The Missing Needle: Sweet Medicine – Bitter Coating

                Intern Dr. X was posted in Casualty (The Accidents and Emergency Department) during his internship posting in AIIMS, New Delhi. This is the same intern doctor whose adventure, ‘The Mystery of the Retained Urine’  some of you may have read earlier. http://agnipathdoctors.blogspot.in/2015/05/sweet-medicine-bitter-coating-mystery.html

A young lady came to Casualty with a needle accidentally and embedded in her foot. Dr. X independently attended the patient. He got x-rays done which showed the position of the needle inside the sole of the foot. He took the patient to the Casualty Operation Theater (OT). 

After giving local anaesthesia and making the area insensible to pain, he made a cut (incision) in the foot just above the position of the needle, as seen in x-rays and started to search for the needle.

       

     After 5 minutes he did not find the needle, but he was not worried and the patient was lying comfortably. After 15 minutes, he still had not found the needle. He started to get worried. The patient started making sound of discomfort. After 30 minutes, the needle has still not been found. 

Dr. X now became worried and beads of sweat appeared over his forehead even in the cool winter of Delhi. The patient also was now squirming, moaning in discomfort and repeatedly asking him when the procedure was going to be over. After 45 minutes, Dr. X decided, enough is enough, and it’s time to face the music.

 

            He sent a message to the Surgery Senior Resident (SR) doctor, regarding his position. The Surgery SR become very angry that he has taken up a patient with foreign body for exploration, without consulting anyone, a procedure that is even difficult for senior surgeons. Since there was great rush of patients in the Casualty, he asked Dr. X to come out and see the patients in the Casualty and Dr. Dev (fictional name) the surgery junior resident to assess and try to remove the needle. 

            Within 5 minutes, Dr. Dev sent the message that the needle was out and he was now cleaning the cut and putting stitches.

Dr. X was simply amazed. He asked Dr. Dev how he was able to find and remove the needle so fast, when he has failed after trying for 45 minutes. 

            Dr. Dev just gave a mysterious smile, made a comment regarding ‘magicians never tell’ and kept quite. Dr. X impressed, amazed, baffled, puzzled and flabbergasted and lots of other things, to say the least.

            What happened was, Dr. Dev went inside the OT, and he checked the x-rays of the patient. From this he decided the best way to approach the needle. On inspection of the patient, he found Dr. X has given the skin cut, in the best possible place, right over the needle. He started exploring the wound through the same skin opening. To wipe the blood from the wound, he started to lift the dressing pad (made of cotton and gauze cloth) from the instrument trolley placed near the patient. 

When lifting the pad, he felt a prick in his hand. To his surprise, he found the needle lying entangled in the dressing pad. 

Most likely, after giving the skin cut, some amount of bleeding is expected and must have occurred. While Dr. X was wiping the blood from the wound with the gauze pad, the needle must have got entangled in the pad. The needle got removed while lying entangled in the pad. Dr. X failed to notice that the needle was out and was searching for the needle in the wrong place in vain.

            Never undertake any intervention without informing your seniors and their advice. This may be minor operation as in this case or handling a major project in your case. 

When in doubt get help early. It is better to risk looking a fool, then to be proved a fool. Which you will look after you foul up something important. 

When you have looked in the obvious place then look in the not so obvious place. When the obvious solution is not working then think of applying something unusual. The history of science is filled with examples that thinking in different direction, people have made new discoveries, inventions, etc, when other people had reached a dead end

(Based on true incident)

— NKD

© Author. All rights reserved. 

DISCLAIMER: This article is intended only for fun purpose. The author does not promote or recommend any behavior illustrated here or claim it to be useful. Use of the information herein is at you one's own risk. Before trying to emulate or follow anything the reader is well advised to take into account ethical, moral, legal and other considerations. The author recommends that Medical Practice should be of the highest ethical and moral level keeping in mind the interest of the patient as foremost. 

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