I’m making my way through Cameron’s Current Surgical Therapy, specifically the vascular section, since this is the kind of problem I am most worried about handling alone at night. For one thing, I have a terrible knack for imagining that I feel pedal pulses when there aren’t any, so I always have to make myself get the doppler and check (if the pulse is palpable, it necessarily ought to be audible with doppler; although sometimes, finding the doppler in the depths of the nurses’ station, or on another floor entirely, is almost more challenging than finding the pulses). For another thing, there are so many possible ways to treat vascular problems nowadays, and I feel inadequately versed in all the options, and which ones are appropriate in the middle of the night, and which ones are adequate in emergencies and which ones aren’t.

So I’ve gotten to the chapter on pseudoaneurysms, which touches on infected pseudoaneurysms of the femoral artery, and mentions that proximal control on these can be difficult. Which gives me flashbacks to vascular rotation last year, when I somehow found myself scrubbed with one of the most senior and demanding (but also rewarding) of the vascular surgeons. The case was supposed to be a simple oversew of a leaking femoral patch angioplasty. Half the subsequent bloodbath can fairly be blamed on the attending, for being so silly as to suppose that it would be that easy (as he acknowledged later, it was an ostrich-like plan; not that I made any objection at the time). The other half can fairly be blamed on me, for not yet being facile at controlling bleeding vessels with forceps or right angles to facilitate tying off, and for not being good at using the last two fingers as a third hand, in order to retract one thing and hold another at the same time (which faults he explained loudly, in between recommending anesthesia that if they hadn’t called for quantities of blood for transfusion yet, they’d better hurry; anesthesia, not having looked into the field or at our suction canisters, did not understand the urgency).

By the end of the case, a certain quantity of the patient’s blood volume was in those canisters, and another, smaller, portion was on me and the attending; and I had a much better grasp of the concept and significance of having proximal and distal control before trying to do anything to a blood vessel. These two pages of the textbook sound like a reminiscence about that case. . . The site turned out to be infected, and required one or two more operations to thoroughly correct the problem.

Advertisement