“Ok, give me a 4-0 prolene on an R.B.-1 needle,” Dr. Warner asked.
Instantly, Nurse Booker handed him the suture and needle, taking back the bloody dissector in return.
With a few delicate stitches, Dr. Warner repaired the damaged tissue, as Dr. Fullerton continued suctioning. Moments later, the flow of blood ceased completely.
“Ok, what’re his sats?” Dr. Warner asked, anxiously.
“BP’s holding at eighty over forty-one, pulse is coming up too at forty-five. Pulse ox is seventy-eight,” Dr. Fullerton responded instantly.
“Ok, he’s stable for now. Call CT. Tell ‘em we’ll be sending him up shortly,” Dr. Warner shouted to Nurse Holder. Looking back to Nurse Booker, he said, “Another 4-0 and an R.B.-1.”
With the retractors removed and the broken ribs repositioned, he began to close the wound.
Fifteen minutes later:
Dr. Warner stood in front of the illuminator and examined the CT images of the patient’s brain. A disturbing frown enveloped his face as he realized the extent of the damage.
“Massive hemorrhaging along the frontal and temporal regions,” Radiologist Dr. Jeremy Styles said in serious tone.
Pointing to the lighted X-ray, Dr. Warner replied, “Hmm, agreed. There’s significant hemorrhaging of the left temporal lobe extending into the external capsule and across into the frontal lobe. He has a slight midline shift and I’m seeing significant mass effect.”
“With the extent of the hemorrhaging, intracranial pressures must be massive,” Dr. Styles concurred.
“Who’s on call tonight?” Dr. Warner asked.
“Dr. Gates.”
“Call him. He needs to get here ASAP.”
“He’s been called. He thinks he can be here in about thirty minutes,” Dr. Styles responded in grave tone.
“THIRTY MINUTES?!” Dr. Warner shouted. “We don’t HAVE thirty minutes. His sats are dropping again. That kid will be dead in fifteen if we don’t get someone in here before then. Is there any other neurosurgeon we can call?”
“Not in this area. Not close by.”
Dr. Warner stared at the films. Beads of sweat formed on his brow as he contemplated the options. He turned to Dr. Styles and his face became resolute.
“Call OR. Have him prepped and ready for a craniotomy,” he said, in a low confident voice.
“You’re going to do it?” Dr. Styles responded incredulously.
“I don’t have much of a choice.”
“But you’re not a neurosurgeon,” he replied, apprehensively.
“I am today,” he shot back. “Call the OR.”
Waiting Room:
Geoff Robbins sat on the uncomfortable faux leather chair and stared at the blank wall across the room. The short time in trauma unit two had done little to ease his worry and now his mind raced with speculation about his brother’s survival. Sitting alone, he nervously rubbed his thumb into the palm of his hand as his mind rushed from one tangent to the next. After nearly thirty minutes, he winced in pain as his palm had now become red and swollen.
“Geoffrey?” he heard his name shouted loudly from behind.
The voice instantly registered in his mind and he leaped to his feet.
“Mom, Dad,” he shouted back as they hurried across the waiting room.
As she neared, his mom could see his red swollen eyes and the distraught look on his face. She immediately grabbed her son and hugged him tightly, his father clinging to the two, comforting them like a blanket. For the moment, words were impossible as the three cried in anguish.
Still vague with details, his mother swallowed the knot in her throat and forced herself to speak.
“Geoffrey, what happened? Have you heard anything yet?” she asked, struggling with every word.
“There was an accident. Some redneck crashed into Bobby,” Geoff responded, his voice filled with anger as he wiped away his tears. “I think they said Bobby broke his leg, arm and some ribs.”
“Oh my God!” his mother shrieked in grief. “No… this can’t be happening.”
“There’s more,” Geoff muttered grimly.
Both parents pulled back and stared fearfully into Geoff’s eyes. The torment on his face telegraphed the gravity of his next statement and they stood and listened with reluctance, knowing full well his next words would be nearly unbearable to hear.
“I heard the doctor’s say he had a severe head injury… something about massive bleeding,” he responded in a low grave tone. He stopped, swallowed hard and forced himself to continue. “Mom, his heart stopped. They had to shock him… it was just awful.”
For his mom’s sake, he bravely fought to hold back his tears. Staring at her son in disbelief, denial momentarily insulated her from the truth. Suddenly, she noticed Geoff’s body trembling slightly and a tear that streamed down his face. In an instant, the reality of his words registered in her mind.
“My God NO!” she cried out in angst.
Her knees buckled and she began to collapse. Quickly, Geoff and his father grabbed an arm and lowered her to a chair. As the three sobbed with unrelenting despair, their grief grew in intensity as the unknown hung over them like a heavy weight.
The O.R.
Nurse Holder burst through the doors as Dr. Warner scrubbed in for surgery. Even before she spoke, he could tell the situation had turned critical by the intensity in her eyes.
“Dr. Warner, his sats are dropping again. You better hurry,” she said, her voice emotional, yet distinct.
