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November 23, 2012 7:50 pm
The doctor’s office on Snowdrop ward never changed, whether you came to work at dawn or 11 at night. There was always the same deflated lilo that the junior doctors used for naps on nights; the same bag of Haribo; and the same stack of unintentionally purloined patient notes. But recently the windowsill had accumulated some new items: a series of deformed paper clips and sculptural lumps of Blu-Tack. “It’s Dr A’s project,” my colleague explained. “He’s inventing a tool for getting foreign bodies out of ears. It’s going to be revolutionary.”
I remembered the conversation I’d had with Dr A a few weeks earlier. Getting soft things out of ears is easy: you impale them on a wax hook and haul them out. But round items, such as marbles, are harder. They spin when you poke them and slip out of reach. We often had to take children to theatre and give them an anaesthetic in order to remove a bead, which seemed excessive. But what, Dr A wondered, if there was a tool with a flipper on the end, which could flick a battery out like a pinball? Or a tool with a sticky bit, like a fishing game at the fairground?
Such fiddling has given us some of the least imposing but most useful inventions in medicine: things we use daily, without ever really considering their ingenuity. “If you were clever,” a surgeon said to me once – we were standing next to an open abdomen and the surgeon was resting his hand comfortably on a length of colon as he talked – “you’d have invented something by now. Like Fogarty. Guaranteed millionaire before he even qualified. Just from twiddling about with a bit of surgical glove.”
Thomas Fogarty was a scrub technician in Cincinnati in the 1940s when he first started to experiment with his eponymous catheter. Before Fogarty, arterial surgery was a fraught affair, with awful mortality and morbidity rates. To remove a clot from an artery you had to make a long incision and open up the whole vessel before scraping out the blockage. Fogarty came up with the idea of threading a hollow bendy tube – a catheter – along the artery instead, feeding it cautiously past the obstruction. Once safely through, he inflated a balloon at the tip. Pulling the inflated balloon back out pulled the clot out with it, clearing the obstruction through a single small hole. Urinary catheters already existed; for a balloon Fogarty used the amputated fingertip of a surgical glove. When he couldn’t get the latex to glue to the rubber he secured his device with fly-fishing knots instead.
Fogarty catheters are now the universal standard: his balloon embolectomy procedure revolutionised vascular surgery.
Fogarty’s spiritual brother was surely Frederic Foley, a Massachusetts surgeon who came up with another device involving a balloon in the 1930s. We often need to put a tube – a urinary catheter – into the bladder, in order to drain it; Foley worked out an ingenious way of keeping such tubes in place (they fall out instantly, otherwise).
Foley catheters are ubiquitous and known simply as “foleys”. They have a deflated balloon at the leading end. Once you’ve fed the catheter into the bladder, you inflate the balloon by squirting a syringeful of sterile water up the tubing. You can assess whether you’ve successfully completed the procedure by pulling gently on the catheter: “Give it a ginger tug!” the nurse who taught me used to say. The balloon anchors the tubing in place; no plasters or strapping required. It is brilliantly straightforward; so simple, in retrospect, that it’s easy to start to wonder if you could have thought it up yourself.
Sophie Harrison is a hospital doctor in South Yorkshire
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