Tale of an Unsterile Instrument

After we had finished our first of the three years in nursing school in a hospital-based diploma program, we could work on our days off and be paid.  On these occasions we had to wear a different uniform than the student uniform, and we were referred to as nursing technicians.  Many of us made use of this way of starting to put money away for college.  My father had told me that after nursing school, I was on my own, so I knew I needed to start earning and saving as soon as I could.

At the beginning of the day, we would go to the office of the nursing supervisor and find out where we were needed.  We would, of course, not be sent to a place where we had not already had experience, so usually we ended up on a medical/surgical unit.  Once in awhile, the operating room would be short staffed.  I was one of the only students who would agree to go there.  I had enjoyed the time I spent there as a student and didn’t mind going back. 

Except….on one such occasion, I was asked to be the scrub nurse for Dr. H who had a reputation for hating students.  Once outfitted in a scrub dress, cap, mask and gloves, I would look like any other nurse, so there was reason to think he might not know I was a student.  But, he had a reputation for being very precise and difficult.  We were all terrified of him, because we knew he had no patience with students.  If I made a mistake of any kind, he would guess and be furious.

 When I was assigned to scrub with him, I protested.  The RN who was to be the circulating nurse in the room said I shouldn’t worry.  She knew exactly how he liked things.  She wrote his preferences on a piece of paper and taped it to the wall right behind my back table.  When one scrubs for surgery (or at least it was true 60 years ago) there are two sterile tables to be concerned with.  There is a tray that goes right over the patient, adjacent to the area being operated on.  It is from this table the scrub nurse passes the instruments to the doctor.  The back table contains other instruments and supplies that might be needed to restock the tray one is working from.  There was plenty of opportunity for me to go to the back table and check the list the RN had taped to the wall.  I fooled him all morning.

I knew he had not figured out my lowly student status, because after lunch he asked me where I had been at lunch time.  He had wanted to buy my lunch.  If he had any idea I was a student, he would have know that I got my lunch for free, and that I sat in an area of the cafeteria designated for students.

The afternoon did not go as well as the morning…that is an understatement.  One of the last cases of the day was an intestinal resection necessitated by a cancerous tumor.  All went well until I handed him the clamp to close off the intestine so he could cut it without intestinal contents getting into the abdominal cavity.

“This is not my clamp!” he roared.

The tray of instruments had been prepared and sterilized the prior afternoon by someone who was supposed to know his preferences.  I certainly did not know he had his own special clamp for this part of the procedure, so I had handed him the standard issue used by most surgeons.  I frantically looked through the tray on the back table…no luck.  The circulating nurse came and looked without touching anything…no luck.

She told Dr. H she would go and find his clamp.  She came back in the room quite quickly and informed him she had found the clamp, but it had not been sterilized.  She would put it in the high pressure autoclave and it would be ready in…I think she said…three minutes.

He shouted that he wasn’t waiting three minutes.  I don’t remember if I had to say to him that I would not hand it to him or if he figured this out on his own.  He directed the circulating nurse to put the clamp in the basin of sterile water which was adjacent to the OR table.  She protested.  He insisted.

She put the non-sterile clamp in the basin, and told him she would have to record on the surgical record that he had used a non-sterile instrument. 

Dr. H said, he didn’t care what she said on the record.  He directed her to bring him some antibiotic crystals to place in the abdomen in hopes of preventing an infection.  Then he said, “It doesn’t matter.  The guy is full of cancer anyway.”

I could hardly wait to be done and get out of there.  As the scrub nurse, I had not participated in his breech of protocol and had no responsibility.  It was the circulating nurse’s job to report this.  I was sickened by what I had seen and heard.  Dr. H was renowned throughout the Midwest as a top surgeon.  People came from great distances to have him operate on them.

I, of course, also wondered, if I wasn’t a student would I have known that his special clamp was missing from the tray?

I never knew what happened to the patient following surgery.  I’m pretty sure neither he nor his family were told what happened in the OR.  I would not be telling this story, except that I'm pretty sure both the patient and Dr. H are long dead.