Thursday, February 28, 2013

Instrument toss: I claim the Guinness record for distance


A recent exchange on Twitter reminded me of an incident that occurred when I was a resident.

There are many stories about surgeons throwing instruments. I was never a habitual instrument thrower but I had my moments.

I was doing a cutdown (a minor surgical procedure to gain intravenous access) on a newborn in the neonatal ICU. This was in the early 1970s, and the section of the hospital that contained the unit was not air-conditioned.

It was the middle of August. I was having some trouble finding a suitable vein. The instruments on the cutdown tray were all discards from the operating room. They were stiff and didn't work well.

At a critical point in the process, I put a clamp on a tie around a flimsy vein. Because the jaws of the instrument were not aligned, it slipped and the tie was lost.

My patience, still to this day not one of my strong points, was also lost.

I threw the clamp toward the open door of the unit. It skidded along the floor out the door across the hall and through the open doors of an elevator. The doors closed and the clamp was never seen again.

I somehow managed to finish the procedure.

Other than occasionally into a garbage can, I haven't thrown an instrument since.

22 comments:

Anonymous said...

I have a surgeon at my hospital who is known for flinging instruments. As the story goes, a couple of times it was simply because they weren't in an order he preferred. He wouldn't care who or where he'd fling them towards. Needless to say he's an asshole

Skeptical Scalpel said...

Throwing instruments was tolerated long, long ago. It's not tolerated now. Throwing something at someone should be reported to your human resources department. The surgeon should undergo an intervention.

Anonymous said...

I don't agree with throwing instruments in the OR or any procedural setting...that being said, this story is awesome!

Michael Schroeder said...

Instead of throwing the defective instrument that keeps on showing up in the set, I worked with a surgeon that would bend the handle to distort it so it REALLY couldn't be used. Then SPD seemed to figure out it needed to be replaced.

Chris Porter MD said...

You probably also have the record for height!

Skeptical Scalpel said...

Anon, thanks for commenting.

Michael, that's a good suggestion.

Chris, I didn't think of that but you're right.

DocInKY said...

I remember as a resident doing a cholecystectomy with my attending staff, the old way. He had a DeBakey forcep in his had and told me to apply the cautery to it as he had a bleeder in it. In an eye blink his arm and hand shot it like a rocket over the anesthesia screen - hitting the back tile wall like a bullet.

He had a very small hole in his glove. Not on purpose, but scary. He certainly would be a contender for the fastest velocity in the "instrument toss" olympics.

One of many reasons I double glove....

Skeptical Scalpel said...

Those cautery burns can be painful. Personally, I never could find the right combination of gloves to fit me for double gloving.

Emergency Laughter said...

Good evening Doctor,
First time commenting here. I enjoy your blog immensely. I was a scrub for about 15 years and dealt with a few throwers. The worst was a very prominent Neurosurgeon who once announced to the room that, "Patients talk to God. God talks to Neurosurgeons." I started laughing until I looked up and realized...ruh rhoo...he was serious. I believe he's now one of the highest paid convicted felons in the nation.
You don't see many throwers anymore. Anyway, I like your style Sir.

Anonymous said...

@Emergency Laughter,

I know it's super fun to gripe about physician salaries, but think for a second about all the C-level executives, politicians, pro athletes, musicians, and home decorating/cooking show hostesses with felonies. A certain bow-tie wearing neurosurgeon probably doesn't crack the top 1000 highest-paid. Good story though...he sounds like a real pain to work with.

Skeptical Scalpel said...

Good comments. Thanks.

Emergency Laughter said...

Dear Anonymous,
I think I gave the wrong impression. I have NO qualms about Physician/Surgeon income. My comment about the neurosurgeon/felon pay was tongue-in-cheek. You're right, I forgot about all the mega-rich felon athletes, actors & exec's.
I have great respect for Surgeons and the ultimate responsibility they carry. Compare their takehome to what some make tossing a ball around or baking a pretty cake...gets me pissy.
One of the reasons I don't watch TV medical dramas.

