The Crock

(1967 photo by Don Dale)

I had many an adventure in the building above, the 36th Tactical Hospital as seen from the top floor of the medic barracks across the street.

The operating suite at the rear of the building comprised a scrub room, two ORs, a lounge and locker room, a sterile-supply room, a workroom for assembling instrument and linen sets, a holding room for patients about to have surgery, a small office where surgeons dictated case notes, and offices for the chief OR nurse and the anesthesia team. The walls in both ORs were tiled in hospital green. The floors were conductive black linoleum. We all wore conductive shoes so we'd be grounded. Sparks can be dangerous in an environment rich with oxygen and anesthetic gases.

The first really unusual case I scrubbed on was a belly-wound explosion. I was on call but sound asleep when the CQ woke me up in the night. (There's always a Charge of Quarters on duty. During overnight downtime, the CQ waxed and buffed the barracks hallways and common rooms. We rotated the duty, and we hated it.)

I asked the CQ why he was waking me up. "The Crock has exploded," he told me.

I knew what he meant.

I forget the boy's name, and I wouldn't mention it if I did remember. "Crock" was Bitburg ward-medic jargon for a chronic complainer. This patient had managed to get on everybody's nerves starting two days earlier when he was checked in with belly pain.

It wasn't that we were heartless. We were used to dealing with people in pain. But this guy, a young enlisted man, was over the top. He whined. Nothing suited him. He wanted this, and he wanted that. And he wanted it now. The ward medics thought he was behaving like a child, and he had been the prime topic of conversation in the chow hall.

I first saw him when I went to the ward to shave him from nipple-line to mid-thigh in preparation for an appendectomy. He was alert when I met him, despite his pre-op cocktail. He complained about how extensively I had to shave him, and he bitched about my using cool water. (We had a good reason for that. Think about it.) He tried my patience, but I kept my mouth shut, did my job well, and told him I'd see him shortly in the OR.

I scrubbed on the appendectomy. It's a routine operation, and it went smoothly -- no problems. Within 30 minutes the patient was awake and on the way to the recovery room.

Two days later, in the middle of the night, he exploded.

He developed a deep infection at the surgical site, the pus built up, and, well . . . he burst. Pus had splattered the bed, the bedclothes, the bedside table, and the wall at the head of his bed. He had complained loudly about pain in the hours before this grenade of infection had gone off in his belly. The on-call doctor saw him and found nothing wrong. His surgeon had been called in and found nothing out of the ordinary. His temperature was on target. The wound didn't show any signs of an angry redness. All his vital signs were normal.

Clearly he had been in pain. But equally clearly, throughout his hospital stay, the level of his complaining had been so high that his new complaints seemed routine.

All that aside, the surgeon was upset, the ward nurses and medics were upset, and the OR staff was upset. Patients were not supposed to explode after appendectomies, and we were all questioning what we could have done better.

After the on-call team was scrubbed and just before the patient was wheeled back into the OR, the anesthesiologist came around to dab a drop or two of oil of wintergreen on our masks. "He smells to high heaven," the anesthesiologist told us. "He's still full of pus."

As we positioned the boy on the OR table, we were grateful for the masks and the oil of wintergreen.

The anesthesiologist gave the boy a shot of Demerol to knock him out, intubated him, and adjusted the machine that fed the right combination of Halothane and oxygen to keep the boy deep enough for surgery. The surgeon enlarged the wound, cleaned it, redid the sutures where the appendix had been excised earlier and washed inside the patient's belly with an antibiotic solution. I threaded needles and clipped them into suture-holders while he began to sew the wound back up. The surgeon left a drain in place, in case infection developed again, and gave orders that the patient was to be checked every 15 minutes until further notice -- by a nurse. "I don't want him going sour again."

The patient was discharged from the hospital a week later. He was still complaining about everything, but he had recovered quickly.

What did we learn? HAI's (hospital-acquired infections) were more uncommon in the 1960s than they are today. Was this an HAI? Had the infection come instead from the original inflamed appendix? Had a deep suture not been tight enough to prevent leakage from his bowel? Had one of us inadvertently broken the sterile field or, perhaps, not scrubbed well enough? We would never know.

But it was a cautionary message that surgery was more than just a job. Patient by patient, it was a matter of life and death.

And there was another lesson: It pays to listen carefully. Even if the patient is a little boy who cries wolf.