You know you’re in trouble when, during a routine skin excision, you start wishing you’d ordered cross-matched blood. Okay, so maybe that’s a slight exaggeration, but as the pulsing deep temporal artery spurted like a Yellowstone geyser, I started wishing that the infiltrative BCC had chosen to infiltrate somewhere else.
I summoned my colleague for help, calmly mentioning that I was “having a slight problem with haemostasis” in an attempt not to alarm the patient — the statement being reminiscent of Monty Python’s Black Knight saying “It’s just a flesh wound” after his arms were amputated. Several artery clips and ligatures later, we managed to tie off all three of the arterial branches that had been transected as they traversed the tumour excision margins.
The specimen was removed, the defect repaired uneventfully and the patient left the surgery happy enough. Those of us left behind (including the nurse facing the mess, the backlogged patients and my now-running-late colleague) were not as chipper, but the only real casualty was my outfit.
My new blouse and favourite trousers had been sprayed, liberally and repeatedly, with scarlet. I felt like a living piece of modern art. After rinsing out these offending items, I was suddenly faced with a teenaged-girl-like “I have nothing to wear” crisis, but fortunately was able to scrape over the respectability line by putting my dark-coloured trousers back on and borrowing a cardigan to go over my undershirt.
Having wet pants is not pleasant but, according to the Medical Board, it’s preferable to consulting with no pants at all. I wished I’d worn a gown, but it’s not standard procedure and I didn’t expect to be Jackson Pollocked.
I try to live life by the six Ps (Prior Planning Prevents Piss Poor Performance), but the truth of the matter is that surgical challenges, like everything else in medicine, can catch you unaware. Our medical training teaches us to respond coolly and logically under pressure, but the fight or flight response can result in unwise decision-making, particularly in the inexperienced.
I recall a story I was once told of a GP registrar who got into trouble excising a skin cancer, when, unable to close the defect, he panicked and decided to reattach the lesion. Yes, you read correctly. He took the specimen out of the jar and started to sew it back onto the patient’s leg.
I’m not sure how he planned to explain his actions to the patient, or whether he even realised that the hole he was digging for himself was far bigger than the one he was filling with formalin-soaked tissue.
Personally, I’d much rather get timely help to save my skin than struggle on alone in an attempt to save face. Anyway, the story goes, the practice nurse had the nous to alert another of the practice’s GPs, who swept in and saved the day.
Thanks to my colleague’s skilled assistance, my surgical “uh-oh” experience also had a happy ending. The histopathology came back with clear margins, the patient’s post-op course was smooth, his wound healed beautifully and the blood washed out of my clothes without staining.
I’ve been left with a much better appreciation of the anatomy of the deep temporal artery and some good hands-on practice at clipping and tying off its branches, although I’m going to try to steer well clear of that particular artery in future.
It could have been a lot worse: I could have been wearing white.
(The involved patient has consented to having this published)
First published in Australian Doctor on 7th September, 2012: On getting help