A routine procedure with one of the primates in her lab becomes much more complicated when neuroscientist Paula Croxson cuts herself with the scalpel.
Paula Croxson is a neuroscientist, science communicator, musician and open water swimmer. She received an M.A. from the University of Cambridge and a M.Sc. and a Ph.D. from the University of Oxford before moving to New York to run a neuroscience lab. She is now Associate Director for Public Programs at Columbia University's Zuckerman Institute. She is also the flautist in alternative rock band Marlowe Grey and nerdy rock band Pavlov’s Dogz. The swimming is apparently for “fun.” She is also a senior producer for The Story Collider.
This story originally aired on August 23, 2019 in an episode titled “Surgery.”
Story Transcript
I never really liked surgery days. I’m good at it. I’m very good at it. I spent years of long, long days being taught, observing, practicing, being critiqued and honing my skills, so I know I’m good at it. But something could always go wrong. I’m only human.
And so I'd wake up in the morning of surgery day with a dry mouth that wouldn’t go away all day. I couldn’t have any coffee because my hands would shake. Also, I didn’t want to have to stop and pee in the middle of the night’s ten-hour long procedure.
I would make myself eat breakfast, though, because I needed to be alert and strong and not feel dizzy. So I would make sure that I had my little routine to steel myself for the day.
I set the timer for five minutes. I hit my knee into the button to turn on the water and run warm water over my hands. I pull open this sterile metal packet and pull out the scrub brush. It’s covered in a sort of pinky soap that smells like chemicals and I start to scrub in.
I use the bristle side first on the backs of my hands, on the sides of my fingers, and I scrub twenty times on the left side of my left index finger, and then on the back, and then on the right side, and so on covering every surface of my hand twenty times.
On my palms and my fingertips, the sensitive skin, I switch to the sponge side and I scrub the same. I scrub all the way up my arms to my elbows, until my arms are already aching. And I haven't even started the day yet.
Then I rinse my hands off. The timer goes off at the same time. I've got this down to a fine art.
I gown up, put on my gloves and go to help set up.
My colleague is already there chatting about his weekend plans and unpacking instruments. My research assistant is there too. It’s his first day in surgery. He's a little nervous but excited to learn and ready to help.
And there's a monkey on the table, wrapped in blankets and draped with a sterile sheet, his head shaved and swabbed with iodine to make it sterile, so it’s yellow. He looks tiny under there.
I know this monkey. I've worked with him for a couple of years now teaching him a complex memory task, so complex that only primates can really do it, and working toward the goal of finding out something that will help to find a prevention or maybe even a cure for Alzheimer’s disease or dementia.
I care about him because I've spent hours working with him over those years and because he's expensive, but I also just care about him. It’s hard not to form a bond after you spend that much time.
So we need a full team of people to take care of this little guy. My colleague and I will do the surgery. My RA will assist. There's two veterinary technicians just to do the anesthesia, just to make sure that everything is okay. And there's a veterinarian in the room just at the start of surgery just to oversee and make sure that everything goes smoothly.
So we’re ready to go and I start to help unpack the instruments. I open the sterile packs and I tip the instruments onto the steel table covered with a sterile white sheet. Forceps, scissors, hemostat clamps, a scalpel handle, a scalpel blade, which is in one of those metal packets too.
I open it. I hold the scalpel blade properly in a pair of clamps on the handle. I click them together. And then I drive the point of the scalpel straight into the end of my right index finger.
I don't have time to think. I grab my finger and I swing away from the sterile table, because I know that it won’t be sterile if I bleed on it. My blood is full of millions of little pathogens. So instead, I bleed down the wall and on the floor. My finger is gushing blood.
Then I go next door, past the glass partition and through the open door into the prep room because, like any good surgeon, I’m kind of squeamish and I usually pass out when I cut my hands.
My colleague sees me through the open door sitting on the floor, head between my knees next to a red clinical waste trash can and says, “Are you all right?”
