What patients have doctors encountered that surprisingly survived

I have been a doctor for many years and have never seen such a shocking emergency.

The patient’s head was pierced by a steel bar through the temple.

Because it was too thick, firefighters were on hand to help cut it off during the operation.

1．

The patient’s situation this time is rather “special”.

I didn’t say “special”.

Almost every doctor and nurse who comes into contact with this patient emphasizes this.

That night, I was on duty and the nurse knocked on the door.

“Doctor Jin, the emergency surgery department has a consultation. A 48-year-old male fell and suffered severe craniocerebral trauma.”

Before leaving, she added, “It’s a special case. Please go to the doctor immediately.”

“special?”

Special is the “jargon” in our department for quickly understanding the situation, usually implying that the patient’s condition is “very unexpected”.

There is no easy work in the middle of the night; this is the iron rule of neurosurgery emergencies.

Emergency cases in neurosurgery (cranial surgery) often occur in the second half of the night, because craniocerebral trauma and acute spontaneous intracranial hemorrhage are the two largest groups of emergency patients and surgical cases in our department.

Moderate head trauma often occurs in the middle of the night, especially severe head trauma.

The most common causes of craniocerebral trauma are car accidents, falls from heights, and fights.

Late at night, friends get together for a drink, and then drive under the influence of alcohol; or they accidentally step on empty air and fall down on a bridge or stairs; or there is a fight between two people with the question “What are you looking at? What’s wrong with you looking at me?” The consequence may be that they come to our department to meet us.

So I’ve long been accustomed to scenes like this – patients with blood all over their faces, emergency rooms reeking of alcohol, vomit on the ground, terrified family members, and patients wailing with half their lives left…

“special”?

How could it be more special?

At the door of the emergency room, the doctor Xiao Ma used the word “special” again, and there was even a rare hint of fear in his eyes.

“Teacher Jin, today’s patient’s condition is a bit special, and it’s a bit annoying.”

Xiao Ma is a local and “annoyed” is his catchphrase.

As my apprentice who I brought up in medical school, Xiao Ma has been working in the affiliated hospital for 3 years. He can be considered a veteran who has seen all kinds of things. This is the first time I heard the word “special” from him.

I was stunned for a moment, and while walking quickly towards the patient, I habitually asked Xiao Ma for the patient’s basic information as soon as possible.

“Xiao Ma, is the hospital cleared today? VIP patient? How many hours has he been injured? Is there a CT scan from another hospital?”

“Teacher Jin, given the situation today, there’s no need for us to organize a clearing. In his condition, other patients are so scared that they don’t even dare to get close to him. You see…”

As I got closer, I was shocked.

This is more than just “special”, it’s simply shocking!

The first thing I saw was not a bloody head, but a steel bar about one meter long.

The steel bar was as thick as an adult’s thumb, with some dirt and blood attached to it. The entire steel bar had passed through the patient’s head and lay there steadily, like a living person being hung on a clothesline like a piece of clothing.

Moreover, it is “hung” horizontally from one temple to the other temple. Don’t you think it’s scary?

Foreign body implantation during craniocerebral trauma is actually quite common in our neurosurgery department.

I have seen patients with head injuries brought to our department being stabbed by knives, pierced by bullets, and smashed into by rocks…

But this kind of penetrating wound is the first time I have seen it in my 10 years of medical practice.

After all, the probability of this degree of penetrating injury occurring is too low.

To be frank, the probability of this happening is probably lower than the probability of a person being hit by a plane while walking on the road.

To explain why this type of penetrating injury is extremely rare, I need to first give you some basic knowledge about craniocerebral trauma.

It is common sense that the brain is the most important core organ in the human body.

Our bodies have also evolved a very effective protection mechanism during the long process of evolution to protect our brains from or minimize damage from external violence.

Through the triple protection of the scalp, skull and cerebrospinal fluid, the brain seems to be wearing armor with a bulletproof vest inside, so under normal circumstances, intracranial penetrating injuries are difficult to occur.

Even if there are, the most common ones are bullet and firearm injuries.

I didn’t have time to be surprised. I glanced at the ECG monitor beside the bed and asked the family member standing next to me, “How did you get injured…”

The middle-aged woman next to the patient seemed to be the patient’s lover. She obviously had not recovered from the shock yet and her voice was trembling.

“Around 6pm, my husband went to the construction site to check and accidentally slipped and fell into a deep pit with a lot of half-cast steel bars…”

It is common to see patients who step on empty air and fall and suffer external injuries from various punctures, but it is a very low probability event among low probability events for a patient to be pierced directly through the skull by a steel bar as in this case.

