The cardiothoracic surgeon was in a tight spot. His patient was asleep on the table, about to have an open heart procedure. Passing a thermocatheter into the bladder was essential and usually a relatively, simple procedure. In this case, despite an experienced staff, attempts to pass the catheter were unsuccessful. I was operating on my own patient and could not help them for about 20 minutes. They could not start their case without a catheter in place and simply had to wait. As I recall, the cardiothoracic surgeon was DH, a model of patience, skill, and good manners. I was more troubled about making him wait than he was about waiting, with his patient asleep on the operating table.
When I walk into the cardiothoracic suite, I might just as well have been the Pope. Everyone was so happy to see me. They had prepared all of my favorite instruments including a full urology table, a new flexible fiberoptic video cystoscope, and the latest Teflon Glidewires and catheters. The entire open heart team was bogged down — now that I had arrived, it was up to me to get them out of the mire.
In the back of my mind, I remembered some of the risk factors associated with open heart cases. These patients were usually anticoagulated, making them prone to troublesome bleeding. I recognized this man’s name and realized that he had been one of my patients. After his prior surgical procedures for prostate cancer, he had likely developed dense scar tissue in a very critical location — right where the catheter had to pass. I had seen cases like this before and knew how quickly they could turn into goo. Fortunately, the Teflon Glidewire sailed into the bladder through a narrow scar. This allowed me to gently pass silicone urethral dilators and create an open pathway for the 16 mm thermocatheter. The new flexible scope and color monitor allowed everyone to view the whole procedure — for the first time. Prior to televised cystoscopy, the only thing the nurses saw during cysto procedures were the backs of the urologist’s ears. I thought my contemporaries would have clamored to use the new equipment, but it took several years for them to catch on, leaving me the only one to use the new equipment for a while. Nowadays, flexible instruments and video monitoring are the norms.
Bleeding was minimal and I wrapped things up with a story or two while I connected the thermocatheter to a down drain, disconnected the flexible scopes, and removed the surgical drapes. I knew it had been simple, but most everyone else thought it was brilliant.
Seeing that they could now proceed, the cardiothoracic team praised my work. Had they played Giuseppe Verdi’s Grand March from Act II of ‘Aida,’ it would not have been any more dramatic. Clear urine tumbled down inside the plastic tubing leading to the drainage bag. The thermocatheter was connected to the monitor and constantly displayed the patient’s internal temperature.
As I was removing my surgical gown and gloves, I thanked everyone for their help and confidence, reminding them that the only problem with their ebullient praise would be if I let what they were saying go to my head. Some surgeons don’t filter praise like this very well and begin to think that they are God’s Gift to Warthogs. You can tell who they are because of their chapped lips that they get from kissing mirrors. Fortunately, I put things into perspective when I went home to MK that evening. I instantly recognized that my status hadn’t changed at all — it was still my job to clean the bathrooms and take out the trash.
Ever vigilant,
RT
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