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November 22, 2013 6:37 pm
Last week I broke the handle off the door of our garden shed. Our neighbour came round to help. He arrived with an ice axe and a monkey wrench. “I use this at work,” he said, waving the wrench: he’s a paediatric orthopaedic surgeon (it’s that kind of road). After an initial misunderstanding, I realised he wasn’t talking about this particular tool, but rather something similar that had been through the autoclave. I stood about helpfully, waiting for him to bark “AXE!” or “WRENCH!”, but it only took him two minutes to winkle the door open. “I love operating,” he said.
Medicine is always finding ingenious uses for everyday objects. In contrast to law, say, or accountancy, it is a profession with a determinedly practical outlook. A lot of kit resembles the kind of detritus you might find in a kitchen drawer: cling film, rubber bands, staples, bulldog clips. In your first job, as the most junior doctor in the hospital, you learn to carry the ubiquitous roll of tape. We use it to stick everything to everything: cotton wool to arms, nasogastric tubes to cheeks, scraps of paper into the notes. Always thinly edged with fluff, the tape is a linty rejoinder to every hospital campaign about hygiene. It is usual to hang the roll about your person, threaded on to your stethoscope or dangled next to your ID badge, where it can gather more fuzz from your jumper.
To do an electrocardiogram you need a packet of special stickers. You arrange these across your patient’s chest in a line, then attach the wires using either little crocodile clips or the kind of poppers you find at the crotch of a Babygro. If the trace emerges looking unusual, your patient is either having a cardiac event or your fastenings have fallen off.
On your first trip to theatre you’ll be introduced to the stapler. This version is more butch than the average office stapler but it’s basically the same thing. There are lots of different sorts: some fire off big metal staples for speedy wound closure; a cunning tubular variant enables you to join two lengths of colon together by planting the staples in a ring. In A&E, by contrast, they are very keen on superglue.
At school I learnt to put butter on burns; this is not a good idea. Medicine uses a specialised form of cling film. Indeed, the recommended first aid dressing for a burn is ordinary kitchen cling film (best to discard the first couple of inches in order to reach a more sterile section – and lay it over the injury, rather than winding it round anything, so as to avoid causing constriction). Cling film keeps the wound clean and protects it from bacteria. More important, it works to reduce evaporation (a devastating amount of fluid can be lost through a large burn) in exactly the same way as wrapping a cucumber in the fridge. And you can see what’s going on underneath it without the trauma of pulling it off, a property now exploited in many transparent medical dressings.
Alongside the domestically inspired equipment already in everyday use, there are various unorthodox fixes which might become orthodoxy one day. (Frederick Foley’s experiments with scraps of latex in the 1930s, for example, led to his invention of the balloon urinary catheter.) This is how many medical inventions come about. Procedures are taught in standard ways but when it comes down to the ward or the operating theatre or the back garden, it is still just the doctor, the patient and the door that needs levering open (or the lung that needs draining, or the tracheostomy that needs unblocking). Everyone has their own way of doing it: sometimes that involves paperclips.
Sophie Harrison is a hospital doctor in South Yorkshire
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