I quickly checked the data on the ECG monitor: blood pressure 110/70 mmHg, heart rate 67 beats/minute, respiration 19 times/minute, oxygen saturation concentration 96%.

After reading the data, I was shocked.

This… is simply unbelievable!

Falling from a height, exaggerated steel bars, and penetrating skull injuries.

Amidst all these dangers, the patient’s vital signs are still very stable until now?

Without giving it much thought, I immediately checked the patient’s bilateral pupils (a test used by neurosurgeons to quickly determine the patient’s consciousness and intracranial nerve damage: pupillary reflex).

The patient’s steel bar and head were wrapped with very tight gauze. From the outside, there was a little blood stain, but not much. I did not open the bandage quickly, but first carefully observed the position of the steel bar. Although the bandage was very thick, I could judge the approximate position of the steel bar based on experience.

My heart rose to my throat again.

A terrible possibility suddenly popped up in my mind. The current data is normal, and it is very likely just an appearance.

Because this steel bar went straight through the patient’s skull base, entered from the front of the left external auditory canal, and the other end came out from the front of the right external auditory canal. To put it simply, this steel bar just went through both sides of the patient’s “temples”…

There is a move often mentioned in martial arts novels, “Twin Peaks Piercing the Ears”.

It has to be said that the older generation of martial artists did discover the “vital point” on the human skull, and this is exactly the location they were referring to.

The location where he was injured was estimated to be the vital point. Even if it was said that he was in danger of death, he was still overestimating his chances of winning.

In a word, no matter what type of intracranial penetrating injury it is, the most fundamental thing to do to survive is to see where the injury is inside the brain.

At least 70% of the cells in the human brain are in a dormant state. If the dormant cell area is damaged, it will not be a big problem, but if any “brain functional area” is damaged, the situation will be dangerous.

Therefore, in craniocerebral trauma, there are three situations that are important bases for us to judge the risk of death of patients:

1. For direct injury, it is necessary to ensure that the steel bar penetrates the skull and completely avoids the brain stem (core functional area, consciousness center, respiratory and heartbeat center). If the brain stem is injured, death is almost certain.

2. Even if it is not fatal, even if it damages any brain function area in our skull, the result is almost irreversible serious damage. If the steel bar directly damages the motor area, the hands and feet will be unable to move from then on. If it damages the sensory area, then the feeling will be lost from then on… If it touches any brain function area, then no matter what kind of damage it suffers, it will be close to the “vegetative state”. Who can bear such a way of life?

3. Even if you are lucky enough and the steel bar does not damage the brain stem or any brain functional area, then the nearby major arteries may be damaged or compressed. The slightest movement or any tiny abrasion may cause the arterial blood vessels to rupture and cause intracranial hemorrhage. The high-speed arterial blood flow will impact the soft brain tissue, just like a high-pressure water gun hitting tofu. The nearby brain stem will also collapse in seconds, and the tragedy of life going from birth to death may be staged in just a few seconds.

If he wants to avoid any kind of damage perfectly, he may need to save the galaxy at least 800 times in his previous life before he dares to take a chance on such good luck.

Moreover, judging from the visual observation, he seemed to have run into the muzzle of the first possibility.

The location where the steel bar pierced the patient’s brain was right in the brainstem area.

That is what I call the core functional area of ​​life, which controls human consciousness, breathing, and heartbeat, these three things.

As long as there is just one injury, the patient may become a vegetative state at the very least, or suffer respiratory and cardiac arrest at the worst, which means death on the spot.

Just as I was worrying about the difficulty of the operation, the patient suddenly started talking.

“Doctor, you must save me, my family…”

I was stunned for a moment.

From the time I came in until now, I had already assumed in my mind that in such a “tragedy”, the patient should have lost consciousness.

“Can you hear me?” I quickly confirmed with the patient.

“Doctor, I can hear you,” the patient replied calmly.

I quickly calmed down and a glimmer of hope arose in my heart again. The patient was still conscious.

“Uncle, don’t worry, what discomfort do you feel now?”

“I just felt black in front of my eyes, and the wound on my head hurt a little, but nothing else.”

“Okay, now I need you to cooperate with me and do a few simple movements.”

I quickly checked his limb muscle strength and pathological reflexes.

Combining information from all aspects, I secretly and quickly made a preliminary judgment again.

