I would not mention my work at the hospital, but I will tell you about this case that happened today. My first day back at work, and while I was preparing my known schedule for the coming weeks with our secretary in our office at the hospital, an emergency came in by air ambulance. Just a coincidence that I was on hand. I was asked to take a look at the casualty.
My wife and I job share with two other people. Three months on, and three months off. My work partner is youngish, but a very competent surgeon. I should know, because I partly trained her myself. We have an office supplied by the hospital for administration, now shared by my wife and myself, for the next three months. It is not exclusively ours. My wife prefers to work on the wards. Both our work partners are gone already, but the paper work and reports are bang on up to date, making follow up on her cases easy for me. My wife the same. Our office is efficient, and such change overs cause no problems for qualified people all round.
Where is she off to this time? I asked. South America, exact destination unknown at the time of departure the secretary told me. With Oxfam again? I asked. Probably. Or the Red Cross she wasn’t sure. My work partner lived to volunteer with various charities working in deprived areas for much of her three months off, but she’d probably have a vacation in the tourist parts first, to ‘get into step’ as she put it. I think she has persuaded my wife’s work partner to do much the same. Though they might go to different nations. He is married. She is not. Back to the emergency.
An eleven year old girl fell from her bicycle in wet conditions while going a message to the nearby shop for her mum. She was not wearing her helmet. If she had been she would not have been an emergency with a split skull lying here. No other serious injuries.
Ex Rays? I asked. Just done. Let me see them. A part of the skull was pushed in, in the rough shape of a question mark with a line fracture from the centre going toward the front of her head. Just above eye level it was three centimetres long, while the question mark was eight centimetres high from just above and behind the ear. The lower part of the forward break, not the curve of the question mark, was pushed in a little, held in by the other part, and would have to be got out again.
Prepare her for surgery and I’ll go and get ready. Providing there is a team available. There was.
On the operating table with her head shaved on one side she was laid on her side, with her head supported for perfect access. Okay I’m going to make an H shaped cut in the flesh and expose the skull at the break. An H on it’s side.
I spoke as I did so, telling the watching medical students what little I knew about the case, and how she came to be here.
Now our hospital is huge, and a teaching hospital at every level. The viewing gallery was packed with enthusiastic young men and women starting out on a career in medicine. Not all would become surgeons, but it was part of their training anyway.
We have camera operators who are not actually in the theatre, or in the viewing room, and sometimes I wonder if he or she is even in the hospital, or even the same country. They do a fine job for the students and us anyway.
Feel free to ask questions I told them, because I could hear them as well as they could hear me.
What are her chances of survival? One of them asked me.
One hundred percent. I answered. This is not as serious as it might seem, but a safety helmet could have saved her a few months of recovery time.
I was wearing glasses with screens on them giving me a perfect broad screen view of the wound. The staff and others could see that, but what they couldn’t see was the further information also being fed to me on my screens by the computer on my ship, which was following proceedings. It was a simple colour code, because I could have carried this procedure out without it, but when a life is at stake I prefer the reassurance the programme gives.
The wound was highlighted on my screen as amber with the sunken bone highlighted in red.
There appears to be no internal bleed, but there will be internal bruising. We’ll keep a close eye on that for a few days. I told my audience. Sister will see to passing that on to the ward. She nodded. Standard procedure. Now I must raise this part that is stuck down. I took a very sharp instrument from the tray, placed it in the break and pushed down then levered up. Taking care not to break off any part that may fall inside. Better to be positive with a procedure like this I was telling them. One positive move being better than several timid attempts that can do more harm than good.
The section of the break that had been highlighted in red now showed as amber, with the bone structure now in the correct place, and fitting snuggly together. I’d left little damage with the tool.
Now I will dry the skull carefully, and thoroughly, and along the break especially.
Just talk amongst yourselves for a moment I said.
After a couple of minutes I stood back from my work, and held up a now half empty tube of something.
Can we get a close up of this again. The camera operators must have been fed up having to show this.
This is my favourite tool, and it should become yours as well. You don’t have to use it, but your patients will suffer less during recovery if you do.
Most of you know what it is, but I’ll explain in case some of you don’t. I’ll also give you some tips on using it.
It is of course superglue in a gel format especially for use in surgery such as this. Though you will find other uses for it in the treatment of your patients.
Can we return to the break again camera. Now as you can see it is a clear gel. Therefore you can’t see it very well, but I’ll talk you through it.
I took an instrument clean from the tray and used it as a pointer. It is advisable to stitch a bone like this with it, as opposed to applying it to the whole length of the break. So if you pay attention I’ll show you where I have applied it, and just as importantly where I have left it off. I began at the top, and without touching the skull I pointed to the first part of the question mark. About thirteen millimetres I’ve left here. Bone to bone. Then glue for about the same. Then a further space, then more glue. The spacing and stitching was irregular.
I worked my way over it all showing them what I’d stitched, and what I’d left. I had placed small stitches on the T of the break on the three sides, but not on the part where the three parts met.
The importance of this is the healing time. The parts without glue will start to knit within hours. The stitched parts can take up to a week to begin. The glue dissolves completely in time, and never causes problems. Providing you make the surface smooth. A little raised smooth bump is good. All of it will stitch itself soon. Flesh also.
I continued. I have reshaped whole crushed skulls with this stuff, and had to apply it to whole breaks, and that’s fine, but for a faster repair it is better to stitch.
I’ll sew up now, but ask any questions you care to ask. It’s what you’re here for, and I’ll do my best to answer.
They asked a few more questions, and I answered them, while I finished up.
When the questions finished I told them that I could almost get away without stitches in the flesh if I trusted the tapes I could have used instead. However when it comes to explaining to her grandchildren the importance of proper safety wear in years to come, she needs a slight scar to show them. No laughter. I used very few stitches. Trusting the nurses to cope with the dressings.
I told them that they could visit the patient on the ward, or in her room, at the discretion of the nurse in charge, to view progress. However don’t make nuisances of yourselves, and don’t all turn up at once.
I half turned away from the microphone, and said to the theatre team, what’ll I do with this spare bit? Then I shrugged, pretended to throw something over my shoulder and walked out saying I have another scheduled operation this afternoon, maybe I could have used it during that.
Some spoilsport in the gallery was saying, he always does that.
No more about our hospital work, except to say that in a few weeks I expect the wound area to show green on my screens as I do my rounds, and to remind you all to wear protective clothing when it is necessary. Such as riding a bike.