Yes, I still have my appendix!

(I should probably mention that bits of this post are a bit...graphic. Sorry.)

I’m feeling rather smug this afternoon, having wrestled with and finally subdued the autoclave. For those who don’t know, the autoclave is a bit of kit that is used to sterilise instruments. Control of the autoclave usually lies safely in the hands of theatre staff who may be trusted not to screw it up. This is because they have completed THE TRAINING. If you do things without THE TRAINING, badness will result. I can’t be specific- but I’m pretty sure that zombie apocalypses are involved.

My autoclave

 Now, I’m all in favour of staff having to demonstrate that they can successfully use a piece of equipment before they’re let loose upon it. But personally I find that it stifles any urge that I might have to experiment. I tread warily around new toys, nervous of what I might do to break them. The great and noble urge (as the late and wonderful Terry Pratchett would have it) to “stick your finger into the plug socket of the universe just to see what would happen” has been quashed by the layers of safety built into our everyday lives.

In part, this has been one of the more empowering (to use an irritating word) aspects of working for BASMU. I’m a one-woman hospital; if I want equipment sterilised or X-Rays taken, I have to use the training that we received or work out how to do it myself. Before starting this job, I had never even seen the equipment used to cross match blood samples, let alone been the proud possessor of the necessary bits! And whilst I very much hope that I never have to use that particular facility (If I’m doing blood transfusions at sea, the situation has deteriorated somewhat) it’s nice to know that probably nothing terrible will happen if you just poke around a bit.

Clinicians from a century ago had the burden of being much more self-reliant. “Call the Midwife” and James Herriot’s books about working as a veterinarian in the 1930s are full of tales of make-shift operations in stables and the delivering of babies in East-end slums. And they did all this without any of the backup that I can call upon in my daily job. I visited the site of the Thai-Burma railway line (on the border of Thailand with now Myanamar) which was built through the labour of Allied soldiers in Japanese POW camps. The thing that struck me was how doctors in the camps improvised in truly appalling circumstances to treat their patients. I even remember seeing pictures of syringes that were made from lengths of bamboo!

Before coming South, loads of my fellow doctors relayed a story that was published in the Christmas edition of the British Medical Journal. Apparently a Russian doctor, whilst over-wintering in Antarctica, had developed appendicitis. I was informed, with unseemly relish, that he had taken his own appendix out with nothing more than a lot of local anaesthetic and an assistant to hold the mirror. No, the story got better; it was two assistants! An extra one, in case the first one fainted! I would then be fixed with a beady eye and asked if my appendix was still in situ. I could tell that my questioners were already picturing me on the operating table, scalpel in trembling hand, beads of sweat breaking out on my upper lip as I made the first dread incision into my own abdomen...

To a certain extent, this willingness of doctors in days gone by to “have a go” may reflect the levels of medical knowledge one hundred years ago. Jack London relates an eye watering tale in his “People of the Abyss” of a homeless man in the Whitechapel district of London in 1905. This gentleman attended a hospital with a hernia which was then smeared with Vaseline to help reduce it and was then turfed out onto the streets. It might be laughable if not for the fact that the man died later from a strangulated hernia.

 In the trusty “Ship Captain’s Medical Guide” the indefatigable Charles Burland , MD FRGS, confidently recommends “a brisk emetic in the form of half a teaspoonful of Ipecacuanha...a cup of hot strong coffee is also useful...” to treat acute asthma. Now, don’t get me wrong, I’m all for cups of coffee. I’m just not sure that the middle of an asthma attack is the right time to administer one. Or indeed to start bouts of vomiting.

Charles Burland's exhaustive text on what the Captain could expect medically

My favourite museum in all the world is the Herb Garrett and Old Operating Theatre opposite Guy’s Hospital in London. I particularly love the descriptions of surgery in the days when speed was what you really looked for in a competent surgeon. The operating theatre was sited above a church, which meant that the space between the floor of the theatre and the rafters of the church had to be packed with sawdust lest blood drip onto the heads of the congregation below. There was a bucket of sawdust that lived under the operating table and would be kicked towards whichever end of the table had the worst “run-off”. And when the contents of the bucket resembled a “bloody porridge”...the cry would go up “More sawdust!” The state of a surgeon’s white coat generally indicated his (no ladies in those days- boys only club) level of experience- a muckier coat indicating a greater level of experience.

Old Operating Theater

So in no way do I wish for a return to those bad old days. Things like pathology and radiology should be done by people who are experts! Patients deserve to be treated by specialists.

Hmmm...strangely maggots do still sometimes get used in wound management

But as specialisation marches on within our hospitals, it’s awfully nice to have a chance to experiment with these skills and to improve my understanding of them. Admittedly this urge “to boldly go” did lead to a certain amount of apprehension (read- naked fear) on my part. I was utterly convinced that at any minute the autoclave would go “bang” and fill the room with clouds of super-heated steam. Half an hour was therefore spent cowering in the corner of my surgery behind the A&E trolley (which I didn't doubt could protect me from the shrapnel of the exploding autoclave) and squealing nervously every time it let out a little hiss of steam. But, I am proud to say, I did it. I took one little step closer to self-sufficiency. I acquired a new skill. And from now on, I shall look at autoclaves with a steely gaze and take no more of their nonsense!