Metzenbaum Meltdown

It’s been a week of instrument incidents this week, at least on Tuesday anyway. I didn’t sleep well on Monday night, and by nine o’clock on Tuesday morning, I confess I was wafting round the practice, trying to be all efficient. It wasn’t easy. Somehow the standard tasks of ensuring the rooms were well stocked with needles and syringes seemed unusually complicated. I thought I was finally getting into my stride though, as I emptied the instruments from the autoclave, put them away, and packed up a raft of new kits for sterilisation.

Irene came into the room at this point and started to chat. My brain being otherwise occupied (the routine tasks were taking up all of the limited space in my one cylinder brain) I looked at her vaguely and failed to answer to her satisfaction. She looked at me with narrowed eyes and her head on one side.

‘Are you tired this morning? You’re not usually this quiet. I went to a concert last night. I’m tired.’

I admitted that I wasn’t at my best. My inclination was to remain silent, but it seemed impolite. ‘What concert did you go to?’ I had to try to appear normal at least. She named a singer I had never heard of and I tried to carry on the discussion as I set up the autoclave to sterilise the instruments I had just packed.

The autoclave has something of a pre-set routine. When you first switch it on, it automatically says that the door is open, and the locking mechanism doesn’t work until the programs become available. So I meticulously emptied the outflow, ensured the distilled water was topped up and then, to pre-empt the frustrating period when the door won’t lock, I carefully pushed the door to and set the locking mechanism in place. With a sigh of relief that everything was beginning to settle down, I turned my back as the machine began to run through its program. Irene had continued chatting, but now she was looking at me with a very confused look in her eyes.

‘So what’s in the autoclave?’ she asked. I frowned at her for asking such a crazy question. Obviously the packs I had just set up so carefully, but her eyes weren’t looking at me. They were directed towards the neatly stacked rack with the kits all neatly packaged in their white paper parcels. I had just set the autoclave off on its hour long programme with nothing inside.

All day long, I seemed to be all fingers and thumbs. There had been a spell lately when it seemed I was unable to do the simplest task without dropping something on the floor, and on Tuesday the effect was magnified. Opening up some suture material while Dagny was operating, I thought that rather than risk handing it directly to her from the package, I would drop it on the instrument table. Of course, it flipped out of my hands and missed by several inches. Somehow, every needle I used became detached from the syringe. I spent so much time running in and out of theatre to get new ones that I began to worry that someone would comment. It was a relief therefore when Dagny, usually so efficient, managed to drop the straight scissors from her kit. I retrieved them and offered to get a new pair.

‘I’ll need some Metzenbaums anyway,’ she said ‘you can just get some of those and I can used the curved scissors for everything else.’ Metzenbaum scissors are long slim scissors designed to cut delicate tissue. I collected a pair from the instrument cupboard. Once again, Dagny being occupied with her operation, I decided to drop them directly onto the instrument table. I should have known better. They too slipped to the floor with a clatter that seemed so loud in the quiet operating room. Fortunately, Dagny was not in Scary mood (in fact, she has been so unscary lately, that if I didn’t know how much she loved her nickname, I might feel the need to change it) and she just laughed and asked if we had another pair. At this point, Magne, ever the gentleman obviously felt that he should join in with this game of throwing things on the floor and dropped the chuck-key of the drill. Really I didn’t feel so bad then. The final flourish occurred as Dagny was stitching up. As she went to set the scissors back on the table after cutting her suture material, she misjudged it and the last pair went toppling to the ground. She completed clipping the line of sutures using a scalpel blade. Obviously the idea of asking for yet another pair seemed too high a risk. After all, judging by earlier events, I probably would have stabbed her in the toe.

Thursday, thank goodness, was much more relaxed. Dagny’s sister-in-law brought in her lovely little dog (that’s him in the picture at the top of the page) to be castrated. In contrast to Tuesday, theatre was a hive of extreme efficiency. I’ve never seem Dagny operate so swiftly. So much so that I barely had time to stabilise the anaesthesia before it was time to switch the machine off. I spent the rest of the morning discussing some modification of the anaesthetic regimes with Wivek, who is thoroughly knowledgeable in this, as with so many other things. We want to be sure that the patients are as comfortable and as safe as possible during surgery, and so we are reviewing the analgesic (pain-relief) protocols. When all is said and done, however many times you throw your scissors on the floor, in a good veterinary practice the well-being of the animals always comes first.

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