I presented the first patient. “This is Clarence Fermby. We did his pilonidal yesterday. At surgery we found several collateral sinus tracts and I unroofed them after we cored out the main cyst. Underneath that dressing everything is packed with iodoform gauze. There’s no significant bleeding. His temp is normal and he’s due to have his dressing changed this afternoon.”
Dr. Trumbo the staff surgeon smiled. “Change it an hour after his pain meds. The first change is uncomfortable as you know. Let Clarence sleep and let’s go on to the next patient.”
We moved right along and came to David Mepps, a marine who was a week post-op. He was on his stomach with his pajama bottom pulled down to his knees. He was only on a moderate pain med for when he took his sitz baths. I pulled the adhesive bandage off.
“Ouch, doc. And your hands are cold.” He winced as all marines do with pain of any kind.
“I’m going to remove the iodoform gauze now.” I did it in one quick motion lifting it like a piece of wide linguine straight up in the air. It unraveled to about 3-feet in length.”
“Holy shit doc. When’s it going to stop hurting?”
I looked at Trumbo and back to Mepps. “When it’s fully closed and I no longer need to add the packing. This iodine gauze stimulates healing. The corpsman will put in a smaller packing and each day it will get smaller and smaller.”
“When am I going to go back to duty–back to Nam doc.?”
Marines are strange creatures. Mepps should be glad he was out of harm’s way and back in the states. He shouldn’t have been sent to Vietnam in the first place. Pilonidal cysts invariably became infected when the soldier hit the humid tropic jungles and bushes of Vietnam, Cambodia or Laos. Post-op healed pilonidal cystectomies also had a good chance of being re-infected even if fully closed. Mepps would go to an environment friendlier to his derriere but I wasn’t going to tell him. Marines went apeshit if they weren’t combat duty bound.
“That’s up to the Marine Corps not me Mepps. You’ll get orders when you’re healed.” We moved on.
“This is LCPL Andrew Clyde. He came in two-days ago with greenish foul drainage from an abdominal incision.” I removed the dressing to show a dime-size pink area of flesh from which pistachio-green pus oozed when you pressed on its edges like I did now.
“Did you probe the little hole Dr. Glassman?” Trumbo donned rubber gloves to touch the area.
“I did and it goes down 6 cm with no pain elicited. I x-rayed his belly yesterday.” I had the x-ray with me and I held it up to the ceiling light fixture for background illumination.
“Hmmm. How’s his temperature?”
“No temperature spikes as long as it’s draining. Shall I schedule him for surgery for Monday?”
“Monday will be okay. This is not life threatening.” Trumbo studied the x-ray like it was a Rembrandt.
Andrew Clyde looked at the x-ray with us. “What is that big ring-thing doc?”
“It’s a stainless steel ring attached to a large gauze surgical sponge left inside your belly from when you had that hunk of shrapnel removed–in Subic Bay Naval Hospital in the Philippines.”
“Is it big surgery again doc?”
“No. You will have some pain and because it’s infected you’ll be moved down the back of the ward to one of the closed rooms for a day-or-two.”
“How the fuck did that get left in doc?”
“It rarely happens. At the end of the surgery before they close the wound the OR nurse does a sponge count to make sure nothing’s left behind.”
“The broad couldn’t count right huh doc?”
“No. Usually the gauze sponges are even numbered. What usually happens in situations like yours is they reach the right count and miss the fact that whoever made up the gauze packs added an extra one. The ring is there in case the count is incorrect and they get an x-ray and see it. If the count is correct but an extra sponge wasn’t picked up originally there’s no suspicion to get an x-ray. It happens in civilian life too. We’ll take it out Monday.”
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