Handling the bloodier side

[bobbacklund]

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So, I was following a family medicine Dr. this summer. Now, my exposure to surgeries etc. is very limited, so I was nervous about how I would handle it when he told me I was going to scrub in on a C-section. Well, I scrubbed in and I made it with flying colors. I was actually pretty pumped at how well I'd handled it.

What I don't get is how 2 days later I'm watching the Dr. remove an epidermal inclusion cyst from a woman's upper back and I have to leave the room because I'm about to pass out.

Now I'm just confused. Comments? Advice? Similar experiences?

Later Days

 

[smq123]

So, I was following a family medicine Dr. this summer. Now, my exposure to surgeries etc. is very limited, so I was nervous about how I would handle it when he told me I was going to scrub in on a C-section. Well, I scrubbed in and I made it with flying colors. I was actually pretty pumped at how well I'd handled it.

What I don't get is how 2 days later I'm watching the Dr. remove an epidermal inclusion cyst from a woman's upper back and I have to leave the room because I'm about to pass out.

Now I'm just confused. Comments? Advice? Similar experiences?

I've seen autopsies, watched a woman have C. diff diarrhea into a bedpan (long story), delivered babies, scrubbed in on c-sections, Whipples, and open appys, and never had a problem.

It took a breast mass removal for me to get dizzy. 😕

Maybe the room was just too hot. Maybe you forgot to eat breakfast on the day of the cyst removal, or was a little dehydrated. Who knows why - but I wouldn't worry too much about it.

 

[Inuranic]

I've seen autopsies, watched a woman have C. diff diarrhea into a bedpan (long story), delivered babies, scrubbed in on c-sections, Whipples, and open appys, and never had a problem.

It took a breast mass removal for me to get dizzy. 😕

Maybe the room was just too hot. Maybe you forgot to eat breakfast on the day of the cyst removal, or was a little dehydrated. Who knows why - but I wouldn't worry too much about it.

Does anyone know what causes the dizziness? It doesn't make sense. Nausea I get, but dizziness/light-headed? What kind of evolutionary response is that?

 

[AmoryBlaine]

Well there is nothing that says that being a doctor means you're never allowed to be queasy. I've been quite literally up to my elbows in blood with trauma patients and liberally sprayed with amniotic fluid in deliveries w/o batting an eye. But some stuff makes me practically lose it to this day. Specifically I am talking about feet.

I still have yet to get used to the smell of nursing home patients. I've had to leave a few rooms b/c I thought I was going to get pre-syncopal.

 

[PeepshowJohnny]

Does anyone know what causes the dizziness? It doesn't make sense. Nausea I get, but dizziness/light-headed? What kind of evolutionary response is that?

Pre-syncope and syncope is a mixed cardiac and neuronal response. It can have a lot of reasons it gets started but the most common involve situations where blood pools in the lower parts of the body (standing for a long time, a quick rise after extended seating.) The usual coarse is a quick bump up of sympathetic to rev up your heart and pump the small amount of blood its getting (decreased preload). However, that's not enough and your brain says "Ineed more oxygen here" and you get "woozy" and sit down or pass out. Either of these move the brain down to be at a more equivalent height to the heart and it's easier to get blood to it. Another version can occur due to excessive PARASYMPATHETIC discharge from pain, defecation, heat, shock etc.

A lot of the times it's synergistic: You're standing in a long surgery, the OR is hot, you're not moving your legs much and blood is pooling in your veins. Suddenly something grosses you out and BAM everything hits at once.

As I said before, the response is to move you into a position where it's easier to pump blood to your brain. Now obviously that's BAD in certain situations where you NEED to move to stay alive, but our body does the best it can.

 

[bobbacklund]

Well, I had had breakfast that morning, but the room WAS hot and I had been on my feet all morining, plus my shirt collar and tie were really tight on my neck. I doubt that helped anything, haha. Plus it smelled really bad, which I think is what did me in.

Hmm, looks like everyone's got that certain something that gets to them no matter how much other nasty stuff they've gotten through.

 

[Inuranic]

Pre-syncope and syncope is a mixed cardiac and neuronal response. It can have a lot of reasons it gets started but the most common involve situations where blood pools in the lower parts of the body (standing for a long time, a quick rise after extended seating.) The usual coarse is a quick bump up of sympathetic to rev up your heart and pump the small amount of blood its getting (decreased preload). However, that's not enough and your brain says "Ineed more oxygen here" and you get "woozy" and sit down or pass out. Either of these move the brain down to be at a more equivalent height to the heart and it's easier to get blood to it. Another version can occur due to excessive PARASYMPATHETIC discharge from pain, defecation, heat, shock etc.