I say, “I will be. I just need to sit here until I stop feeling like I’m going to pass out. And then I'll scrub back in and I'll come and help.”
And he says, “Fine. I've got this.”
And the veterinarian says, “You're going to have to scrub that.”
And I say, “I know. I know I’m not sterile anymore, but I just have to sit here first because I feel really faint.”
But she says, “No, you're going to have to scrub that now.”
Through my haze I realize what she means. Some rhesus monkeys have a virus called herpes B virus. It’s a herpes virus, not unlike the herpes viruses that cause cold sores or genital warts in humans. It causes conjunctivitis in monkeys and it can make them feel kind of rundown. Like human herpes viruses, it’s passed through fluid contact. Unlike human herpes viruses, it’s incurable.
But unlike human herpes viruses, if it gets into a human and it crosses the blood-brain barrier into the central nervous system, it can cause viral encephalitis and the person could die.
There's a protocol in place for this. The first part of the protocol involves scrubbing the affected area for fifteen minutes.
So she says to me, “You're going to have to scrub that for fifteen minutes right now.”
And I say, “I don't think I can. I feel really faint.”
And she says, "Do you give me your consent to scrub it for you?”
And somewhere in the back of my brain, a little voice says, “You don’t need this. The scalpel blade was sterile.”
But I’m weak and I’m woozy and she's a veterinarian and she must be right and so I say, “Okay.”
So she takes me gently by the hand and leads me over to the scrub sink and she starts to scrub my hand. She opens one of those brushes and she takes it out. She runs the water and she starts to scrub the tip of my finger and my open wound with the bristle side.
I don't remember the next part, but I have it on good authority that I was screaming at the top of my lungs. And when I come to my senses, I’m doubled over the metal scrub sink with my head on the cool stainless steel and one of the vet techs is holding me up by the shoulders so I don’t collapse onto the floor.
I’m vaguely aware that surgery is still going on behind me with the door open and, oh, God, my RA. It’s his first day! I’m worried about him and I’m deeply embarrassed by the guttural animal sounds that are coming out of my mouth. And I’m pissed because I don't need this. We haven't even touched the monkey yet and the scalpel blade was sterile and this is not necessary.
Thankfully, at this point, the vet has switched to using the sponge side. And I say in a very quiet voice, “Do you think someone could get me a chair?”
So they get me a chair and she scrubs me for another ten minutes. I just kind of sit there at this point and, eventually, she stops. She turns off the water. I wrap my bloody, flayed open fingertip in a paper towel. I strip off my sweat-stained surgical gown and I go to employee health.
There's one person in employee health who knows what to do if someone has had an exposure to herpes B virus. She knows to call the CDC. She knows to take blood from you and get someone to take blood from the monkey and a swab from you and a swab from the monkey and send it all off and give you a two-week course of antivirals just in case something should happen.
I find her and she says, “Why are you here?”
I say, “I don't know,” and I tell her what happened.
And she said, “Yup, you don’t need to be here. There is zero chance that you have herpes B virus,” and she sends me away.
It never even occurs to me to question whether I should go back to surgery. There's no one else to do it. My colleague can’t do it on his own. It’s my RA’s first day. Everyone else is running anesthesia. We’re a small team and everyone has their part.
So I go back to the unit and I try and get in, only I can’t because it’s a fingerprint reader and I've destroyed my fingerprint.
And I hesitate. It’s going to be a long day. I have at least eight more hours of standing without time to pee. I’m going to be in pain, probably going to make it worse by handling metal instruments. I’m probably going to bleed inside my surgical gloves and have to replace them.
But the pain that I’m going to go through is nothing compared with the headache the monkey is going to have when he wakes up. And who else is going to sit with him for hours after surgery to make sure that he's okay?
Somebody has to do this work. And if it has to be somebody, it should be me and it should be my team. It should be people who are so well trained and so attentive and who cares so much that they'll scrub the shit out of the end of someone’s finger just to make sure they don’t get B virus.
So I get security to let me in. I scrub in again and I go to work. Thank you.