Vital Times 2021 - 93

unsuccessful, and eventually, she refuses all oral
intake. She remains febrile and delirious and
dies on the third postoperative day. The cause of
death is attributed to " emotional exhaustion " and
dehydration, but sepsis due to a wound infection
and aspiration pneumonia are more likely.
1922
It is now 1922. The patient's husband brings her
to a hospital. She is scheduled for surgery on the
following day. She is admitted to a hospital room
and given an evening meal and a sleeping pill. The
next morning, on the day of surgery, she has a light
breakfast and is told to change into a hospital gown
and remove all underclothing. She is then given an
intramuscular injection consisting of scopolamine
and morphine, which makes her drowsy and dries
her mouth. She is then transported to the operating
room and transferred onto a hard, cold operating
room table.
Two nurses are in the room. One introduces herself
and explains that she will be administering an
anesthetic with ether. An intravenous line may or
may not be started. A wire gauze mask is placed
over the patient's face and nose while she breathes
quietly, and liquid ether is dropped onto the
gauze. After a few episodes of breath-holding and
coughing, she loses consciousness. Her gown is
removed, and the skin over her breast is sterilized
with alcohol. The surgeon wears a mask and
gloves. Sterile drapes surround the incision site.
A nurse monitors blood pressure with a
sphygmomanometer and listens to the patient's
breathing and heart sounds with a stethoscope.
The surgeon must work quickly. Bleeding cannot be
controlled by electrocautery, which William T. Bovie
has only recently begun to explore. Flammable
ether would also be contraindicated with the use
of an electrosurgical current. The operation takes
45 minutes to complete. The patient is transported
while still heavily sedated back to her hospital
room. During transport she vomits and is quickly
turned on her side in an effort to expel gastric
contents. In her room, the patient awakes in
excruciating pain.
On the first hospital day, she develops a high fever
and requires a tent of humidified air to assist her
with clearing her airway congestion. Pain remains
intense, and she is given morphine injections
every 4 hours, but this causes further respiratory
depression. On the third hospital day she becomes
cyanotic, with alternating sweats and chills.
Supplemental oxygen is added, but her condition
does not improve. She refuses oral fluids because
of persistent nausea from the morphine. Her
condition worsens, and on the fourth postoperative
day, her blood pressure drops and her pulse
becomes rapid and weak. Her breaths are shallow,
and she is unable to clear her airway of secretions.
She loses consciousness and dies in the
presence of her husband on the evening of the
4th postoperative day. Without antibiotics, she
develops an infection. The cause of death is
attributed to aspiration of acidic gastric contents
either during surgery or while emerging from
the anesthetic.
Annual Publication 2021 | 93

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