Infected Appendix

The two years I spent on active duty in service to our country was in the US Air Force from 1969 to 1971. Those were good years for me professionally, because I had just completed my training as a general surgeon and was a good transition into private practice. I was the only surgeon assigned to Moody Air Force Base in Valdosta, Georgia, and it was perfect for Cathy and me. The war in Viet Nam was raging and surgeons were needed and were continually being sent there. I was fairly certain the Air Force was not going to suddenly move me from Moody to Vietnam.

I had the total flexibility of arranging my work schedule to suit my needs, but because I was eager to gain needed experience I was aggressive in doing as many operative cases as possible. I developed a close working relationship with Dr. Bill Retterbush, a local Valdosta surgeon who had a large and growing private surgical practice. When I wasn’t busy at the base the Hospital Commander gave me permission to assist Dr. Retterbush with his operative cases, and the extra pay to assist him supplemented my Air Force salary. Our Hospital Commander saw the benefits of my gaining additional operative experience and enhanced judgments which I could learn from a more experienced surgeon. It was a  beneficial arrangement for Dr. Retterbush, the Air Force and for me.

I was able to treat or assist in the treatment of a number of unusual patients during those two years. One patient I remember well was referred to me on a Friday afternoon by the base pediatrician with suspected appendicitis. Following my examination I agreed with the pediatrician and was certain of the diagnosis. He was a ten year old dependent of an active duty Airman, and his parents had not delayed in seeking medical attention. I was confident he had an early case of appendicitis and was not in immediate danger of perforation which severely complicates the treatment. I scheduled an operation for him later in the afternoon. I asked Dr. Parkhurst, the referring pediatrician if he would like to assist me in the procedure.  Earlier he told me if I needed an assistant he would really enjoy the opportunity. He had never seen an appendectomy but in the past year had referred several patients with the infection.

The time was late July, and the south Georgia weather was especially hot and humid. The air-conditioned hospital provided much-needed comfort for the patients and hospital personnel, but I was soon to discover just how essential a cool environment is to the treatment and recovery of surgical patients. I had been told the air conditioning unit in the OR had been malfunctioning, but the use of fans had made the situation more tolerable. I was confident in my ability to do the appendectomy quickly and be completed in forty-five minutes or less. I would have been much less likely to schedule a longer case because of the heat and humidity. This was mistake number one!

By four PM on Friday afternoon most of the hospital personnel had gone home for the weekend. The only people left in the hospital were the emergency room staff, the inpatient staff and a few laboratory and x-ray technicians. Our anesthetist was Captain Coleman, who was career military and very skilled in her profession. She was very verbal, and in addition to keeping me aware of the patient’s condition during procedures she would engage in light-hearted chatter which helped lessen the usual tension in the OR.

At the beginning of the procedure I noticed that she had decided to simply mask the patient rather than insert an endotracheal tube which is routine for every major operation. She knew I was able to do an  appendectomy quickly and rather than traumatize the child unnecessarily she could keep him asleep safely by mask for the forty to forty-five minutes needed. That was a mistake number two!

With Dr. Parkhurst ably assisting me I located the diseased appendix quickly and placed the needed sutures securely before removing it. All the while I was showing Dr. Parkhurst the anatomical landmarks which he had only been able to palpate externally. He seemed to be really enjoying the experience and so was I. Within fifteen minutes of beginning I was ready to close the wound and realized we had not heard a word from Captain Coleman the entire time. With my eyes fixed on the operative field I asked her if everything was ok, to which I heard only a garbled response. I looked up to see her seated on her stool just at the moment her eyes rolled back in her head, and she began to topple backwards off the stool. I moved quickly behind her and caught her between my knees while grabbing the mask she had just released and kept it on the boy’s face. I didn’t miss a beat in the administration of the anesthetic gas that was keeping him asleep. I told the circulating nurse to quickly move a gurney into the OR and get someone to help her get Captain Coleman on it. I was pretty certain she had simply fainted from the heat but was not sure whether or not she had a cardiac event also.

When I finally looked at Dr. Parkhurst he had the most startled look at what he had just witnessed. I had never experienced anything like it, but knew we had to get this operation completed and awaken this child as soon as possible. I said, “Bob, have you ever closed a surgical wound?” He said he had not. I told him I could talk him through it easily enough, and was sure I could keep the child asleep while he did it. I wanted to show strong leadership and confidence, because I thought if I got rattled Dr. Parkhurst might faint. After what I had just seen anything could happen.

Just as Dr. Parkhurst began to follow my instructions Captain Coleman recovered and even though still a little groggy insisted she could take over long enough for us to finish. Much to my assistant’s relief I rescrubbed my hands, donned another sterile gown and finished the procedure. Despite this unbelievable turn of events we still were able to finish in under forty-five minutes.

Thankfully the young man recovered quickly and was able to go home with his grateful parents the next day. They never knew what had happened in the OR other than we had removed his appendix. We all learned valuable lessons in the hot OR that afternoon at Moody Air Force Base, and we carefully stored them in our experience bank. In my forty- plus years of operating on thousands of patients I never had another anesthetist faint during a procedure. It was quite a challenge for me and for Dr. Parkhurst. The experience was enough for him, because he never again asked to assist me in the OR.

Dr. John