Macho man versus the Needle.

CHEST DRAINS!

SNORE!

I've done tons of them over the last three years.

Sticking in chest drains to relieve a pneumothorax/haemothorax post stabbing by knife/bicycle spoke/pen...Oh God I'm soooo bored by them now.

This procedure frightened the living bejeezus out of me as a student...yet three years post qualification I feel like I could do them in my sleep.

Yes, yes..ok...I know it's a pretty gruesome and barbaric procedure...slicing through skin, using blunt scissors to dissect through fat and muscle, and then popping the pleural cavity and shoving a big fat drain 23 cm around your lung while being careful enough not to puncture your heart.

But honestly - when you're guaranteed at least three every weekend shift...it gets pretty tedious.

Which is why I'm totally blah blah blahzaay about it.


Except that on one occasion it provided me with an amount of hilarity I'm not used to experiencing while slicing through someones chest.

A young 19 year old boy presented with a pneumothorax one busy Saturday evening in the front room. It was pretty obvious that he needed a chest drain. However, I had a feeling that this boy ( who was also high on tik at the time) was not going to be very co-operative. As we were operating with inadequate amounts of staff ( including porters, nurses, cleaners, security guards etc)I politely asked one of the ten family members if they would like to assist in positioning the patient properly during the procedure.

Of course, the taller than 6 foot, big burly older brother stepped forward, and in that "I'm in charge of this gig" manner announced that he would do it.

"Are you sure?" I enquired "It's a pretty gruesome procedure. Blood, guts, gore and all that - are you sure you can handle it?"

Not about to be shown up in front of his family, he informed me, in that quintessential South African way of expressing that everything would be cool, that things were...

"Hundreds, Doc, hundreds!"

Except, things were more like one hundred and twenties.... as in 120 seconds into the procedure, while my fingers were stuck inside his brother's chest, I found myself screaming for somebody to come and pick the dude up off the floor.

Have you ever seen anyone actually faint?

IT'S HILARIOUS!!!!!

I mean, it is also SO very dangerous as the patient could seriously injure their noggins, or c-spines, etc..

BUT! It's also nonsensically funny.

This is how the sequence of events went before macho man's head introduced itself to the floor:

1:A gentle degeneration of his conversation with me into a mere open mouthed and fixed stare

2:Soggy beads of sweat formed above his brow

3:Ominous swaying occurred reminiscent of a tree in the last stages of its felling...

4:Eyes rolled back into his head...

One last helpless gasp uttered and then...

TIMBER!!!

The man's head, along with his macho pride and ego, deposited themselves on the bloodstained floor of the unit with a comical thud.

He remained out for the count of about five seconds before hastily standing up and attempting to regain his composure.

While breathing heavily, and swallowing incessantly he attempted to explain, mostly to salvage his shattered ego, what had happened.

"Oh? Wow! SHU! Erm...you know, erm, doctor, I didn't eat anything today yet,erm.. and erm, I'm feeling like my sugar levels are low, you know...and erm, I think I should go and get something to eat because I'm not really feeling well hey, Ja it's because I didn't eat today you know, erm...ja...you know?"

Ja I DID know. You just fainted at the sight of blood my friend.

Viciously sinking my canines into my bottom lip was the only method I could think of to stop myself from enjoying a belly-aching cackle and embarrassing this poor man even further.

And so, sensing his acute mortification that he had totally inflated the strength of his consitution in front of a lady that looks more like an 18 year old girl than a doctor, I simply nodded and let him slink off to the tuckshop without "ROFL"-ing like I really wanted to.



I haven't conducted any formal studies, but the anecdotal evidence I've collected has shown me that the sex most frightened of medical proedures, and the ones needing the most reassurance are those patients in posession of testicles.

The real alpha male macho types who have perfected that "Big Dick" swagger, inevitably are the ones fainting and screaming like little girls when faced with a little needle or a dribble of blood!




Fainting in the face of an unpleasant experience ( ie watching a chest drain insertion):

Medical term: Syncope - brief and sudden loss of counsciousness

When faced with the sight of blood, syncope is the result of a non-cardiovascular cause, in particular due to autonomic nervous system problems.
The autonomic system is responsible for regulating heart rate, blood presure and response to fear, anxiety or emotional stress.

Vasovagal syncope typically occurs when a person is standing upright and experiences an unpleasant emotional or physical stimulus ( eg fear and anxiety at the sight of blood, or pain).

The autonomic system causes the heart to beat faster and stronger, and sends an incorrect message that the heart's ventricular chambers are full of blood.

Receptors in the heart then send a message to the nervous system saying that blood pressure is too high, when it is actually too low as the heart's chambers are NOT full.

The brain then recieves this faulty message and slows the heart rate and dilates the blood vessels, dropping the blood pressure even lower and thus pumping less blood to the brain...thereby increasing the risk of fainting!