When the Air Hits Your Brain: Tales from Neurosurgery by Jr. Frank Vertosick
Book: When the Air Hits Your Brain: Tales from Neurosurgery by Jr. Frank Vertosick
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Authors: Jr. Frank Vertosick
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about medicine must be garnered from daytime television. Soap opera M.D.’s may fornicate in the linen closets, but the average surgical house officer would more likely be caught sleeping there.
The emergency room awakened me at two in the morning with word that an ambulance carrying an auto crash victim was pulling in. Before heading down to the ER, I stopped in the bathroom. Any patient too ill to wait for me to pee was likely to die with or without my help.
I entered the trauma room just as a pale and bloodied young woman was being lifted from the ambulance stretcher onto the trauma room gurney. She was strapped to a “backboard,” a wooden platform used to immobilize the entire spine. A paramedic in a blue jumpsuit droned her report to all within earshot: “Caucasian female, age twenty-two…unrestrained passenger in a car traveling at high rate of speed down Bigelow Boulevard. The car crossed the center line and collided with another vehicle. Victim was found awake but incoherent outside of the vehicle. Blood pressure 100 over 60, pulse 125. An open laceration in the right frontal parietal area was packed to stop bleeding. Large blood loss was apparent at the scene. No obvious limb fractures or deformities were noted. The patient moves all four extremities spontaneously, but follows no commands…”
Fearing that more trouble was on the way, I asked the paramedic what had happened to the other victims of the crash.
“Two people in the other car were taken to Mercy Hospital,”she replied, adding under her breath, “and the driver of her vehicle was dead at the scene. We pronounced him and called a coroner’s ambulance.”
“You pronounced him?” I asked with mock indignation. Officially, only a licensed physician can make the pronouncement of death.
“It doesn’t take an M.D. to know when a headless guy is dead,” she answered with a slight smile. I still had a lot to learn about street trauma. The paramedic crew retired to the front desk to complete their reports and await the return of their backboard.
Nurses quickly cut the clothes from the injured woman’s arms and torso. Until the extent of spinal injury is known, excessive movement of the patient is unwise and the more civil methods of removing clothing are too dangerous. For those with minor injuries, watching a beloved sweater being shorn from their bodies like fleece from a sheep can be more traumatizing than their accidents. The victim’s lower body was encased in a blue MAST suit, a comical set of inflatable pantaloons used to force blood from the expendable legs into the not-soexpendable head.
I donned a pair of latex gloves and removed the gauze pads the paramedics had stuffed into the head wound. Pulling away blood-caked hair, I separated the edges of the lacerated scalp. The wound was eight or ten inches in length and filled with road dirt and fragments of windshield glass. The glistening ivory surface of the skull showed; a jagged fracture ran parallel to the laceration. Pink, macerated brain tissue the consistency of toothpaste leaked from the fracture line.
The Edwin Smith papyrus, an ancient Egyptian medical text dating back to 1700 B.C. , declared that any patient with brain tissue oozing from a skull fracture had “an ailmentuntreatable.” Nearly four thousand years of medical progress had not disproved this grim prognosis.
I ruffled through the papers stuffed under the backboard, searching for her first name…Shirley. Under normal circumstances I would never address a new patient by her first name. Such uninvited familiarity is the province of car salesmen, not physicians, but a severely head injured patient requires a less polite approach.
A first name is the most durable lifeline to the outside world, the first word recognized and the last word forgotten. When a dementing illness erases our awareness of home, spouse, and children, we will still answer to our first name. A first name can pierce the delirious fog of head
The emergency room awakened me at two in the morning with word that an ambulance carrying an auto crash victim was pulling in. Before heading down to the ER, I stopped in the bathroom. Any patient too ill to wait for me to pee was likely to die with or without my help.
I entered the trauma room just as a pale and bloodied young woman was being lifted from the ambulance stretcher onto the trauma room gurney. She was strapped to a “backboard,” a wooden platform used to immobilize the entire spine. A paramedic in a blue jumpsuit droned her report to all within earshot: “Caucasian female, age twenty-two…unrestrained passenger in a car traveling at high rate of speed down Bigelow Boulevard. The car crossed the center line and collided with another vehicle. Victim was found awake but incoherent outside of the vehicle. Blood pressure 100 over 60, pulse 125. An open laceration in the right frontal parietal area was packed to stop bleeding. Large blood loss was apparent at the scene. No obvious limb fractures or deformities were noted. The patient moves all four extremities spontaneously, but follows no commands…”
Fearing that more trouble was on the way, I asked the paramedic what had happened to the other victims of the crash.
“Two people in the other car were taken to Mercy Hospital,”she replied, adding under her breath, “and the driver of her vehicle was dead at the scene. We pronounced him and called a coroner’s ambulance.”
“You pronounced him?” I asked with mock indignation. Officially, only a licensed physician can make the pronouncement of death.
“It doesn’t take an M.D. to know when a headless guy is dead,” she answered with a slight smile. I still had a lot to learn about street trauma. The paramedic crew retired to the front desk to complete their reports and await the return of their backboard.
Nurses quickly cut the clothes from the injured woman’s arms and torso. Until the extent of spinal injury is known, excessive movement of the patient is unwise and the more civil methods of removing clothing are too dangerous. For those with minor injuries, watching a beloved sweater being shorn from their bodies like fleece from a sheep can be more traumatizing than their accidents. The victim’s lower body was encased in a blue MAST suit, a comical set of inflatable pantaloons used to force blood from the expendable legs into the not-soexpendable head.
I donned a pair of latex gloves and removed the gauze pads the paramedics had stuffed into the head wound. Pulling away blood-caked hair, I separated the edges of the lacerated scalp. The wound was eight or ten inches in length and filled with road dirt and fragments of windshield glass. The glistening ivory surface of the skull showed; a jagged fracture ran parallel to the laceration. Pink, macerated brain tissue the consistency of toothpaste leaked from the fracture line.
The Edwin Smith papyrus, an ancient Egyptian medical text dating back to 1700 B.C. , declared that any patient with brain tissue oozing from a skull fracture had “an ailmentuntreatable.” Nearly four thousand years of medical progress had not disproved this grim prognosis.
I ruffled through the papers stuffed under the backboard, searching for her first name…Shirley. Under normal circumstances I would never address a new patient by her first name. Such uninvited familiarity is the province of car salesmen, not physicians, but a severely head injured patient requires a less polite approach.
A first name is the most durable lifeline to the outside world, the first word recognized and the last word forgotten. When a dementing illness erases our awareness of home, spouse, and children, we will still answer to our first name. A first name can pierce the delirious fog of head
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