The Bouncing Betty
Eventually it happens to everybody working in Health Care. There are guidelines called Universal Precautions, dictating how one should always wear gloves, splash shields etc. when dealing with a patient's body fluids and such. You've all seen ER. But it will eventually happen in your career, a needle stick, a scalpel scrape, a bit of sputum in your eye. You just hope it's not a big deal and the patient does not have a disease like hepatitis or HIV.
About two years into the job, I realized I had not had a single incident to speak of. I was a rookie with no battle stories. Not even a possible suture needle stick. Those are most common. And I say possible because the needle can jab your gloved hand, and hurt, even break skin, but NOT PERFORATE THE GLOVE. I can't explain it - they really know how to make latex gloves these days.
One night working L&D, my time was up. I had an exposure incident that blew the doors off any incident I have seen or heard about since. They still bring it up every once in a while in that department.
Everything was normal about this C-section, except the Doctor was new to the area. The patient had an epidural, and was lying there between us, and the father was by her head, calmly looking at us putting his wife back togethor again. The baby had just been passed off the field to the Neonatologist, and it was time to take out the placenta.
During a C-section an incision is made in the actual uterus to get the baby out abdominally, it makes sense that the placenta should come out that way, as well. The doctor grabbed hold of the umbilical cord at its base and began pulling the placenta off the interior wall of the uterus. At the end of the umbilical cord (where the baby was moments ago) there was a surgical clamp preventing blood from pouring out of the placenta via the umbilical cord.
This part of a C-section can get a little stressful since everything that was cut getting to baby is highly vascular tissue. A blood loss of 1000 cc's is not uncommon (think of half of a 2-liter bottle of coke). Trying to sew anything back togethor again is hard when you have to get a liter of blood off the field in order to see what you're doing. Often times it's literally a deep puddle of hot blood that you have to stick your hand into, just to scoop totally opaque fluid out of your way.
You get the picture. C-sections are quite bloody. While he was pulling the placenta out, I was already sucking up blood and using absorbent pads called "Laps" to soak up the blood from the uterine incision.
The placenta wasn't coming out. He was pulling pretty hard on that cord, and so far it wasn't coming out of the uterus. Suddenly the side of my face was splashed with a huge amount of hot blood. I was looking to my right when it happened, although I don't remember why. But I knew instantly what had happened.
The doctor's hand had lost its purchase for a split second, and in that time it traveled right up to the end of the umbilical cord, milking about 200 mL of blood with it. The clamp prevented the blood from flying out of the end of the cord, so it instead created an instant water balloon of blood, right at eye level. When it exploded, the entire volume of blood went right into the side of my head. It was about the same volume as a coffee cup.
Unfortunately, I was breaking Universal Precaution protocol and not wearing a clear face shield. I had on glasses, and figured, as many people do, that a little spray of blood won't get into my eyes if they are on. Plus I had a mask over my nose and mouth. That was the last time I went into a case without a face shield.
The heat of all that blood is what surprised me. Most of it hit me right above my left temple and started oozing down my face and head. I felt it clog my left ear, making everything get a little quiet, and then came down into my left eye. I closed it and looked down at the surgical site with one eye, having lost depth perception. My nose started to tickle and I tasted something salty. I kept making little spitting sounds to keep it off my upper lip. It was still oozing, and I felt it go down my neck.
The only people to notice were the Surgeon and the surgical tech passing instruments. And they were frozen. Literally. When I looked at them, they were both completely wide-eyed, and I remember them being pale white. That's how shocked they were. And they had masks on, and the tech was black.
Knowing I had to play it cool since the father was watching, I acted like nothing serious had happened despite my stinging left eye and my coworkers' catotonic reactions. Looking back, I am sort of proud that I never broke sterile technique - I just stood there looking down at the field, sucking up blood, and taking the placenta off the endometrium.
I said something like "gimme a lap", but I couldn't use it on myself since from the neck up you are not sterile. The tech wasn't moving anyway. She was staring at the side of my head and mumbling. The Doctor said, "Oh my, I am so sorry" then called one of the circulating nurses over.
She turned away from her paperwork and approached the field and stopped. Her eye followed the stunned expressions of the surgical team to the left side of my head. When she saw the amount of blood covering me, she jumped back with her hands flying up to her mouth, as if she realized she was a little too close to an open flame or a poisonous snake.
The father amazingly didn't notice the splash take place, and didn't see it either since only my right side was in view. He nonetheless realized something was amiss. He asked what was wrong, and nobody knew what to say to him. What could we say, except "everything was going well"?
