Schwab: The night before Christmas and all through the OR … .

By Sid Schwab

Editori’s note: Today’s column is adapted from Sid Schwab’s “Surgeonsblog.”

It was exactly ten years ago today. On emergency backup, I was called in to see a man with an unusual injury. It was the middle of the night, and I wasn’t particularly pleased.

Reading his chart before going into the room, I could hear the man referring, it seemed, to every nurse within shouting distance as a “ho.” So I must admit I was a little rude to him. Just lifted up his garish shirt and had a look. (What was this guy, a pimp? He called me a “ho,” too. Several times.) Occupying the entire circumference of his enormous belly was a band of mottled skin, maybe five or six inches in width, oozing, and dirty.

Despite wearing gloves and boots and the most ridiculous pants I’d seen in a while, the man was hypothermic. Given the potential for rapidly progressing infection, the dead skin needed to go. I put in a page for Larry, the anesthesiologist, and called the OR.

“You’re going to hate me for this,” I told Larry. “He’s huge, I’m going to have to reposition him two or three times during the case, and he has an enormous beard [anesthesia folk hate beards]. “Great,” said Larry, as he hung up the phone.

By the time I next saw my patient, they’d removed his clothes and put them in a couple of bags. Boots, gloves, heavy coat with fur-crested sleeves (who wears that? Heard of PETA?); and now, in the warmth of the room the stuff smelled like a barn. Larry was much more mellow than I, probably getting a laugh over my obvious displeasure. He gave the man the usual once-over and piloted the gurney to the OR.

It took four of us to move him onto the OR table. He’d told us he was 280, but he was 350 if he was an ounce.

I won’t belabor the surgical details. Suffice it to say it was unpleasant. Rolling the man from side to side, to Larry’s grumbling (he’d crossed over to my mood halfway through), I cut away a belt of skin and subcutaneous crud which, had I been able to do it all in one piece, could have wrapped twice around a telephone pole. It had taken the poor nurse fifteen minutes to scrub clean the man’s stomach: No running water where he lives? Everyone had his or her own reason to be repulsed by the whole thing. After I finished, having assured myself it looked like he’d wake up, I went to take a shower.

When I came back to the recovery room, the man was gone. Kathy, the world’s best recovery nurse, seemed uncharacteristically befuddled. “What happened?” I inquired (you might call it). “Where’s my patient?” I was ticked: I hadn’t yet decided whether to send him to the floor or the ICU. Who’d made that decision without me??

“He checked out,” Kathy said.

“Checked out? What are you talking about?? He died??”

“No. I mean he checked out. Pulled out his IV, insisted I take off his bandages. Said he had important work to do that couldn’t wait. He said he’d been so cold in the ER he couldn’t even remember who he was, could barely talk.”

“You gotta be kidding. There’s no way he… How could you let him…”?

“I don’t know. He just talked me into it, like I was a child. I just went blank, like he…”

“Oh, man! This is bad. He’s gonna die out there…”

“I know you won’t believe this, but he looked great. And the wound? It looked like it was healing already. Almost like it never happened.”

“Jeez, Kathy! We gotta…”

“Sid?” Kathy asked as I tried to storm out the recovery room door.

“What??”

“How about his story? About how he got the injury?”

“What story? I didn’t even hear the story. What story?”

“Getting stuck in a chimney, being pulled out by some animals. They were trying to slay him, I think he said. Oh, and he left these for you,” Kathy grinned, tentatively, as she handed me half a dozen wrapped boxes.

“Yeah, right. Keep ‘em. The man is nuts. I gotta get home and get Danny’s presents under the tree before he wakes up. Merry frickin’ Christmas.”

Email Sid Schwab at columnsid@gmail.com.