Anonymous said...

Although it is unlikely that a surgeon can get away with such egregious behavior these days, throwing instruments still happens. Just make sure that the instrument doesn't hit anyone, and your cursing is not directed to a particular person.

Physicians, and surgeons in particular, still get away with behavior which have long been taboo in corporate settings, or even the local Subway. Bullying, sexual innuendo, extramarital affairs, constant cursing: they are just part of the OR culture.



Skeptical Scalpel said...

I agree that such behavior is totally unacceptable today. As I said, I haven't thrown an instrument since that day.

Cursing unfortunately does still occur especially when things aren't going well. I cut way down on it over the years. I agree that it must not be aimed at any individual.

Here's a link to an interesting article on the subject: http://www.bmj.com/content/319/7225/1611

Anonymous said...

I am having flashback's to my days as an Orthopedic Rep when I had an Orthopedic Surgeon throw a Cup Positioner at me when he could not get the cup to seat in the acetabulum. The cup positioner STUCK into the wall. I ducked to the left to avoid being hit and left the room never to work with him again. BTW, the reason he threw it at me was it had a blue handle and the surgical technique video I left him had an Orange handle, he accused me of bringing in the wrong instrument.

Anonymous said...

Good timing: http://www.washingtonpost.com/national/health-science/anger-management-courses-are-a-new-tool-for-dealing-with-out-of-control-doctors/2013/03/04/74a44f86-67ed-11e2-85f5-a8a9228e55e7_story.html?hpid=z1


I suggest not reading the comments section if you don't want to be grumpy for the rest of the day. The public resentment of physicians is awfully high.

Skeptical Scalpel said...

Thanks for the link.

Quote from article "flinging scalpels at trainees" is a slight exaggeration, but typical of such stories.

You are right about the comments. I had to stop reading them when Obama was brought up.

Anonymous said...

I just read the Washington Post article and a bunch of the comments about patients feeling like the doctor had an attitude or was disrespectful. How about also having a discussion on patients having a bad attitude and being disrespectful too? Maybe because I am a med student, patients speak more freely in front on me, but quite a few patients are harboring bad attitudes too.

Anonymous said...

Here is a great one! I've not always had a positive attitude when I've had to go in to a doc who I could tell didn't like me and left me in pain for months. At the same time, I've made a number of apologies to the ER staff when I was sent 2 weekends in a row to the ER. Low potassium the first time, swollen abdomen the second. I've met a lot of nice physicians. I've also had some mental scarring from a physician who bullied me, threatened me, left me in pain, so its a cross section of everything. I think there are docs there who need some help and there are patients who want everything too. There's room on both sides for improvement. I think the focus would be helpful in getting a list of maybe the top 5 gripes (and be honest) that one side has with the other, do some education and see if there isn't a way to work out a compromise.

My example: I'm waiting for a doc for an hour. Office staff had only 2 people in the waiting room, chatted with people. That time could have been spent calling patients and saying the doc is running an hour behind, come in 45 min. late if you want. Its the simple things that matter. I know many places are busy, but not all are. Just saying ...

Anonymous

Skeptical Scalpel said...

You are correct that it goes both ways.

Unfortunately, I don't think most doctors who leave patients in pain or make them wait for excessive amounts of time would be receptive to education. Similarly, some patients don't really "get it" either.

Your experience in the waiting room could have been handled much better with a little common sense. Daly, that is in short supply.

NYDoc said...

Impressive arm. You could have played pro football.
That being said, working with instruments that are no better than rejects can drive even a saint mad.
Hemostats that won't hold the tissue, needle holders that won't hold the needle, scissors that shear instead of cutting...
Cannot really blame you.
Cursing in the OR...
Indirect, preferably not too poly-syllabic, and done without malice, that's my motto.

Skeptical Scalpel said...

NYDoc, we are of like minds.

Post a Comment