"Everything is fine up here, but it seems that about a quart of your wife's blood is seeping into every orifice of the assistant's face."
The nurse put on gloves and took my glasses off, so I opened my eye and tried to get back into the case. Not only was everything a little pink in my left field of view, it was completely fuzzy. I couldn't see a thing without my glasses. I felt like Velma in Scooby Doo. Then I realized there were streams of blood creeping down my chest, right over my nipple.
How many people, I wonder, have had their nipple immersed in a stranger's blood? What a perversely unique thought. But that's what was going through my head at 3 in the morning while providing dangerously little help in that case. It made me smile.
Begging for my glasses, they were cleaned and put back on my head, and the side of my face and neck were wiped down with a damp towel. This was all done by very nice, sympathetic nurses.
Once the skin was closed, the room agreed I should go change and shower. When I took off my surgical gown in the OR, my scrubs underneath were so bloody and my face was so smeared with blood, it honestly looked like I was the bad guy in a hospital slasher movie. Everyone sort of said a collective, "Oh my God, go change."
The locker rooms have showers, and I took one for the first and only time at work. While most of the blood was cleaned up off the side of my face, it was still very much in my chest hair and all the way down to my navel. The shower water was red around my feet as I rinsed this woman's blood off my naked body.
I had to go to our emergency department and the Doc down there used a Q-tip to get the blood out of my ear and nose.
A call came down to the ER. It was a nurse who looked through the patient's chart and wanted to inform me the patient was clean. I have to admit - the first thing I thought of as her blood started stinging my eyes was whether or not she was positive for anything. I forget who that nurse was, but I guarantee she has been exposed to body fluids before and has endured the forced patience of wondering if the patient is positive. She didn't have to call that information down to the ED secretary but she did.
It was difficult to explain to the ER doc exactly how it happened, but I stumbled through it. Since he was a Vietnam veteran, he quickly told me it sounded like one of those Bouncing Betty mines. The kind that first spring up to chest level, then explode, making the detonation deadlier. We were both sort of amused how the Surgeon's hand just sprang up to face level and suddenly blood exploded on me.
The secretary walked over and told me the good news while the doc was cleaning out the inside of my nose and talking about mines in Vietnam. I was washed with a sense of relief. The camaraderie in health care transcends disciplines and departments. He was happy for me, and silently share my releif - he no doubt had been there before.
He knew I wasn't smiling about the Bouncing Betty analogy anymore. I was in the clear, and had earned one hell of a battle story.
We just kept smiling.
About two years into the job, I realized I had not had a single incident to speak of. I was a rookie with no battle stories. Not even a possible suture needle stick. Those are most common. And I say possible because the needle can jab your gloved hand, and hurt, even break skin, but NOT PERFORATE THE GLOVE. I can't explain it - they really know how to make latex gloves these days.
One night working L&D, my time was up. I had an exposure incident that blew the doors off any incident I have seen or heard about since. They still bring it up every once in a while in that department.
Everything was normal about this C-section, except the Doctor was new to the area. The patient had an epidural, and was lying there between us, and the father was by her head, calmly looking at us putting his wife back togethor again. The baby had just been passed off the field to the Neonatologist, and it was time to take out the placenta.
During a C-section an incision is made in the actual uterus to get the baby out abdominally, it makes sense that the placenta should come out that way, as well. The doctor grabbed hold of the umbilical cord at its base and began pulling the placenta off the interior wall of the uterus. At the end of the umbilical cord (where the baby was moments ago) there was a surgical clamp preventing blood from pouring out of the placenta via the umbilical cord.
This part of a C-section can get a little stressful since everything that was cut getting to baby is highly vascular tissue. A blood loss of 1000 cc's is not uncommon (think of half of a 2-liter bottle of coke). Trying to sew anything back togethor again is hard when you have to get a liter of blood off the field in order to see what you're doing. Often times it's literally a deep puddle of hot blood that you have to stick your hand into, just to scoop totally opaque fluid out of your way.
You get the picture. C-sections are quite bloody. While he was pulling the placenta out, I was already sucking up blood and using absorbent pads called "Laps" to soak up the blood from the uterine incision.
The placenta wasn't coming out. He was pulling pretty hard on that cord, and so far it wasn't coming out of the uterus. Suddenly the side of my face was splashed with a huge amount of hot blood. I was looking to my right when it happened, although I don't remember why. But I knew instantly what had happened.
The doctor's hand had lost its purchase for a split second, and in that time it traveled right up to the end of the umbilical cord, milking about 200 mL of blood with it. The clamp prevented the blood from flying out of the end of the cord, so it instead created an instant water balloon of blood, right at eye level. When it exploded, the entire volume of blood went right into the side of my head. It was about the same volume as a coffee cup.
