The new year brings with it a renewed vigour and tenacity that can heal any medical ailment
Representation Pic
I don't think anything can be done for him,” the casualty medical officer called me after looking at the state in which the patient was wheeled into the emergency. Siddharth had been riding a bike that had a head-on collision with a truck, whose driver had turned into a “No Entry” lane. I went to the ER to see him. His face had split into two, with both halves of his upper and lower lips three inches apart. There was barely a semblance of a nose. The gravel from the road was mixed with the putrid stench of dried blood that filled his mouth and nose. It looked like he was missing an eye. His face resembled a ruin discovered at a destroyed archaeological site with a lifeless body attached to it. “How old is he?” I enquired. “Thirty,” replied one of his relatives. “We must do everything we can to save him,” I told the team.
The ER doctors were able to get intravenous access and supplement the blood and fluids he’d lost. “We can’t insert a breathing tube through his mouth to protect his airway,” claimed the intensivist, “as everything is blocked and fractured.” “We’ll have to do an emergency tracheostomy,” I suggested. After giving him a thorough wash to remove the muck he was covered in and sanitise the skin, he was taken to the OR and a hole made in his windpipe to connect him to the ventilator, so that he could get his supply of oxygen. Alongside, the anaesthetist stabilised his vital parameters and shifted him back to the ICU.
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“He will need urgent surgery, perhaps more than one,” I told the family once we saw the extent of damage on the CT scan of the head. There was a large expanding blood clot causing pressure within the brain and the fractures of his facial bones looked like a glass that had been shattered. Luckily, there was no major abdominal injury or fractures of the bones of the arms and legs or even the spine. “We will open up the head and remove the blood clot first, and then the plastic and facial surgeons will try and fix whatever they can to realign the face,” I explained to an extended family of over 20 people who had gathered there. “Will he survive?” his mother asked with an ashen face. “We’re going to try our best, but I’m not sure if we’ll be able to save his eye,” I reasoned, looking at the extent of damage from the scan. One cannot fathom the plight of parents envisioning their son on the precipice of death. A life that they had nurtured with all their heart had come to an abrupt halt and even a possible end.
The same day, we took him to the OR and made a large question mark-shaped incision, whose tail ended in front of the right ear. The skull bone was cracked at multiple places and looked like a badly arranged jigsaw puzzle. We drilled around it and removed all the broken bone. The dura—the layer covering the brain—was tense, and as we cut it open, a thick blood clot emanated like a teeming river in a warzone. The brain looked harsh, red, and angry, but once we removed all the debris, it started to pulsate again. We put back the pieces as best we could and handed it over to the plastic and maxillofacial surgeons who, over the next 12 hours, reconstructed the entire face. Multiple fractures of the jaw and cheek were reduced and secured with mini plates and screws. His lips were stitched back with fine sutures barely visible to the naked eye. The ophthalmic surgeon was able to restore the eye and adjust it within the socket it had recessed into. The nose, too, was reconstructed with multiple splints within it. As there was no way for us to insert a tube into his nose to feed him, the general surgeon sewed one directly into the stomach. Several medical and surgical specialties came together to ensure he came out alive from the OR.
The next day when we saw him in the ICU, his head was twice its size from all the swelling that sets in a day after any kind of major injury. “We’re going to keep him on a ventilator and knock him off with medication to give the brain some rest for the next 48 hours,” I told the anxious family. Two days later, once we discontinued the sedatives, there was still no sign of him being awake. The CT scan looked good. The blood had vanished and the brain looked like it was healing. The shadow from all the tiny metal plates looked like stardust shining inside his head. The universe was conspiring with us to pull off something magical.
“I’m going to be on leave for the next few days and will resume on New Year’s Day,” I told his family, “but the entire team is present here and will look after him. We have to give this a little bit of time, and God willing, he will wake up,” I explained to the sea of jittery faces in front of me, urging them to hold on to their faith.
The New Year is that random time of the year when everyone longs for new beginnings. We use the date to start a new resolve, a new practice, a project, or sometimes even a new love. We need that date to break old patterns and reconfigure something afresh; sometimes it requires letting go, while sometimes, it requires holding on even harder. It requires courage but tenderness, strength but vulnerability. It requires the tenacity to kindle the light within us.
Some beginnings are tucked into endings. Sid had nearly lost his life when he came to us. When I saw him after five days of being away, he was sitting up in bed and gave me a thumbs up. He could comprehend what I was saying and acknowledged it. He still couldn’t talk because of the tube in his windpipe. The swelling on his face had subsided and his eyes had opened up. I put up random fingers in the air from a distance and asked him to count them after covering his good eye. The eye we thought we might not be able to redeem was working well. He was able to count. He was still being fed through the pipe in his stomach but that will come out soon in addition to everything else that is helping him heal. He will be free again: free to choose the life he wants to live, free to walk through the portals of possibility that his life has in store for him with a renewed reverence for it.
We will be able to wish him, along with all our readers, a Happy New Year.
The writer is practicing neurosurgeon at Wockhardt Hospitals and Honorary Assistant Professor of Neurosurgery at Grant Medical College and Sir JJ Group of Hospitals.
The surgical beginning
10
1
07.01.2024
The new year brings with it a renewed vigour and tenacity that can heal any medical ailment
Representation Pic
I don't think anything can be done for him,” the casualty medical officer called me after looking at the state in which the patient was wheeled into the emergency. Siddharth had been riding a bike that had a head-on collision with a truck, whose driver had turned into a “No Entry” lane. I went to the ER to see him. His face had split into two, with both halves of his upper and lower lips three inches apart. There was barely a semblance of a nose. The gravel from the road was mixed with the putrid stench of dried blood that filled his mouth and nose. It looked like he was missing an eye. His face resembled a ruin discovered at a destroyed archaeological site with a lifeless body attached to it. “How old is he?” I enquired. “Thirty,” replied one of his relatives. “We must do everything we can to save him,” I told the team.
The ER doctors were able to get intravenous access and supplement the blood and fluids he’d lost. “We can’t insert a breathing tube through his mouth to protect his airway,” claimed the intensivist, “as everything is blocked and fractured.” “We’ll have to do an emergency tracheostomy,” I suggested. After giving him a thorough wash to remove the muck he was covered in and sanitise the skin, he was taken to the OR and a hole made in his windpipe to connect him to the ventilator, so that he could get his supply of oxygen. Alongside, the anaesthetist stabilised his vital parameters and shifted him back to the........
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