Never Again

I think the title of this post was said by somebody famous (I'm going to get irate emails from various people for not knowing who said this, I know!) about what the Nazis did to the Jews after WWII....I am using it in reference to an event that happened yesterday in the ER.

******

Background: When you go to I&D (incision & drainage) an abscess, it is important to remember that the contents are under pressure (that's why they're so painful!), and that's why you're supposed to be very careful when doing this....When you stick in the needle that shoots in the numbing medicine, you leave a hole that pus sometimes uses to escape. So that is Hazard #1. Hazard #2 is the fact that an abscess is basically a lump of necrotic tissue and pus, and it smells like nothing else. It's comparable to GI bleed smell, for those of you with medical backgrounds...It is truly awful, and everyone in the vicinity will know you are doing an I&D as soon as you make the incision. Hazard #3 is simply that, should you NOT have released some of the pressure with the needle sticks while numbing the patient up, be ready for Vesuvius when you make the incision across the dome of the abscess. So because of the aforementioned hazards, one should probably always put a gown, a hat, and most definitely a face mask with a splashguard on it on when doing an I&D. But we in the medical field are fairly lazy, and after doing a few of these with no Vesuvius-like eruptions, I was getting lazy as well about gowning up. Thank God I DID have a face mask on though....

******

So to move on to the events of yesterday...I was I&Ding a large abscess on a patient's jaw, and as I take out my syringe with the numbing medicine in it, I see a stream of pus, flying straight toward my face as if in slow motion. Yes, pus can move in slo-mo. That is why I am SO thankful I was wearing a mask and splash shield!!!!! I would have loved to see my expression, though as I couldn't, I have to imagine it looked something like JD and Turk, below:

For those of you who know how OCD I am, you can only imagine how disgusted I was. I just turned to the nurses and said, "Exactly how much pus am I wearing right now?" because I couldn't see below my face shield and I really didn't want to look. I had it ALL over my shirt....And of course I still had to pack the wound, so I couldn't just run & change. And in true Grady fashion, no one would go get me clean scrubs. (In a community hospital, the nurses would've actually sympathized with me and would've had scrubs waiting before I had even finished the procedure - ahhhh sometimes I miss community hospitals!) Of course I got misdirected to where I could get scrubs, so for the next 20 minutes I was wandering around the hospital, smelling like an abscess, trying to find where I could get clean scrubs.

******

So here is what I will be wearing the next time I suit up to I&D an abscess:

And as to doing an I&D again in just a mask and gloves, I say, Never again!