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The Night The Lights Went Out In The O.R.

I graduated from podiatry school and went through residency in the mid-‘70s, about the same time power instruments were introduced to podiatric surgeons. We wore grounded booties and used noisy nitrogen-driven drills. When you walked past an O.R. with a foot case going, it sounded like a Black & Decker convention. We loved our power instruments.
The problem with these new tools was young podiatrists became totally dependent upon nitrogen- and later electrically-powered drills, saws and wire drivers. Hand tools like osteotomes and mallets were retired to hospital storage closets. The new breed of DPM only used power instruments and most of the new guys had their favorite manufacturer. Mine was Stryker. I loved the thrill of stepping on the pedal and revving up a drill or oscillating saw and then going to work on a bunion. I was good with my Stryker saw and people knew it.
A few years after residency, I had a busy practice with a fair amount of podiatric surgery. My main hospital purchased a new nitrogen-driven power drill/saw/wire driver for me. Life was good. Occasionally, I did cases at a rural hospital way out in the middle of nowhere. This was a small 29-bed place that didn’t have the latest of anything when it came to equipment. Their power equipment was an ancient Stryker saw with a hand piece that weighed about 12 pounds and shook like a wet dog when it ran. The big old saw blades created an excursion of about 8 mm. All osteotomies were of the shortening variety. It was old and awkward but it was still power so I used it.
One day, I was starting a bunionectomy with a proximal closing wedge osteotomy (the Austin bunionectomy had just been invented). I was in the little hospital so I had the old Stryker. I revved the shaking saw a few times and it sounded great. I started to cut away the medial bump from the first metatarsal head when there was a sudden loud pop followed by a long hissing sound. The big saw in my hand came to an abrupt halt. The nurse turned off the nitrogen tank and the room became silent.
At that point, I silently thanked God for a DPM who helped with my training during my residency at Waldo Hospital in Seattle. Dr. Ka Hung Lau was a great teacher of surgical technique. He was patient but demanded perfection, preparation and forethought. Part of that process was to make sure his student (me) was ready for anything.
One day, I finished a lesser metatarsal osteotomy on one of Dr. Lau’s patients. He looked the job over and told me I was almost good. He then told me to do the same osteotomy on the other foot but he threw a curveball at me. He dropped the power saw into a pile of dirty towels. He said, “Your power saw just broke. Now what you going to do?” I stood there with a dumb look on my face and then hollered for a nurse to bring the backup saw. Dr. Lau waved the nurse away and said, “It broke too. Now what you going to do?” My antiperspirant began to wear off. I stammered and fidgeted. Dr. Lau reminded me time was running out for the tourniquet.
Dr. Lau then showed me how to complete the case with hand-powered instruments. He used a hand-powered drill to start the osteotomy and an old Joseph saw to complete it. He drove the K-wire with the hand drill. The end result was every bit as good as the operation I had just completed with power equipment. This became a regular exercise in my training. Any procedure I could do with power equipment I could also perform with the old stuff.
Now I’m back in the O.R. of the rural hospital with my dead Stryker saw. I asked the nurse to get out a set of osteotomes and a mallet. Then I asked for a hand drill and a Joseph saw. I completed the case just slightly slower than usual. The O.R. crew was impressed. The patient never knew about the equipment problem.
Thanks to teachers like Dr. Lau, I have never had to wake a patient up and explain the operation stopped because of equipment failure. I urge all young DPMs to learn both ways of doing foot surgery.

Dr. McCord (pictured) is a Diplomate wtih the American Board of Podiatric Surgery. He practices at the Centralia Medical Center in Centralia, Wash.

By John McCord, DPM
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