Ever since I moved to London, I don’t think any event has moved me as much as today did.
As part of the neurosurgery team, you know that your surgeries don’t essentially or always result in someone waking up to go back to their normal life. Sometimes it’s literally about the bare minimum. Sometimes it’s just about keeping someone alive.
Your conscience kills you when you know that someone has a poor neurological recovery but there’s a bit of your conscience that says “You did whatever you could. Without the surgery he wouldn’t be alive” and then your mind learns to accept it and live with the consequences.
But what happens when you’ve failed to give the bare minimum?
I got a call at 4:00pm on the on-call phone which was lying on the table. The patient was to be positioned soon and since my on-call colleague was indeed on-call, it was her chance to scrub in, I went to hunt for her. I eventually found her and said that I’d help with the positioning and everything and that I’d call her when we were to get started with the actual surgery.
Eventually she came down at the perfect time to get scrubbed.
I was semi-scrubbed so I thought I’d hang around for a bit. Joining me was a young woman who was in her early twenties who was trying to decide what career she wanted to take in the world of healthcare. Nurse/PA or a doctor. Whilst I was standing there, I was explaining the surgery to her.
From the intricacies of the curvilinear incisions, the beautiful pericranium, the temporalis muscle to the raw bone underneath, she was gasping at the sight of it. She wasn’t disgusted, flabbergasted or appalled. She was interested. She was intrigued. She was someone I wanted to see growing up to be a Neurosurgeon.
The moments of fascination, little did I know, soon came to an end when the blood from the dural venous lacunae started pouring like a fountain of doom. It was laughing at our agonized eyes. It was swallowing every little light in the room and sucked every bit of smile from our faces. We knew we were in for some deep trouble.
The alarms on the anesthetic monitors started beeping violently. The anesthetists rushed to pull the crash bell. Before we knew it, there was someone starting chest compressions on his chest whilst the brain lay open there with blood uncontrollably pouring from one end. No one in that room, I can guarantee, was aware of what was going on. Every single person in that room was acting from muscle memory and adrenaline. Everyone had one goal. To make sure he doesn’t die on table.
Even though we got his circulation back for 5 minutes, we couldn’t hold him with us for longer. At least not long enough for us to finish what we had started.
The word rapid closure meant nothing to me till today.
All I knew about rapid closure was that the prophylactic 2-0 nylon would be kept ready on the table in case something went wrong but nothing ever did and thus I had never seen it ever being used.
By this point of time, our consultant had come in as I had called him and he was staring at the bloody ground before taking control and said, “He needs to undergo rapid closure”.
I was scrubbed in at this point of time. I was initially meant to take turns for CPR but somehow in the mess of things I ended with the suture in my hand and I started doing one end of the closure whereas my registrar was doing the other end. Doing a normal closure is usually difficult but doing a closure whilst the patient is undergoing CPR was another level of trauma that I don’t think anyone should experience.
The composure required to close the wound was phenomenal. My brain completely shut off to everything around me. The only thing that existed in my world at that point of time was the needle, the brain, the skin and me.
We closed within the next 10 seconds, bandaged his head within the next minute, took him off the table within the next 15 minutes.
I felt an unexplainable void. I had no emotions, feelings or expressions. I felt numb.
As I write this 4 hours from when it happened in my room at home, my brain, feet and heart are still in theatre watching the blood pressure and heart rate sinking. I can still feel the helplessness and hopelessness I felt at that point of time. I can still feel the buzzing noise of the anesthetic machines around me. I can still hear the noise of the scrambling feet rushing to save the last remaining life in him. As I close my eyes, all I can see, is the person we could not save.
No matter how old I get, death will always be something I could never be immune to.
The Soul Of A Surgeon 