Unfortunately, I was breaking Universal Precaution protocol and not wearing a clear face shield. I had on glasses, and figured, as many people do, that a little spray of blood won't get into my eyes if they are on. Plus I had a mask over my nose and mouth. That was the last time I went into a case without a face shield.
The heat of all that blood is what surprised me. Most of it hit me right above my left temple and started oozing down my face and head. I felt it clog my left ear, making everything get a little quiet, and then came down into my left eye. I closed it and looked down at the surgical site with one eye, having lost depth perception. My nose started to tickle and I tasted something salty. I kept making little spitting sounds to keep it off my upper lip. It was still oozing, and I felt it go down my neck.
The only people to notice were the Surgeon and the surgical tech passing instruments. And they were frozen. Literally. When I looked at them, they were both completely wide-eyed, and I remember them being pale white. That's how shocked they were. And they had masks on, and the tech was black.
Knowing I had to play it cool since the father was watching, I acted like nothing serious had happened despite my stinging left eye and my coworkers' catotonic reactions. Looking back, I am sort of proud that I never broke sterile technique - I just stood there looking down at the field, sucking up blood, and taking the placenta off the endometrium.
I said something like "gimme a lap", but I couldn't use it on myself since from the neck up you are not sterile. The tech wasn't moving anyway. She was staring at the side of my head and mumbling. The Doctor said, "Oh my, I am so sorry" then called one of the circulating nurses over.
She turned away from her paperwork and approached the field and stopped. Her eye followed the stunned expressions of the surgical team to the left side of my head. When she saw the amount of blood covering me, she jumped back with her hands flying up to her mouth, as if she realized she was a little too close to an open flame or a poisonous snake.
The father amazingly didn't notice the splash take place, and didn't see it either since only my right side was in view. He nonetheless realized something was amiss. He asked what was wrong, and nobody knew what to say to him. What could we say, except "everything was going well"?
"Everything is fine up here, but it seems that about a quart of your wife's blood is seeping into every orifice of the assistant's face."
The nurse put on gloves and took my glasses off, so I opened my eye and tried to get back into the case. Not only was everything a little pink in my left field of view, it was completely fuzzy. I couldn't see a thing without my glasses. I felt like Velma in Scooby Doo. Then I realized there were streams of blood creeping down my chest, right over my nipple.
How many people, I wonder, have had their nipple immersed in a stranger's blood? What a perversely unique thought. But that's what was going through my head at 3 in the morning while providing dangerously little help in that case. It made me smile.
Begging for my glasses, they were cleaned and put back on my head, and the side of my face and neck were wiped down with a damp towel. This was all done by very nice, sympathetic nurses.
Once the skin was closed, the room agreed I should go change and shower. When I took off my surgical gown in the OR, my scrubs underneath were so bloody and my face was so smeared with blood, it honestly looked like I was the bad guy in a hospital slasher movie. Everyone sort of said a collective, "Oh my God, go change."
The locker rooms have showers, and I took one for the first and only time at work. While most of the blood was cleaned up off the side of my face, it was still very much in my chest hair and all the way down to my navel. The shower water was red around my feet as I rinsed this woman's blood off my naked body.
I had to go to our emergency department and the Doc down there used a Q-tip to get the blood out of my ear and nose.
A call came down to the ER. It was a nurse who looked through the patient's chart and wanted to inform me the patient was clean. I have to admit - the first thing I thought of as her blood started stinging my eyes was whether or not she was positive for anything. I forget who that nurse was, but I guarantee she has been exposed to body fluids before and has endured the forced patience of wondering if the patient is positive. She didn't have to call that information down to the ED secretary but she did.
It was difficult to explain to the ER doc exactly how it happened, but I stumbled through it. Since he was a Vietnam veteran, he quickly told me it sounded like one of those Bouncing Betty mines. The kind that first spring up to chest level, then explode, making the detonation deadlier. We were both sort of amused how the Surgeon's hand just sprang up to face level and suddenly blood exploded on me.
The secretary walked over and told me the good news while the doc was cleaning out the inside of my nose and talking about mines in Vietnam. I was washed with a sense of relief. The camaraderie in health care transcends disciplines and departments. He was happy for me, and silently share my releif - he no doubt had been there before.
He knew I wasn't smiling about the Bouncing Betty analogy anymore. I was in the clear, and had earned one hell of a battle story.
We just kept smiling.
posted by All Rounder | 9:25 PM
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