“Shit!” he blurted out uncharacteristically. “What are they now?”
“BP is seventy-eight over thirty-nine, pulse is only thirty-five.”
“What about his pulse ox?”
“Pulse ox is seventy and dropping fast,” she replied, nearly in frantic tone.
“Dammit, he’s starving for oxygen,” he said loudly, more for his benefit than hers. “Is he prepped and ready to go?”
“Yes doctor. The patient’s been anesthetized. His head’s been shaved, sterilized and secured in the Mayfield holder.”
“Great job,” Dr. Warner replied simply, as he rushed through the doors of the OR.
Hurrying to the edge of the gurney, he quickly viewed his patient, then grabbed a red and black marking pen from the surgical tray. In seconds, he drew a line that marked the extents of the skull entry and a line that marked the incision.
Tossing the pens to the tray, he said, “Eight blade.”
While Nurse Booker assisted both Dr. Fullerton and anesthesiologist Dr. Bradford Johnson, Nurse Holder assisted Dr. Warner.
Handing him the scalpel, Nurse Holder responded simply, “Eight blade.”
Dr. Warner entered the skin and began to pull the scalpel along the red colored incision line. Blood oozed from the wound and Dr. Fullerton brought in the suctioning wand to evacuate the thick red liquid. In seconds, a large gaping slit crossed Bobby’s skull through his left temple.
“4-0 and an A.B.1” Dr. Warner asked.
Nurse Holder handed him the prepared suture and needle.
Pulling back the left side of the incision, he placed a few stitches to the left side flap of skin holding it back in place. Working quickly, he repeated the procedure to the right side while Dr. Fullerton continued to suction the bleeding wound.
“Retracter,” Dr. Warner called next.
Quickly, Nurse Holder handed him a scissor-like device used to spread tissue. He inserted it into the incision and firmly secured it in place. Taking another, he placed it on the opposite side of the first and engaged the locking mechanism. With the incision now fully open, Dr. Warner prepared to enter the skull.
“Ok, let’s create the burr holes,” Dr. Warner said. “Dr. Fullerton, stand by with suction.”
“I’m on it,” he replied, simply.
Taking the craniotomy drill from the surgical tray, Dr. Warner held it above Bobby’s skull. He took a deep breath and exhaled. He nervously searched the eyes of the personnel around him. All returned anxio
us stares.
“Starting the burr holes,” he announced, forcing confidence into his tone.
The loud whine of the drill drowned out the sounds of the patient’s monitors, sending an eerie feeling of crudity to an otherwise delicate operation.
“Suction,” Dr. Warner called as bone shavings and blood collected around the ever deepening hole.
Dr. Fullerton immediately held the wand to the area, instantly clearing away the debris.
Keeping his eyes on both the computer and the drill, Dr. Warner watched as he neared the break-through point in the procedure.
Suddenly, a line of blood oozed up and out of the burr hole in a tiny red stream and began to fill the incision cavity.
“Oh Shit! Suction,” Dr. Warner called out in frantic tone.
As Dr. Fullerton moved the wand in to draw up the small reservoir of blood, Dr. Warner grabbed strips of cotton batting and held it around the burr hole. As one saturated, he added another.
“His brain’s under intense pressure,” Dr. Fullerton observed.
“How’re his sats?” Dr. Warner asked, his voice sounding harried.
“Still dropping, doctor. BP’s seventy-two over thirty-four, pulse is thirty-two, pulse ox seventy,” anesthesiologist Dr. Johnson shot back quickly.
“Hang a unit of o-negative,” he responded.
Nurse Holder nodded and quickly hurried for more blood.
As the stream of blood slowed to a small trickle, Dr. Warner continued with the next burr hole. He positioned the drill once more and began to bore his next hole. As before, Dr. Fullerton suctioned up the extraneous bone debris as well as the ever growing intensity of blood. Within minutes, the drill broke through and another large stream of blood shot out of the hole.
Instantly, both doctors worked frantically to absorb the growing pool of blood. Nurse Booker quickly handed rectangular cotton batting, while accepting saturated batting in return. As the flow began to slow, Dr. Warner began the final burr hole. Moments later, as the drill broke through the skull, more blood oozed from the hole. Once again, both doctors worked quickly to control the bleeding. In less than a minute, the flow slowed to a trickle.
“Dissector,” Dr. Warner asked.
“Dissector,” Nurse Booker responded in return, handed him the long metal instrument.
Sticking the small curved end into one of the burr holes, he carefully separated the dura membrane that protected the brain from the skull. Moving from hole to hole, he repeated the process.
“Ok, bone saw,” Dr. Warner asked.
Nurse Booker instantly handed him the device.
“Dr. Fullerton, you ready?”
“As I’ll ever be,” he replied grimly.
Dr. Warner inserted the edge of the blade into a burr hole and switched on the powered tool. The saw came to life and the loud roar of the motor completely drowned out all other sounds.
