An Unusual Appendectomy

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 of medical practice for me because I had just completed my training as a general surgeon, and this was the beginning of my surgical career. I was the only surgeon assigned to Moody Air Force Base in Valdosta, Georgia, and that was perfectly alright with Cathy and me, because the war in Viet Nam was raging and surgeons were continually being sent there.

I had the total flexibility of arranging my work schedule to suit me, but because I was eager to gain needed experience, I was aggressive in seeking out and 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 I was given to assist him supplemented our meager Air Force salary. Our Hospital Commander saw the benefits of my gaining additional operative experience and enhanced judgments and techniques that I could learn from a more experienced surgeon. It was simply a  beneficial arrangement for 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, and after my examination I was certain of the diagnosis. He was a 10-year-old dependent of an active duty airman, and his parents had not delayed in their seeking medical care. I was confident that he had an early case of appendicitis and was not in immediate danger of perforation which severely complicates the treatment and increases greatly the complication rate. I scheduled him for operation later that afternoon. I asked Dr. Parkhurst, the referring pediatrician if he would like to assist me in the procedure, because he had earlier told me if I needed an assistant, he would really enjoy the opportunity. He had never seen an appendectomy but in past years had referred many patients with that infection.

The time was late July and the south Georgia weather was especially hot and humid that summer. 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 patients. I had been told that the air conditioning unit in the OR had been malfunctioning, but the use of fans in the operating suites had made the situation more bearable. I was confident in my ability to do the appendectomy quickly and be out of the OR in forty-five minutes or less. I would have been much less likely to schedule a longer case that weekend because of the heat, but thought I could do this one quickly. That was mistake number one!

By 4 PM on a Friday afternoon, most of the hospital personnel had gone home for the weekend, and 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 always did an excellent job. She was usually very verbal and in addition to keeping me aware of the patient’s condition on the OR table, she would engage in some light-hearted chatter which was not distracting and helped lessen the usual tension in such a setting. At the beginning of the procedure I noticed that she had decided to simply mask the patient rather than place an endotracheal tube which is routine for every major operation. She knew that I was able to do an uncomplicated appendectomy quickly and rather that traumatize the child unnecessarily, she could keep him asleep safely by mask for the 15-20 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 deftly removing it. All the while I was showing Dr. Parkhurst some anatomical landmarks that he had only been able to palpate externally. He seemed to be really enjoying the experience and the teaching. Within 10 minutes of beginning, I was ready to close the wound and realized we had not heard a word from Captain Coleman since we began. With my eyes still fixed on the wound, 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, so she could be treated. I was pretty certain she had simply fainted from the heat but was still not sure if she might have had a cardiac event.

When I finally looked at Dr. Parkhurst, he had the most startled look at what had just unfolded before his eyes! I had never seen 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 confidence, because if I would begin to waiver, Dr. Parkhurst might even faint. After what I had just seen, I wasn’t sure what might happen next!

Just as Bob began to follow my instructions, Captain Coleman recovered and even though still a little groggy, she insisted she could take over her duties long enough for us to finish. Much to Bob’s relief, I rescrubbed my hands; donned a new, sterile gown and finished the procedure. Despite the unbelievable event, we still were able to finish in under 45 minutes.

Thankfully, the boy recovered quickly and was able to go home with grateful parents the next day. They never knew what had happened that afternoon in the OR. We all learned valuable lessons that day at Moody Air Force Base, and we carefully stored them in our experience bank. I am certain that I have used some of those lessons in my decision making processes since. I just don’t remember whether Dr. Parkhurst ever asked to assist me in the OR after that.

Dr. John

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