-Meter moved up a couple more points. I realized that if I had been: pregnant, hungover, or was just getting a stomach flu, I probably would have hurled. I couldn't tear my eyes off of the seemingly endless clot, and kept worrying that the nurse would squeeze a bit too hard to force it through and maybe spray us both, thereby soiling my outfit -- (at which point, I very well may have soiled the floor.)

I think the Gag-O-Meter got to about a 3 today. I'm betting at a 5, I would actually gag. At a 10, that's when somebody would be holding back my hair. I periodically wonder when/if these events will happen for me personally. Perhaps it will be in a couple of weeks during my OR rotation. If not, I have a sneaking suspicion that another body fluid may send me over the edge when I start to suction tracheal tubes in the ICU...

Phlegm.