A Bare-Handed Surgeon is Dangerous


(Caution: some hyperbole here. Think before you believe. Don’t let the details get in the way of a good story. Apologies to those mentioned by name. )

Chapter One: Surgery

Returned to Honolulu from Boise Sunday morning May 15th, after a wonderful weekend event in Idaho.
I have spent much of my career working with surgeons. Trauma at BCH. Neuro-ICU at UCSF. When the surgeon closes the incision, we hope the person’s problem is solved, but when the patient is a surgical disaster or train wreck, the hand-off goes to the ICU nursing staff. Surgeons can only do so much without a good team.

Saturday eve we basked in the glow of a successful event. Fueled by Belgian beer and gourmet pizza, after-dinner talk among the OR people around the table in Boise shifted to surgery. Inevitable any time there is the aroma of meat. Would have gotten down to shop talk much sooner if we had eaten anything that needed slicing.

Here the talk veered into an old theme. “A bare-handed surgeon is dangerous…..” This thought had occurred to me many times over the course of my career, never had it been codified into doctrine so succinctly. Heads nodded.

Initiation

The crew winked at each other as they initiated me into “the cult of the Universal Instrument” – the exact name and size of the one implement to hand to the surgeon in those rare cases when you don’t know what he or she wants next, or when the surgeon is at a loss for what to do next. (Yes it happens). I was stunned to learn that there was in fact a final surgical rule to govern the one remaining area of surgical uncertainty.

Could it be?

Yes. Rachel and Cam said it was true – there is only one choice of instrument – and it *always worked*

Howls of laughter and delight.

OMFG! A very handy tidbit! A True Pearl! Da Vinci Code! Tenth Insight! The Road to Damascus! Jacob’s Ladder! The Holy Grail! The Seventh Degree sign! The GPS of Life! True North! (TVMDC!)

Of course, any true surgeon never admits a brain cramp….. And any surgeons on this list will surely tut-tut …… But…. You will be forced to believe me when I find a pathologist to verify that it happens.

I would hold this gem up to the light so that you too could enjoy the way it sparkles and shines, but that is not to be. Arcana of this importance is limited to the Jedi class of surgical cognoscenti, only to be transmitted orally. Next time we see each other? The person who shared it with me revealed that the only place in the world where the answer to this question might ever be casually disclosed is a particular military shock-trauma OR/ER in Baghdad, where the stakes are high enough to circumvent the usual vetting. Military censors are active there, stepping in to block accidental disclosure. For the rest of my life I must only divulge my new found knowledge to those persons who exhibit the signs of “aficion” as defined by Hemingway during that fateful debauche in Pamplona. Civilian surgeons themselves do not harvest the fruit of this tree until they have been FACS or FRCS for at least ten years.

How Old can you Get before you are truly a Grown Up?

A funny thing. I have been a “grown up” for a long time. One summer day in 1982 or so Mike Hoffman the pediatrician ran through ICU on his way to the OR, asking me to follow him. Assembling there was Doug Schipitsch the surgeon and the late great Kestutis Kemezys, along with the “A” team of that particular OR. The patient was a flaccid two-year-old with epiglottitis, hand-carried by Mike from his pediatric office at a dead run. You could have heard a pin drop. As Kestutis slid in an uncuffed ET tube, Doug quietly asked Jeannine Lauze, the circulating RN, for The Universal Implement, I now realize. The little boy recovered after three days of intubation using an uncuffed ET tube. Worst possible age for epiglottitis. To learn about the Universal Implement brought the events of that day front and center in my mind. In a review of events nearly thirty years distant, memories of the actions of that day jibed with my new insight. Unity, the unbroken line of the past now stretching into eternity. I now realize that Doug and Jeannine were among the illuminati, the meaning of quiet words now made plain. A humble team that later delivered my first born via Ceasarean. Smoke gets in your eyes.

Becoming a Rinpoche

Despite many adventures before and since I never gained this specific insight until May 14 2011. There needs to be a plaque on the picnic table on the deck at Willowway in Boise. My life would have been different if I’d known how to call for this tool in say, 1978. Joe Sar is practically a rinpoche now! A red letter day in my nursing career. Deep gratitude goes out to Rachel, Cameron, and Patrick “the Biking Dutchman”. And the beer was also excellent.

