Little Blob of Fat

Keeping up a professional air can be hard at times. Patients who are wondering about their well being and are potentially very frightened sometimes just need their caregivers to be confident, and that may require a degree of acting on our part.

I once had no idea what the hell was going on with a patient who was more worried than sick, and I made her feel better by calmy and confidently telling her I had no idea what the hell was going on with her. A little while later she was fine, and the entire nurses station just shrugged and moved on.

Just the other night a postpartum mom demanded that she see a doctor before she left because she noticed a patch of dry skin on her cheek. The annoyed nurse wisely called me instead, and I proceeded to have the most in depth conversation I have ever had regarding dry skin, winter, air conditioning, different detergents, make up, skin lotion with scent, without scent. I thought the patient was teasing me. Finding myself sounding like a neutrogena commercial, I told her to "apply lotion to the area and call her Familly Doctor if symptoms persist." That is known as a "Ditzel Call".

One of the funnier moments involved a little blob of fat.

I had been assisting a surgeon with an open cholecystectomy, where the gallbladder is removed. They are usually done laparoscopically these days, but if there is a complication, the surgeon extends one of the port incisions and converts to an open case. An open case is when you actually put your hands into a patient with a big hole cut in their skin, as opposed to doing it all on a TV monitor through many little holes, or ports.

We had to open this guy because he was so big. Once open, it was still a pain in the ass getting the gallbladder out since there was so much fatty tissue everywhere. In surgery, adipose or fat, is pretty bright yellow and typically globular. Depending on how much connective tissue and vessels are in it, the globules can simply break away. During a case on a big heavy, it's not uncommon to have little blobs of fat hanging around on the field, the instruments, or your hands at the end of the procedure. When they are left in the open air for a while they get to be the consistency of, say, a Corn Pop that has been sitting in the milk in your cereal bowl for 30 minutes, then accidently pushed up and over the edge of the bowl by your spoon and is unnoticed until another 30 minutes, long after you have gotten up, put the bowl in the washer, and walked past the table. There on the table, is a mushy yet firmish fat globule, the likes of which I see every day I go to work. Same color, too.

At the end of that case there were corn pops everywhere. They can even roll over the table (fresh) and stick to your shoes (drying). That's why people in surgery where those little blue booties. People think it's for sterility. Nope - Corn Pops.

I had to retract the liver and fatty layers with a very large retractor that kept coming out. It sort of pops out, depending on how much muscle you decide to pull with. A great deal of good surgery is knowing when to be ginger and knowing when to use strength. When a retractor pops loose from fat, under force, some tissue may be ejected.

That's probably how a little Corn Pop got on one of the overhead lights. The next patient in the room was in the process of wiggling over from the transport stretcher to the OR table, when the piece of fat fell off the light and onto her right shoulder. This is a rather big No-No. I was standing on the other side of the OR table, so she was scooting towards me. She had on her hospital gown and a white hospital blanket up over her shoulders, and there it stuck.

She was looking to her left torwards me, where she was scooting to, but she still saw something move out of the corner of her eye because she sort of jerked her head to the right. Luckily, I had already raised my hand up to simultaneously flick the wet Corn Pop off her shoulder and "steady" her. It was admittedly one of the slickest, quick thinking tricks I have ever pulled. Being in midsentence at the time, I didn't even break cadence. Of course I had a mask on, so hiding my grimace was not an issue.

The problem was the anesthesiologist. (Always blame the man behind the curtains). He was standing at the head of the patient and had to duck when I flicked the glob. His reflex to avoid the glob was impressive, since it was moving at flicking speed - much more impressive than his initial reaction to witnessing the glob fall onto her shoulder - he froze. Needless to say, I am glad I didn't hit him with the piece of fat. If it had hit him in the eye I may have been suspended or fired.

The patient knew something had just happened since she saw something had fell or moved near her right shoulder, my hand was now there, and the doctor behind her had suddenly and inexplicably ducked.

She stopped scooting and asked in a slightly accusatory tone, "What was that?"
The anesthesiologist, lifting his head up to stare at me with wide eyes, also seemed to be confused.

With my hand already on her shoulder, I calmly looked her in the eye, and asked, "What was what?" The anesthesiologist's eyes rolled back to the patient, waiting for a response.

"Something just hit my shoulder."

"This is just my hand, dear, you're OK.", I lied. I appropriately held it up as if taking a left-handed oath and looked confused.

I have been married for a while now, so I can't remember the last time I skillfully one handed a bra clasp. I had just reached (almost) behind a woman who was already nervous, done something quick, slick and devilish, and was now trying as hard as I could to appear innocent and smooth to a woman who wasn't sure whether or not to trust me. My teenage years were pretty tame by some people's standards, but what evil shit I did commit has come in handy more than a few times during my adulthood. This was one of them.

"Well what the hell made him jump?" she asked, referring to the doctor behind her head. Uh oh. I almost felt like telling her the truth, but it's harder than you think finding the words to explain how someone else's guts from a preceding case fell off the ceiling and landed right on her. I continued the lie.

"I didn't see him jump. Did you just jump, Doctor?", I asked, realizing that the game could be over with his reply. All he had to do was shake his head.

"I . . . uh . . . coughed." Not bad. Could have been better, but not bad. The anesthesiologist obviously hadn't rounded third until med school.

Putting my hand on her shoulder again and bolstering his questionable explanation, I said, "I have a cough, too. Something must be going around. Keep scooting towards me, please."

That did it. She stopped asking questions and complied with me. I am not sure how confident she was with any of that situation, but it didn't matter. The Versed has a retrograde amnesic effect, so the patient typically can't remember too much of anything once they are in the room.

As soon as the incident passed, the anesthesiologist held up a syringe and said, "versed". Knowing exactly what he was thinking, I responded, "cool", and kept the oxygen mask over the patient's face. Holding the patient's hand as her eyes rolled up from the induction agent, I took a deep breath and thought about the bullet we just dodged.

We never did find that little glob of fat, even though we looked high and low for it. Other team members asked what we were looking for, and shocked by the answer, asked how a piece of body tissue could get over by the anesthsia stack.

I looked them all in the eye, and calmly told them, "Because that's where I had to flick it."