a reply to:
TimBurr
Was a surgical nurse for a lot of years in the military.
I was directly involved in preventing two unintentionally retained foreign objects (URFO). In both cases the surgeons were adamant I was wrong.
First. Open heart. Ten smaller raytex sponges on the field. Doc only ever used one. After sternotomy, he stuffs one down near xiphoid. End of
case. Doc, I'm short a raytec. "I neeeever use raytex. They shouldn't even be on the table." Doc, post-sternotomy, you stuff one in the inferior
sternum area. "Never". Doc, I've checked everywhere before telling you (incision should be first place inspected when count is off, but this guy was
a Richard with ears. Wanted to be sure I didn't lose track first. Foul on me for cowing to the jerk). Just humor me, can ya sweep the xiphoid area
for the sponge? Lo and behold, up comes the bloody sponge like a bloody magician's hankie. This ASCII then slings it towards me, hitting the glass
supply cabinet and slithers down like a menstruating snail. After the surgery, I had a discussion with him, that *I* got in trouble for. No good
save at all in the convo. And no talk with him about conduct unbecoming, team dynamics, or patient safety. Oh, he got it from me, but shoulda been a
Colonel reading him the riot act.
Second, a hectic C-section. One lap sponge short. Doc told right away. She kept sewing. I called X-ray. She was pissed. And kept sewing.
X-ray came back, with a very clear sponge tail visible. She said it wasn't inside, but slipped down under the surgical drape, and that it was
actually external to the patient and she was laying on it. She told anesthesia to wake the patient up. Anesthesia refused. Someone ran out,
literally ran, and found a higher up doc to intervene. Patient was reopened and sponge removed before waking. Doc thought everything was fine,
since patient wasn't woke up. However, the point of no return is starting the skin incision. Joint Commission considers that as intention to finish
the surgery without accounting for missing objects. She was suspended from surgical practice and I never saw her again. The team was recognized for
the save, informally by the hospital commander... which I conveniently left my name off of when asked who was involved with the good save. Let the
junior Os and Es be the focus of the accolades.
As to the person mentioning a surgical towel left in. That's scary. Those typically are NOT radio-opaque (unless that's changed). Those are only
supposed to be used to dry hands after scrub and the initial laydown of the surgical field before the big drapes go up. Those not going in was beat
heavily into us during initial training, due to the large number of URFOs that have been associated with them. With them not going in, it's rare they
are counted at start of case. If one goes in, there's really no way of knowing if it comes out without a starting count.
So. There's two first hand instances of abhorrent physician arrogance. One supported by leadership. One properly addressed.