Moving in a straight line, Dr. Warner began to cut a path between two burr holes. Rocking the saw slightly backward to forward, he worked the blade through the bone. As bone dust and blood accumulated along the path, Dr. Fullerton cleared away the material. Several minutes later, Dr. Warner broke through, into the second burr hole.
He ran his gloved finger over the narrow slit in the skull and felt the cut line. Satisfied with his work, he continued on with the next line. He placed the saw blade back into the burr hole and switched on the power. Again, the saw roared to life. Cutting a new line perpendicular to the first, he worked the saw along the second leg of the rectangle. As he had done with the first, he rocked the saw back and forth, cutting small bits of bone along the line, a little at a time. Several minutes later, the saw broke through into the third burr hole.
With two legs of the rectangular bone flap now cut, he quickly repeated the process on the other two lines. With the five-by-four inch rectangular bone flap now completely sawn through, he reached for a dissector to help separate it from the dura laying just below the skull.
With Dr. Fullerton continuing to suction, Dr. Warner worked the dissection tool inside the burr holes, peeling the dura layer away from the inside surface of the bone flap. Several minutes later, he inserted a probe into a cut line and began to gently pry off the bone flap. Lifting if from the skull’s surface, he separated off the last of the dura connected to the rectangular piece of bone.
With the bone flap removed, the massive hematoma was now evident. Through the veil of the dura membrane, dark red clots of blood could be seen covering the surface of the brain.
“Wow, that’s not good,” Dr. Fullerton said cryptically.
“Yeah I know,” Dr. Warner concurred.
Looking over to anesthesiologist Dr. Johnson, he said, “Four ounces of Mannitol, stat.”
With a simple nod, he responded, “Administering now.”
“What is it doctor?” Nurse Booker asked, nervously.
Dr. Warner picked up a probe off the surgical tray and laid it on the surface of the dura.
“This membrane is the dura layer. It’s the first layer of protection covering the brain. If you look closely, it’s very tense and the edges are expanding up through the hole we just cut.”
Nurse Booker stared blankly back at Dr. Warner, unsure of his message.
“The pressures are forcing the dura out of the hole,” he responded, anticipating her next question. “We’re giving him Mannitol to help reduce the pressure.”
Nurse Booker nodded in understanding.
Looking over to Dr. Johnson, Dr. Warner called out, “Sats!”
“Still dropping… BP’s sixty-nine over thirty, pulse is thirty, pulse ox seventy,” he responded grimly. “We’re losing him. Whatever you’re going to do, you better do it now.”
“Eight blade,” Dr. Warner immediately responded.
Nurse Booker quickly handed him the scalpel. Starting at the corners of the rectangular hole, he punctured the dura and ran the scalpel diagonally across the membrane to the far corner. Instantly, a thick clot, as well as blood oozed from the incision.
Even before Dr. Warner could speak, Dr. Fullerton moved the suctioning wand in to remove the escaping fluid and matter.
Dr. Warner moved the scalpel to the other side of the incision and once again, made another diagonal cut across to the opposite corner.
“Forceps, retractor,” Dr. Warner said in a hurried voice.
Quickly, Nurse Booker handed him the instruments.
Using his forceps, he pulled back the triangular flaps of the dural membrane and secured them in place with the retractors. With blood now freely flowing from the gaping hole, the source of the bleed virtually unknown, and the patient’s vitals continuing to fall, time and opportunity were quickly slipping from his grasp.
“I’ll take the suction, you work the irrigation,” Dr. Warner said to Dr. Fullerton. “We need to clean out these clots and find the bleeder… NOW!”
Dr. Warner took the suctioning wand from Dr. Fullerton. Using his forceps, he began to pull at the massive clot that covered the opening. As smaller clots pulled off from the main clot, he sucked them up with the wand. Breaking down the massive hematoma, he began to catch glimpses of the brain tissue underneath.
“Irrigation,” Dr. Warner called.
Quickly, Dr. Fullerton pointed another plastic wand at the clot. He depressed a button and released a flow of saline into the opening. Pointing the saline irrigator directly at the blood clot, the force of the water began to break it apart in small clumps. As the saline flooded the opening, the small clots drained out and were collected by suction. With the two doctors working together, the large gelatinous clot was nearly gone.
Watching the computer screen, the area just worked showed an absence of material. Beyond the cavity, hidden to the naked eye, the computer image showed more clotting. Using suction, Dr. Warner began to draw out the clot from areas hidden under the skull. Working the wand under the edge of the opening, large areas of the massive clot began to be drawn out. Within minutes, the two doctors had once
again cleared away large areas of the hematoma.
Dr. Warner watched the saline enter the cavity and flush particles into the suction wand. As the color of the flow changed from red to clear, then back to red again, he knew the brain was still hemorrhaging. Concentrating on the larger area of discoloration, he began to test for bleeding. As the water flushed clear, he waited for the color to flow red. As it did, he placed cotton batting over the suspected area and watched for a stream of blood to darken.
“Dammit, I thought we had it,” he responded in a disappointed tone.
Prisoner in Time (Time travel) Page 6