And no, the Universal Surgical Implement is *not* a pair of pliers or a flashlight. My lips are sealed. Until that day when you are worthy.

Friday two nursing faculty of BSU attended my two-hour talk with the Nepali students. Sold thirty copies of my book in Boise, for a $360 “profit” from the event. At my booth I dispensed mission advice, career advice, travel advice, and brief psychotherapy to all comers. Now and again I threw in a palm reading, especially if my customer was an OR nurse.

Chapter Two: Boise, and boxes in Honolulu

Boise is home to New Heart, a praise band composed of pan-African refugees, who sing African Christian hymns in French and other tongues. They performed just before my keynote, a bunch of the audience dancing and singing along in the front row. I started my keynote by reminding the audience “never forget that God speaks and understands every language”. Bought their CD and burned it into mp3s. As I fly over the Pacific I am listening to Christian call-and-response with a Gumboots rhythm. The Afro-Boise beat!

Last night was the farewell dinner on Waikiki, then a chance to walk around in a world-class sophisticated built-up “bubble” environment for the last time until August. Hula show. Street performers. Lots of Juku’ed Japanese girls. Ukulele players in small groups. One guy who looked like Elvis. I am always struck by the opulent wealth, even the homeless here seem wealthy by comparison to their dalit counterparts in urban Nepal. When I returned here after the 2007 trip my re-entry shock was accentuated upon walking Kalakaua Avenue.

Don’t s and Don’t s

PS Don’t text me – it costs a dollar per text. Don’t phone – I will mostly have the BB off. My flat in KTM includes wi-fi, and so email is the best tool – use any one of my four and they will all get through. Or FaceBook (best yet!). I hope to crosspost this on WP, TravelPod and Dkos. Let me know what you think……

About Joe Niemczura, RN, MS

Experienced nursing educator and problem-solver. I have fifteen years of USA nursing faculty background. Add it with fifteen more devoted to adult critical care. In Nepal, I started teaching critical care skills in 2011. I figure out what they need to know in a Nepali practice setting. Then I teach it in a culturally appropriate way so that the boots-on-the-ground people will use it. I travel outside of Kathmandu Valley as well. When the recent violence happened, I knew the cities - I had trained people in those locations. One theme of my work has been collective culture and how it manifests itself in anger. Because this was a problem I incorporated elements of "situational awareness" training from the beginning, in 2011. Global Health Nursing is not all sweetness and light; not solely milk & honey and happy moms and babies.
This entry was posted in medical care in low income countries, The Hospital at the End of the World and tagged , , , , , , , , , , , , , , , , , . Bookmark the permalink.

5 Responses to A Bare-Handed Surgeon is Dangerous

  1. Steve Gruverman says:

    Joe,
    I’m sure I will never be worthy of this information, but that won’t stop
    me from speculating: duct tape. :-0

    Your writing gets better all the time. I really look forward to reading
    your updates (and that’s from someone who needs to get as much of his
    inbox in the trash as quickly as possible). I hope there *will* be
    another book one of these days!

    Have a meaningful trip!

    – Steve

    • Duct tape has it’s medical uses but no this is not it. Good try though.

      I was told that at the Iron Man triathlon, or at ultramarathon races, if a particpant gets a cut on their foot, the medical team will put crazy glue into the wound, then seal it with duct tape. In fact, during my 475-mile walk on the A.T. Last summer, I used “liquid skin” and duct tape on my feet. Duct tape is used by most long distance hikers. But no – not the Universal Tool.

  2. Saskia says:

    I think the name of the universal instrument is…Thingamajigg, in Hawaii also known as “Da Kine”. Anyone would know that this is the code word for a major brain fart and a cry for help by an expert with an intact sense of humor.
    Not sure what the professionals without the humor do – even though I repeatedly get proof that they exist.

  3. Pingback: If you, as a nursing student, MUST learn EKGs….. « Honolulu 2011-2012

  4. Pingback: Did you ever work with one of these doctors? – the 12 Medical Specialty Stereotypes – too good not to share « Honolulu 2011-2012

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s