LIttle Bugs, Big Mess

Being a surgical tech is hard work. I'm just now realizing this. It's not just a physically demanding job. Oh no that would be easy. This job also gets you mentally and emotionally. After an eight hour day at the hospital I am just spent. And its taken two months working at the hospital as a surgical tech for me to finally start feeling like I'm hitting my stride and that I can fly solo on most of my cases. And I'm excited about it.

Most days I really like my job. I don't like working the 7am to 3pm shift because I am in no way a morning person but I'm tolerating it. I have very few bad days where I just hate what I'm doing and question if this is where I want to be. However, a little while back I had a very bad day that I'd like to share with you because it ties in to my previous post about microbiology. I will pick back up on that two part post next time but I wanted to really shed some light on what all those nasty little bugs can do to a person’s body. *Caution- a few of the pictures may be a little graphic*

Not long ago I was working in General surgery with my favorite doctor and was having a routine day of laparoscopic cholecystectomys (where we take out the gallbladder through a series of little ports called trocars instead of one big open incision).

These are the trocars that we use for laproscopic surgery. They are put through the tissue layers and gas is instilled in the abdomen to inflate it to give us room to work. Then long, thin instruments are passed through the trocars.

Around lunchtime the charge nurse came into our room and told us that after lunch we were getting an add-on case. It was a woman with a decubitus ulcer or a bedsore on her butt that had gotten infected with staph. Typically, these things are fairly small so we didn't think it was going to be a big deal.

After I got back from lunch I set up for this case thinking that the rest of my day was going to be a breeze. Boy was I wrong.

Let me give you a little background on my patient. The patient was a female in her late thirties, about 400 pounds, who suffers from muscular dystrophy (refers to a group of hereditary muscle diseases that weaken the muscles that move the human body). Because of the disease she couldn't walk or really get around by herself. However, she managed to live by herself. Which was just fine except for the fact that she had no sensation below her waist and had no idea this ulcer had formed.

Decubitus ulcers are lesions caused by many factors such as: unrelieved pressure; friction; humidity; shearing forces; temperature; age; continence and medication; to any part of the body, especially portions over bony or cartilaginous areas such as sacrum, elbows, knees, and ankles. Although easily prevented and completely treatable if found early, bedsores are often fatal – even under the auspices of medical care. They can be very serious and most of the time they are discovered quickly because they are very painful for the patient and because for those at high risk there are normally caregivers who check for them.

In this case, the patient had no caregiver and no lower body sensation to alert her that something was wrong. She was wheeled into the room and she was in very high spirits. I thought this was going to be routine until the other nurses who were trying to move her onto the O.R. table shifted her to one side. I couldn't see the ulcer but I could smell it. Try to think of the worst smell you've ever come across. Now multiply that by about 1,000. No I am not exaggerating, it really was that bad. The first wave hit me and I had to immediately regroup before I threw up in my mask. The smell was literally that of rotten flesh and I was not at all prepared for it.

This shows the four stages of these ulcers. As you can see the longer they go untreated the deeper they go. This patient had a stage 4 ulcer.
As they worked on getting her onto the table, one of our team members began to frantically search for the children’s Chap Stick that we keep around. When you rub the Chap Stick on the outside of your mask the fruity smell helps to cover up the nasty one.

Finally they got her on the table and under general anesthesia. They rolled her onto her side and for the first time we got to see what we were working this. This was not a small ulcer. It was her entire backside from the bottom of her back to the top of her legs.  It was so bad that the only thing the surgeon could do was remove all the dead tissue, clean it the best we could, and put a dressing over it. There was nothing left to suture together. The ulcer was so deep in the tissue that we could see her coccyx (her tailbone) and the infection had gotten into the bone so the end of it was so soft that it broke off when the doctor gave it a little tug.

The staph bacteria from her skin thrived in this wound because the ulcer had given it an ideal place to live. It was dark, moist, and wasn't regularly cleaned. All these bugs need are a place to get into our bodies and they can quickly get out of control, as was the case with this patient. No, in this case the infection wasn't cause by something we did in the O.R. but a surgical incision is nothing more than a break in the skin (and unbroken skin is our first line of defense against bacteria). This is why we are so crazy about sterile technique.


Always,
Lisa Marie