Several years ago I was working in surgery as a Surgical Assistant, which is pretty close to being a surgical PA. It was a good gig, as I had worked through the ranks to self-promote by using my experience as a platform. At this hospital I was in the Cardiovascular Institute, doing everything heart and lung related.
A patient had come into the emergency room with a specific health-related issue – she had a pulmonary obstruction. That morning she went to the dentist to have a cavity filled. The dentist had his drill, ready to do the deed, and told the patient to ‘breathe the laughing gas through your nose; do not inhale through your mouth.’ True to form for any medical procedure when the patient is awake, they often do not comply with instructions. She sucked air through her mouth at the same time the drill touched the tooth, dislodging the bit where it got huffed into her airway.
She had a tiny drill bit in her lung. Not good.
Fast forward to surgery time. We had her prepped for a VATS procedure, which is a video assisted thoracoscopic surgery. The doc was a young prodigy. He was both a general and cardiac surgical specialist before the age of 30. Six highly trained people, ranging from nurse to MD, ready and able to get a tiny piece of diamond-tipped metal out of our mouth breathing patient. We didn’t bring the A team, we were the A team. Easy peasy. It should have taken a half hour.
Two hours later we were still there.
The drill bit was doing something called migrating. With every breath her lungs expanded, making the metal move around her airway. So we would take an x-ray, then perform a mini-resection of the space where the drill bit was. Only it kept moving around. We had taken a half dozen small sections of her lung tissue out and still hadn’t isolated the drill bit.
We kept working but the problem was still there. And we couldn’t deflate one of her lungs because she was a COPD patient and had respiratory issues to boot. We were at a loss.
Inspiration came from an unexpected source. Dr. J. Guterman talks about it in his book Mastering the Art of Solution-based Counseling. Some of the focus is about the challenges people face and the many roads that lead to solutions, since human issues are very complex and dynamic. Not to mention these issues may change at any given time for even more compound reasons.
A solution-focused answer was needed. Or was it? There is the SMART method: Specific, Measurable, Attainable, Relevant, and Time-measured. This is a common tool used across many industries, including business management, human resources, and psychology. But in this case we had used this method and had come up short. The problem was still there.
Although Guterman’s expertise lies in counseling, sometimes the answer to the lesson isn’t in what you learn in class, it’s what you learn because you’re sitting in the seat. Similar to an intelligent child in a class that moves too slow for their liking; the real lesson for them is to learn to exercise patience. In this case, solution-focused answers have exceptions to the problem, such as personal strengths and incorporating existing resources.
I found the inspiration from one of my existing resources: my kids. We had a toy at home that was one of those 3D puzzles shaped like a ball. Inside the clear plastic was a maze, where you had to rotate the toy to make a tiny metal ball bearing go through ramps, up and down stairs, and into tubes. Once it got to the center you won. But you could cheat to win, if you positioned the ball just right and flipped it, you could get the ball bearing to fall close to the finish line.
So that’s what we did. We tilted the patient into a Trendelenburg position, right lateral position. This was challenging because she was on an imaging table that didn’t have the capability to tilt. So we had to pick her up, move another table into position, and set her down again. Once done she was essentially tipped back 45 degrees, almost on her side.
This allowed the drill bit to migrate up to the middle of her lung, where it stayed. Using a bronchoscope and a tool we borrowed from urology that snares kidney stones, we were able to pluck the drill bit out of her upper lobe. After closing things up and several hours of monitoring she left the hospital that evening on the road to recovery.
In this case, our desk was surgery. A problem was placed on the desk, with a post-it that said, ‘fix this.’ And no solution was apparent. It didn’t matter how long we sat there, the solution was not forthcoming. We couldn’t pawn it off on someone else. It needed to be solved as soon as possible.
The logical methods we use to solve these problems, whether business or personal, are great places to tackle issues by the numbers. And often it works, in many cases without going through the entire SMART acronym. Much like ants marching in a line, though, there is an end at the starting point, and without inspiration at the end of that direction the ants get confused and lost.
We needed to remove ourselves from that environment. There is a solution, one way or another. There always is a solution to every problem, sometimes not the way you want or the way you think things should go. And that solution may come from the most improbable of sources.
In my case it came from a children’s toy. The most unlikely place one could mentally go, considering the vast distance there is between a surgical procedure and a child’s plaything. But it worked.
So if there is a problem that defies logical methods, or an issue where the answer comes with a shrug and a head shake, prudence comes as the better part of valor. The answer may come from an unlikely source, the space between the lines, the calm away from stress. And who knows? Perhaps inspiration is playing with your child and their toys.
At the very least you get to play with your kids.
DAVID F. MAIER 