Counting Basics #11- so you lost a sponge, what now?


Somewhere in the middle of a turbulent case, or not, something countable has gone missing.

The surgeon swears it isn’t in the cavity.

You’ve counted and re-counted and re-counted.

It has disappeared.

Oh, well, time to finish closing.

(obnoxious buzzer sound)


It is kind of like Special Ops or the Rangers. No man, woman, or thing is left behind.

Why would you have gone to all the trouble to counting in the first place if something was willingly left behind?

That’s what I thought.

If after counting AGAIN the item is still unaccounted for, it is time to call x-ray. Because it is time for an intra-op film. After the film is taken and shuttled off to be read by a radiologist, the surgeon can continue to close. The closure can’t be finished before the x-ray read is available. Do not put the dressing on. The anesthesia can’t be stopped before the radiologist has chimed in.

No matter the whining. From the surgeon, from the tech, from anesthesia.

Hold firm.

After an interminable time the phone will ring and it will be the radiologist. Put them on speaker and tell them to begin.

There are two ways this can go:

  1. the x-ray is clean and there is no identifiable sponge, instrument, or suture needle (thingy, technical term you understand).
  2. the missing thingy is visible at (here the radiologist names the area where the thingy can be seen). If this is the case, the surgeon re-opens and pulls out the thingy, sheepishly. Sometimes they will tell the room that they knew it was there. Do not let them fool you. The last conversation that was had with them about it was the impossibility of them leaving the thingy behind. And that was 20 minutes ago. Gaslighting. It’s not just for the normal population anymore.

If there is no thingy identified on the x-ray the surgeon can finish closing up, the dressing can be placed, the patient awakened.

All is good.

Except for the small matter of the missing thingy. But as long as it is not in the cavity the exact location of the thingy is not to something that the room has to be concerned with.

Sometimes it feels like a Bermuda triangle has opened in the room. Or IdaKnow from Family Circle is real. At least she’s a ghost and can’t impact the sterile field.

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