Saturday, September 29, 2012

A Shocking Experience

The book said, “For cutting on the skin, or the shave technique noted previously, usually an intensity of 2(20W or less) is sufficient…rarely over 4(40W).

Part of the problem with being the only physician here at our Seventh-day Adventist hospital is that the handling of every piece of hospital equipment is left to my meager database of medical equipment mechanics. I freely admit that the inner workings of machines are not my forte! I enjoy the study of the body, the flow of blood through arteries and veins, the helper T-cell defense against an onslaught of foreign invaders, or the wheeze generated from constricted asthmatic lungs. However, put a fetal monitor, an autoclave, an oxygen concentrator, or an electro-cautery in front of me and my brain goes numb and freezes up. Have you ever tried reading the manual for an autoclave? Let’s just say, if you’re suffering from insomnia…

One evening not so long ago, I was attempting to come to terms with the intricacies of the electrosurgical unit (ESU). I’ve used similar machines to cauterize skin lesions before but never had to set one up, program it, and maintain it.  In residency training I was used to working with a team of supporting personnel. In retrospect, maybe the ‘team approach’ was not so helpful. I certainly didn’t learn the finer points about operating medical equipment.

The reason for my studious labors was related to the birth of a little baby girl born the day prior in our labor and delivery unit. She had a miniature sixth finger on her hand. Really it was more like a lump on her pinky finger that was attached with a thin curtain of skin. I could have tied a string around it and let it fall off; but then, where’s the learning opportunity? Over the past few months I’ve conquered the autoclave (really, the hospital is still standing and we haven’t had any fires!), read through two oxygen concentrator manuals, and blundered through tocometers and fetal heart monitors on pregnant mommies. It was time to tackle the ESU.

I sat on the cool, white tiled, floor in the theater with our electro-surgical unit innocently resting on a metal roller cart. After a bit of searching, I found the grounding pad, a metal plate, and the electrode tip with a hand piece that looked like a pencil with two buttons.

“First things first,” I said out loud to no one in particular. The theater was empty. The lights and bed didn’t mind my ramblings. “So, what’s the voltage on this machine?” Turning the unit around I found the tiny red switch that alternated the machine from 110 to 220 voltages.

“OK. Here it goes. Hope it’s correct.” I crossed my fingers and plugged the unit into the socket. No smoke, loud pops or other heart-accelerating noises!

I pressed the button on the front that looked like the on/off switch. Nothing. “Hmm. What’s happening? No electricity from the socket? Broken machine? Something else I’m forgetting?” All were highly probable.

I crawled around the machine and looked for additional switches and finally found a potential candidate on the rear. I flipped it and pressed the front button again. Yea! Familiar beeps, buzzes, and lights flicked on.

Luckily, the grounding pad and the electrode only fit into unique slots on the machine. I plugged them into their respective places.

“Now, how to operate this thing?” I figured it was probably a good idea to know how control the machine before trying it out on a patient.

I poured over the textbook again. Under the heading, “Skin Tags”, it listed the power setting as 3/25-30. So which was it? Three or thirty?

I really didn’t want to practice on the little baby girl. I confess, that yes, I didn’t want to cause any more pain than absolutely necessary; but, I also had a bit of professional pride and didn’t want to look inept in front of the family member.

Now, there may be a few readers who are wondering. Why not practice on a piece of meat like a chicken breast? That would be a perfectly reasonable solution. However, I hate waiting. I didn’t have the patience to put things off until the morning when the meat could be obtained from the market.

Impatience and pride – never a complimentary combination! I found the nearest suitable practice material, my arm. Now, just in case you’re getting worried, relax, this story has a happy ending! I just figured this would be a fast, easy way to figure out if the settings were in units of 1 to 10 or 10 to 100.

I turned the settings to 1. The lowest. “Um. Is this working?”

I upped it to 2. “Can’t feel anything. Is there electricity conducting to the hand piece?” I adjusted the grounding pad and checked the wire connections. Everything seemed to be in working order.

I continued to 3. “Maybe this uses units of 10?”

Getting a bit anxious and curious to see if the machine actually worked, I ramped the power setting to 10W.  At last I thought I felt a tingle of electricity.

At 20W I was sure that the ESU was working. The power didn’t seem particularly effective though. Suddenly another worry popped into my consciousness. Would 30W be enough to cut smoothly through the tissue?

On occasion my curiosity gets the better of my common sense. This was probably one of those times. At 30W the electrical spark was very apparent! Despite using the fine needle tipped electrode, I had a neat little red spot on my arm. At least my curiosity was satisfied!

The reader will be relieved to learn that the baby girl with the extra digit on her hand is doing great! I expertly sliced it off in less than a second with hardly a whimper on her part. My arm is fine. The red spot faded after a few days. Not only that, but now I can say I’m on friendly terms with the ESU. We’ve had a wonderful working relationship this week with additional cases. There’s just a few minor details to work out…

“The end of a matter is better than its beginning, and patience is better than pride.” Ecclesiastes 7:8