OR Nurse here. This is kind of a long one...
I was taking call one night, and woke up at two in the morning for a "general surgery" call. Pretty vague, but at the time, I lived in a town that had large populations of young military guys and avid meth users, so late-night emergencies were common.
Got to the hospital, where a few more details awaited me -- "Perirectal abscess." For the uninitiated, this means that somewhere in the immediate vicinity of the asshole, there was a pocket of pus that needed draining. Needless to say our entire crew was less than thrilled.
I went down to the Emergency Room to transport the patient, and the only thing the ER nurse said as she handed me the chart was "Have fun with this one." Amongst healthcare professionals, vague statements like that are a bad sign.
My patient was a 314lb Native American woman who barely fit on the stretcher I was transporting her on. She was rolling frantically side to side and moaning in pain, pulling at her clothes and muttering Hail Mary's. I could barely get her name out of her after a few minutes of questioning, so after I confirmed her identity and what we were working on, I figured it was best just to get her to the anesthesiologist so we could knock her out and get this circus started.
She continued her theatrics the entire ten-minute ride to the O.R., nearly falling off the surgical table as we were trying to put her under anesthetic. We see patients like this a lot, though, chronic drug abusers who don't handle pain well and who have used so many drugs that even increased levels of pain medication don't touch simply because of high tolerance levels.
It should be noted, tonight's surgical team was not exactly wet behind the ears. I'd been working in healthcare for several years already, mostly psych and medical settings. I've watched an 88-year-old man tear a 1"-diameter catheter balloon out of his penis while screaming "You'll never make me talk!". I've been attacked by an HIV-positive neo-Nazi. I've seen some shit. The other nurse had been in the OR as a trauma specialist for over ten years; the anesthesiologist had done residency at a Level 1 trauma center, or as we call them, "Knife and Gun Clubs". The surgeon was ex-Army, and averaged about eight words and two facial expressions a week. None of us expected what was about to happen next.
We got the lady off to sleep, put her into the stirrups, and I began washing off the rectal area. It was red and inflamed, a little bit of pus was seeping through, but it was all pretty standard. Her chart had noted that she'd been injecting IV drugs through her perineum, so this was obviously an infection from dirty needles or bad drugs, but overall, it didn't seem to warrant her repeated cries of "Oh Jesus, kill me now."
The surgeon steps up with a scalpel, sinks just the tip in, and at the exact same moment, the patient had a muscle twitch in her diaphragm, and just like that, all hell broke loose.
Unbeknownst to us, the infection had actually tunneled nearly a foot into her abdomen, creating a vast cavern full of pus, rotten tissue, and fecal matter that had seeped outside of her colon. This godforsaken mixture came rocketing out of that little incision like we were recreating the funeral scene from Jane Austen's "Mafia!".
We all wear waterproof gowns, face masks, gloves, hats, the works -- all of which were as helpful was rainboots against a firehose. The bed was in the middle of the room, an easy seven feet from the nearest wall, but by the time we were done, I was still finding bits of rotten flesh pasted against the back wall. As the surgeon continued to advance his blade, the torrent just continued. The patient kept seizing against the ventilator (not uncommon in surgery), and with every muscle contraction, she shot more of this brackish gray-brown fluid out onto the floor until, within minutes, it was seeping into the other nurse's shoes.
I was nearly twelve feet away, jaw dropped open within my surgical mask, watching the second nurse dry-heaving and the surgeon standing on tip-toes to keep this stuff from soaking his socks any further. The smell hit them first. "Oh god, I just threw up in my mask!" The other nurse was out, she tore off her mask and sprinted out of the room, shoulders still heaving. Then it hit me, mouth still wide open, not able to believe the volume of fluid this woman's body contained. It was like getting a great big bite of the despair and apathy that permeated this woman's life. I couldn't fucking breath, my lungs simply refused to pull anymore of that stuff in. The anesthesiologist went down next, an ex-NCAA D1 tailback, his six-foot-two frame shaking as he threw open the door to the OR suite in an attempt to get more air in, letting me glimpse the second nurse still throwing up in the sinks outside the door. Another geyser of pus splashed across the front of the surgeon. The YouTube clip of "David at the dentist" keeps playing in my head -- "Is this real life?"
In all operating rooms, everywhere in the world, regardless of socialized or privatized, secular or religious, big or small, there is one thing the same: Somewhere, there is a bottle of peppermint concentrate. Everyone in the department knows where it is, everyone knows what it is for, and everyone prays to their gods they never have to use it. In times like this, we rub it on the inside of our masks to keep the outside smells at bay long enough to finish the procedure and shower off.
I sprinted to the our central supply, ripping open the drawer where this vial of ambrosia was kept, and was greeted by -- an empty fucking box. The bottle had been emptied and not replaced. Somewhere out there was a godless bastard who had used the last of the peppermint oil, and not replaced a single fucking drop of it. To this day, if I figure out who it was, I'll kill them with my bare hands, but not before cramming their head up the colon of every last meth user I can find, just so we're even.
I darted back into the room with the next best thing I can find -- a vial of Mastisol, which is an adhesive rub we use sometimes for bandaging. It's not as good as peppermint, but considering that over one-third of the floor was now thoroughly coated in what could easily be mistaken for a combination of bovine after-birth and maple syrup, we were out of options.
I started rubbing as much of the Mastisol as I could get on the inside of my mask, just glad to be smelling anything except whatever slimy demon spawn we'd just cut out of this woman. The anesthesiologist grabbed the vial next, dowsing the front of his mask in it so he could stand next to his machines long enough to make sure this woman didn't die on the table. It wasn't until later that we realized that Mastisol can give you a mild high from huffing it like this, but in retrospect, that's probably what got us through.
By this time, the smell had permeated out of our OR suite, and down the forty-foot hallway to the front desk, where the other nurse still sat, eyes bloodshot and watery, clenching her stomach desperately. Our suite looked like the underground river of ooze from Ghostbusters II, except dirty. Oh so dirty.
I stepped back into the OR suite, not wanting to leave the surgeon by himself in case he genuinely needed help. It was like one of those overly-artistic representations of a zombie apocalypse you see on fan-forums. Here's this one guy, in blue surgical garb, standing nearly ankle deep in lumps of dead tissue, fecal matter, and several liters of syrupy infection. He was performing surgery in the swamps of Dagobah, except the swamps had just come out of this woman's ass and there was no Yoda. He and I didn't say a word for the next ten minutes as he scraped the inside of the abscess until all the dead tissue was out, the front of his gown a gruesome mixture of brown and red, his eyes squinted against the stinging vapors originating directly in front of him. I finished my required paperwork as quickly as I could, helped him stuff the recently-vacated opening full of gauze, taped this woman's buttocks closed to hold the dressing for as long as possible, woke her up, and immediately shipped off to the recovery ward.
Until then, I'd only heard of "alcohol showers." Turns out 70% isopropyl alcohol is about the only thing that can even touch a scent like that once its soaked into your skin. It takes four or five bottles to get really clean, but it's worth it. It's probably the only scenario I can honestly endorse drinking a little of it, too.
As we left the locker room, the surgeon and I looked at each other, and he said the only negative sentence I heard him utter in two and a half years of working together:
"That was bad."
The next morning the entire department (a fairly large floor within the hospital) still smelled. The housekeepers told me later that it took them nearly an hour to suction up all of the fluid and debris left behind. The OR suite itself was closed off and quarantined for two more days just to let the smell finally clear out.
I laugh now when I hear new recruits to healthcare talk about the worst thing they've seen. You ain't seen shit, kid.
tl;dr Don't shoot IV drugs into your taint.
