Doctor Strange (continued)

In December’s edition of Surgeons’ News, we last saw Doctor Strange leaving the operating room as his female colleague beckons him outside. She proceeds to inform him of a case of ‘GSW’ (which probably means ‘gunshot wound’, but maybe the filmmakers thought that using an acronym might convey a sense of gravity to the audience) and further informs him that, apparently, another doctor has diagnosed the patient as brain dead, hopefully with consensus. Strange and his colleague rush to where the patient is and our super surgeon explains that a ‘perfect bullet’ is lodged in the patient’s brain, which has been hardened by alloying lead with antimony (a metalloid) and needs to be removed. The patient is not dead but is dying, probably due to the toxins leaching into the CSF, as Strange explains. 

The attending Dr West expresses his interest in assisting Strange for the suboccipital craniotomy but Strange informs him that his female colleague, Dr Palmer, who brought the case to his attention, will assist him. The scene cuts to the operating room where Dr Palmer can be seen without a mask and with her hair clearly falling out of her surgical cap, which is a breach of sterile protocol. Although Dr West does not appear to be at the operating table, he too can be observed to be looking on without a mask. Strange, who is apparently attempting to create access to the brain with a high-speed surgical handpiece (at 75,000rpm), is also doing so without a mask. There appears to have been time to gown (and, hopefully, scrub) but not to put on masks.

Dr Palmer calls for image guidance but Strange claims that there is no time and he will do it ‘freehand’, against the advice of his colleagues. It is interesting to note that, at this point, none of the doctors in the operating room is wearing a mask but the nursing staff are. As the scene proceeds, all the doctors are suddenly pictured wearing masks and Strange continues with the procedure under the magnification provided by a set of loupes. The image guidance appears to be by means of fluoroscopy, which is largely for the benefit of the audience because Strange does not appear to be referring to it in the retrieval of the bullet. Perhaps in a moment requiring extreme concentration, Strange asks Dr West to cover his watch as he was probably getting distracted by the ticking. While the fluoroscopy seems to be active, only Dr West can be seen wearing a lead apron and none of the surgeons at the table or the nurse appear to be wearing one. Anyway, Strange removes the bullet (the audience can follow it on the image guidance), delivers it on to a tray and the scene cuts. 

The sequence of events depicted in the case of this particular patient appear to have some glaring surgery-related issues in relation to aseptic protocol and patient (as well as operator) safety.