You guys liked my last story about by pain in the ass but pretty good guy dad, so here’s another one. You might want to skip this if discussion of medical procedures bothers you.
Life in the Sterile FieldPost + Comments (104)
As I mentioned in the last post, the old man was a country doctor. He did some surgery, and delivered many (~3,000) babies. When he was in his prime, he was deft with his hands, and fast. Now that he’s in his late 80s, he has degenerative arthritis everywhere, and his hands aren’t what they used to be. For example, when I was home a year ago, I had some stitches that had to be removed, and I basically ended up doing it with his direction because he couldn’t do it. This is a minor procedure he would have done in a minute, tops, when he was in his prime. For a lot of us, the Grim Reaper doesn’t take us with one fell swoop of his scythe — he hacks us to bits piece by piece.
Anyway, as some of you know, my mom has lung cancer. At one point in the course of her illness, she had a chest tube placed which could be drained by a device called a PleurX. This is essentially an expensive vacuum bottle that you attach to her chest tube regularly to drain excess fluid in her chest. It’s an advance in care because it keeps the patient out of the hospital. The downside is that the patient’s family, or a home health care worker, needs to manage the drainage. Not a problem for my family! You mean there’s a procedure we can do on our kitchen table, record the results, and discuss whether her output is up or down, and whether she needs to have that tube removed, literally for hours? Where can we get some of that?
Anyway, a PleurX comes in a sterile package, which contains the vacuum bottle, a sterile drape, gloves, alcohol swabs, and dressings. The idea is that you create a sterile field with the drape, and then the person draining the PleurX has to stay sterile while they perform the drainage. It’s a 25-step process and you have to be very careful to avoid infection.
I’ll skip more details, but what I learned performing this procedure is that keeping a sterile field is very fucking hard, especially if a guy who has done over 100,000 sterile procedures (no exaggeration) is watching over your shoulder, frustrated because he clearly didn’t raise his kids right, since they don’t know the first fucking thing about sterile technique.
There are so many ways to contaminate a sterile field, and I might have done a few of them. Once you open up the pack and put on gloves, you can only touch things that are sterile. Very hard, my friends. I had my assistant (usually the old man) removing Mom’s dressing, but the sterile operator has to put it on. It was a ~8×8 inch clear dressing, and that fucking thing stuck to itself almost every time. Added to the difficulty of the procedure was that if I accidentally touched the dining room table, or touched something else that wasn’t sterile, I’d hear about it from Dr. Frustrated as Fuck (gently, he’s not a yeller, he’s mastered the art of quiet intimidation). According to him, even using an alcohol swab to clean my glove wasn’t good enough if I touched something, but I should still do it because it’s better than nothing.
Well, enough of that story. The key point is that Mom didn’t get an infection and the chest tube is out, so whatever our violations of sterile technique were, they weren’t deadly. I’ll never capture the true essence of my dad — part prick and part saint that he is — but I did learn a few lessons that I take with me to the grocery store every time I go. These aren’t official advice, just my thoughts:
- Gloves are not a cure-all. If you touch a contaminated surface, or someone sneezes and it gets on your glove, and you touch your face, what’s the point of a glove? Since they’re in short supply anyway, better to have good handwashing technique.
- Home is my virus-free field, and transitioning to it is hard. After I check out at the grocery store, for example, I hand san, dump the cart, gather my bags and load them in the car. Then I wipe down my phone with a Clorox wipe, and hand san again, since I contaminated my hands touching the phone. I use the same wipe to wipe down my keys (touched by my contaminated hands). I often hand san twice in the car because I screw up and re-contaminate with something from the store. I also wipe down my steering wheel and shift handle just because I probably touched them out of habit with contaminated hands.
- The experts I’ve seen don’t think that getting the virus from groceries is very likely. And it’s basically impossible to clean every item you buy at the grocery store (or at least a hell of a lot of effort). So what I do is unload everything, and wipe down the packaging of anything I’m going to use right away with a Clorox wipe (or wash with water if it is produce because Clorox residue is going to make you sick). After I’m done putting everything away, I wipe down where it was sitting and then wash my hands carefully. I also wipe the knobs I touched. My assumption is that time will kill whatever virus is on the goods I bought.
- This may seem like a minor thing but I try to use touch free payment (Google Pay in my case, Apple Pay for the iPhone users) so I don’t touch my wallet or shove a card into a slot.
- Masks add a whole new level of complexity to this. Frankly, I think the role of the mask is to let people feel like they’re doing something. Dr. Howard Zucker, head of the New York State Department of Health, would not recommend masks when asked by Cuomo on Friday or Saturday (I can’t recall which day). The hope with the mask is asymptomatic carriers won’t spread the virus if they wear one. The real danger of a mask is a feeling that this questionable piece of protection will make you less vigilant. I have a couple of dust masks that I will use when I go to the store next time. When I take it off, I’ll put it in a paper bag to sit for a few days for any virus to die, and then I’ll sanitize my hands, because the mask could be contaminated.
Well, that’s what I do, for what it’s worth. Mom and Dad locked down a couple of weeks ago, because either of them will die if they get this. Which brings me to my last observation: if you have a terminally ill elderly person that you’re caring for, make sure you have what you need to ease their pain at the end. We have a supply of liquid morphine in the house for Mom.