A lot of the times it's synergistic: You're standing in a long surgery, the OR is hot, you're not moving your legs much and blood is pooling in your veins. Suddenly something grosses you out and BAM everything hits at once.

As I said before, the response is to move you into a position where it's easier to pump blood to your brain. Now obviously that's BAD in certain situations where you NEED to move to stay alive, but our body does the best it can.

...that was exactly the answer I was looking for. Thank you, sir.

 

[ACSurgeon]

Does anyone know what causes the dizziness? It doesn't make sense. Nausea I get, but dizziness/light-headed? What kind of evolutionary response is that?

The evolutionary response our path teacher gave is that (for example) when soldiers are at war, seeing a fellow soldier injured (bleeding or in pain) causes them to faint (appear dead) and enemy soldiers would leave them alone, thinking they are dead. Hence the evolutionary advantage!

 

[FutureInternist]

My Achille's heel is the sound of suctioning.
Kind of a bummer since I want to be a critical care doc. 😉

 

[Hurricane95]

Anyone else think that bovie'd flesh smells a little like crispy bacon? mmm....bacon...

I swear I once scrubbed into a thyroidectomy after not having eaten for like 7 hours and damn, I spent the entire case reeeaaally hungry.

 

[PeaceKeeper]

The evolutionary response our path teacher gave is that (for example) when soldiers are at war, seeing a fellow soldier injured (bleeding or in pain) causes them to faint (appear dead) and enemy soldiers would leave them alone, thinking they are dead. Hence the evolutionary advantage!

Umm... no. Not a chance.

 

[sgglaze]

Does anyone know what causes the dizziness? It doesn't make sense. Nausea I get, but dizziness/light-headed? What kind of evolutionary response is that?

It's your body taking over and saying, "things are bad, you're doing a lousy job, I'm going to just turn you off for a while until things start going well again."

 

[MedicJ]

My main problem is if I get blood on my face. I have been on some car wrecks and shootings that made it impossible to not end the call with a uniform covered with blood. Just look at it for what it is.
My problem is the gross goobers we pull out while suctioning a trach. ICK! I have actually vomited after those calls.

 

[yeasterbunny]

So, I was following a family medicine Dr. this summer. Now, my exposure to surgeries etc. is very limited, so I was nervous about how I would handle it when he told me I was going to scrub in on a C-section. Well, I scrubbed in and I made it with flying colors. I was actually pretty pumped at how well I'd handled it.

What I don't get is how 2 days later I'm watching the Dr. remove an epidermal inclusion cyst from a woman's upper back and I have to leave the room because I'm about to pass out.

Now I'm just confused. Comments? Advice? Similar experiences?

Later Days

I sometimes have this same problem. Though I am an intern now and have certainly seen my share of blood and gore, occasionally I get lightheaded and it is always during something fairly minor, with one thing always in common: a conscious patient. I can take extensive surgeries, blood, pus, the works in an anesthetized patient, but the ones that make me vasovagal are the ones that are in obvious pain or anxiety because of something we are actively doing to them; bone marrow biopsy, arterial puncture, liver biopsy, even occasionally just from sticking a needle in a laceration to numb it while the patient is freaking out. I like to think it means I'm empathetic.

Interestingly it only happens when I watch these things being performed by someone else, I have no problem doing it myself.

 

[DoctaJay]

Anyone else think that bovie'd flesh smells a little like crispy bacon? mmm....bacon...

I swear I once scrubbed into a thyroidectomy after not having eaten for like 7 hours and damn, I spent the entire case reeeaaally hungry.

ha, lol, so true! At times I felt bad about thinking like this. The thoughts felt too Hannibal Lector like. 🙂

 

[Uegis]

Only time I got dizzy was when I was in the OR for an abscess drainage in a IVDU. We started in the abdomen and tracked it down to her thigh via the psoas. The amount of pus I saw just made me queazy to the point where I wanted to vomit. Single most disgusting thing ever. Of course, we didn't close the thigh wound up and having to pack the surgical site with the resident at the end of the case nearly pushed me over the edge. Tons of pus and tons of necrotic tissue with some that "melted" when I packed the dressing. Nice!

 

[bioteach]

Does anyone know what causes the dizziness? It doesn't make sense. Nausea I get, but dizziness/light-headed? What kind of evolutionary response is that?

I am prone to vasovagal syncope, so I have done quite a bit of research on it. I faint in the heat, when standing too long, when getting blood drawn, sudden pain, etc., etc. Pretty much anything that could potentially causes syncope, or at least pre-syncope, happens to me.

