Fillers A memorable patient

In the bad old days

BMJ 2005; 330 doi: (Published 07 April 2005) Cite this as: BMJ 2005;330:824
  1. Russell Hopkins, retired maxillofacial surgeon
  1. University Hospital of Wales

    I embarked on medical training in 1961 as a mature student with two years of general dental practice and three years of hospital oral surgery and maxillofacial trauma behind me. My second six month preregistration post was as a surgical house officer at a busy London hospital. My responsibilities spread over four firms, each headed by a teaching hospital consultant, and included 60 beds on-take alternate weeks with an additional 60 to cover plus casualty at night time. The experience of “hands on” general surgery, urology, and gynaecology was fantastic, but so was the fatigue.

    One evening I was called to casualty to find an obese, partially collapsed lady bleeding copiously from the vagina who had missed a couple of periods. Her pulse was weak, her blood pressure barely recordable, and her major veins impalpable. As I started to catheterise the patient to provide fluid, I sent for the resident surgical officer (who was 10 minutes away at a dinner), O+ blood, and the theatre team. I was told that the team was already working at a nearby hospital. By the time the surgical officer arrived, resplendent in his dinner jacket, fluid was running in nearly as fast as the patient was losing blood.

    He made a rapid decision to operate. “No theatre team or anaesthetist available,” I told him.

    After a few seconds he said, “Hoppy, you give the anaesthetic.” I had had considerable experience of dental anaesthesia and had given gaseous anaesthetics to patients in casualty for minor surgery, so with the confidence of youth and ignorance I agreed.

    The porter had not yet returned with the blood, so the two of us pushed the patient's trolley to the lift, with me keeping fingers on her carotid pulse. It became impalpable, and I said, “It's too late, she's gone.”

    The top half of the patient raised up and said, “No I've not gone yet.” After that embarrassment, we got her to theatre and somehow, using wooden poles, lifted her on to the theatre table.

    The surgeon took off his dinner jacket and brought in the theatre packs of instruments. Not having the confidence to use thiopentone (thiopental) or knowledge of the patient's weight, I opened up the gas, oxygen, and trichloroethylene of the Boyle's machine, applied the facemask, and pushed the patient's mandible forward in the approved manner. By the time the surgeon was ready, her eyelash reflexes had gone, and she seemed relaxed. He opened the abdomen, sucked out pints of blood, and somehow identified and clipped off the ectopic pregnancy. We felt elated: job done, crisis over.

    A few seconds later, however, and the patient was attempting to get off the table. Clearly her relaxation had owed more to hypovolaemia than anaesthesia. The surgeon held on to her from inside the abdomen, and I held down her shoulders while I opened up the trichloroethylene. This pantomime gradually subsided, and the surgeon was able to finish his work and close up the wound. By this time, the porter had arrived with the blood, which we pumped in.

    The next morning we found our patient sitting up eating a hearty breakfast without any memory of the previous evening's surgery. So ended my anaesthetic career. It is worth adding that the patient's wounds healed without infection.

    The memory of these events, which some readers may find difficult to believe, has never left us. Today such a patient would not be admitted to a hospital so ill prepared to deal with a life threatening emergency. Nowadays, I expect there would have been a major investigation as a result of a critical incident report and even possible disciplinary action. (The management refused to reimburse my colleague for the dry cleaning of his blood stained trousers.) On the other hand, a life was saved by the courage and initiative of the resident surgical officer, whose surgical training had included considerable operative practice.


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