Here's a step by step of what happens: an event (i.e. extreme pain, emotional stress like seeing blood and guts, blood pooling in your extremities, etc) occurs and your sympathetic NS kicks in. Your heart rate goes up very suddenly. Since your heart rate increases so suddenly, your parasympathic NS steps in to protect the heart from damage. This slows your heart rate. Heart rate slows, blood pressure plummets, and you get lightheaded. In healthy individuals, then sympathetic kicks back in and brings you back up to normal (hopefully before you hit the ground, but not always). Its a paradoxical sort of thing, to actually slow the heart down during an emergency, but in the long run you'd be better getting a little dizzy than having your heart damaged from overexertion. In most people the parasympathetic response isn't so great as to cause a loss of consciousness (just lucky folks like me), just a bit of dizziness or the need to sit down.

There's a bit more to it here, but that's a simple rundown of the typical syncope-in-response-to-gore process.

So the key to not getting dizzy from looking at gore is to desensitize yourself to it and then that initial sympathetic response will not be so great as to cause the rest of the chain reaction.

 

[JeffLebowski]

So the key to not getting dizzy from looking at gore is to desensitize yourself to it and then that initial sympathetic response will not be so great as to cause the rest of the chain reaction.

Sort of. In the OP's instance, yes this is true. And the best way to desensitize yourself is to occupy your thoughts about it with an interested clinical perspective. I.e. don't think like you're looking at an eviscerated living body with the intestines pouring out, look at it with "hm, the bowel looks healthy, no perforation, no signs of inflammation, etc." Same goes for things with emotional context (with all the masks and a usually stable patient, the OR is usually relatively emotionally sterile and less intense than an ER trauma) - even if the patient's writhing in pain and spurting blood, try to switch to sober clinical thoughts, e.g. his BP looks good, so he's probably not losing that much blood, he's moving around pretty well thankfully so paralysis seems less likely, etc. When you're actually doing the assessment (which as students, obviously we don't really get to do that) it's easier to adopt this mental tasking mindset to get past the gore, as I understand it. It's kind of like anatomy lab...once you've got a task to do, you don't sweat over your incisions & the reality of cutting into a body and all that, you just get in there and scrutinize your task and get done what needs to be done. Just do that for a while and after a while even the bloodiest traumas won't faze you.

 

[HillMill]

I sometimes have this same problem. Though I am an intern now and have certainly seen my share of blood and gore, occasionally I get lightheaded and it is always during something fairly minor, with one thing always in common: a conscious patient. I can take extensive surgeries, blood, pus, the works in an anesthetized patient, but the ones that make me vasovagal are the ones that are in obvious pain or anxiety because of something we are actively doing to them; bone marrow biopsy, arterial puncture, liver biopsy, even occasionally just from sticking a needle in a laceration to numb it while the patient is freaking out. I like to think it means I'm empathetic.

Interestingly it only happens when I watch these things being performed by someone else, I have no problem doing it myself.

My experience is limited to one year of clinical research work, but I had the same issue. I could stand for a 7 hour radical cystectomy, but would almost pass out while watching a patient get an epidural. It only happened to me twice, but I think my issue was I was nervous because I knew the patient was in pain. I haven't had a chance yet (about to start my first year) to test this theory, but I am pretty sure I was holding my breath in those situations, so maybe focusing on taking slow deep breaths would help. At least it might get your mind temporarily off of whatever is bothering you. Who knows though....

 

[DoctaJay]

When I was first doing doctor shadowing in college, I witnessed and slightly assisted in a thoracotomy for a patient who had gotten shot in the back. When they opened the chest blood literally gushed out of his chest and he was dead pretty soon. There was blood all over my scrubs and shoes but I was ok with it.

The next day, a patient came in with with her fingers practically hanging off because she had been attacked by a knife and trying to shield her face. Seeing her mangled fingers almost made me puke right there in the ER. I had to leave the ER and go somewhere else to not embarrass myself.

So yeah, thoracotomies are fine, but mangled fingers are out for me...kind wierd huh? I guess I don't have a future in hand surgery, lol.

 

[nka1985]

I once watched a surgeon open up an infected belly with dead bowel galore (guy had been opened up a few days before for gunshot wounds)...the intestines and fluids literally burst out of the guy and onto the doctor, tech, floor, etc. That, I was okay with. And then I almost passed out when I saw a doc doing a nose surgery, of all things. Crazy. I've actually noticed that I tend to get light headed with low-key, non-critical, slow procedures. For some reason if I have a lot of down time and am not very interested in whats happening, then it gets to me more. I do better if I have a snack before those ops. I still want to be a surgeon though, I figure I'll desensitize to it eventually.