Judging from the bleeding from the gauze bandage on the patient’s head, the patient’s bleeding is currently under control and he is not losing a lot of blood, which is consistent with his stable vital signs.

Judging from the location where the steel bar penetrated, it was very likely to damage the intracranial part of the optic nerve, but the patient’s clear consciousness meant good news: it did not damage the place I was most worried about, the brain stem!

As I said before, the brain stem is the core of our nervous system, and even the slightest damage to it can immediately take away life or cause the patient to become a vegetative state.

Now I need to examine the wound further.

I carefully opened the bandage. During this process I needed to be as gentle and steady as possible and not make any mistakes.

Even though there is good news right now, there is still the possibility of bad news.

This steel bar is across the center of his brain tissue, and the slightest movement could lead to unimaginable consequences.

As the layers of gauze were opened one by one, the family members and interns nearby subconsciously stepped back.

I can understand this reaction.

Such a wound would be shocking to anyone who saw it.

I carefully removed all the gauze, and at this point I could see the patient’s eyeball, and immediately looked at the light reflex.

The left pupil is 5mm, and the light reflex is slow. The right pupil is 4mm, and the light reflex is slow. (A little science: our eyeballs will shrink their pupils synchronously when they are stimulated by light. This reflex can often determine optic nerve damage and central nervous system reactions).

“Can you see my light?” I asked.

“I can’t see clearly, it’s a bit dark…” the patient replied weakly.

“The optic nerve may be damaged.” I said to myself.

The family members nearby came over and asked, “Doctor, can you save him?”

I knew she was asking if she could survive.

In such a scene, what everyone is most concerned about is whether this patient can survive.

I can’t guarantee it.

Because the problems we are going to face next are far more complicated than the seemingly calm situation now.

“This situation is rather complicated. Please come out first so I can talk to you.”

I turned to the patient’s wife and walked towards the conversation room, asking Xiao Ma who was standing by, “What medicines have been given now?”

“The group that stopped bleeding did antibiotic skin tests and tetanus skin tests, nothing else, teacher.”

“Very good, give him another set of sodium valproate intravenous drip. Estimate his weight and give him the maximum dose. If he has a seizure now, it will be really troublesome. Then contact the CT emergency department to do an intracranial CTA (vascular imaging test of the brain).”

After saying that, the patient’s wife and I walked out of the ward and went to the conversation room.

After I had a basic understanding of the condition, I knew the hardest part was coming.

Develop a treatment plan and communicate it quickly with the patient’s family, obtain their consent, and then implement it.

This case today has extremely high risk and unknowns.

I have performed thousands of craniotomies in my ten years of medical practice.

I have always known that for intracranial surgery, life and death on the operating table is often a matter of a split second.

What’s more, the current situation is extremely difficult.

Even though I am extremely anxious, as a doctor, the more I encounter such life-or-death situations, the more I need to be extremely restrained and calm, and to quickly and smoothly advance each of the next steps, so as to give the patient the best possible chance of survival.

In other words, regardless of whether the family members can understand or not, I have to explain to the patient’s family in the most time-saving way possible the several possibilities that may take the patient’s life on the operating table.

“His condition is very difficult. Although he is conscious and his vital signs are stable, there is actually a very dangerous possibility that the steel bar has just luckily avoided some important nerves and blood vessels, or it is also possible that it has only temporarily suppressed the bleeding area.”

I first explained to the family why the patient was conscious and able to speak. After all, many family members of patients are used to questioning the results of the operation by asking, “Why was he fine when he was brought in?”

Seeing the family nod, I went on to explain the risks involved in the operation.

“We need to pull out the steel bar through surgery. This operation is very dangerous. First of all, there is about half a meter of steel bar outside the patient. No matter which side we pull it out directly, we need to put the nearly half-meter long steel bar back into the skull. The steel bar is surrounded by nerves and blood vessels. If it is scratched during the extraction process, or if secondary damage is caused, it is likely to cause the patient to quickly fall into a coma or die…”

After a pause, I continued to explain the postoperative risks.

“In addition, after the steel bars are removed, the patient may suffer from severe bleeding and intracranial infection. Once these two situations occur, they will quickly compress the nearby brain stem tissue and may cause death in an instant…”

“Doctor, you must save him, you must…”

When the patient’s wife heard this, she anxiously interrupted me and burst into tears.

Our department has faced too many life and death situations over the years.

I know that in a hurry, family members may not be able to understand what the doctor explains, but I will still try my best to explain it.

Because only when the patient’s family members understand the facts of the current situation and can calm down and make rational decisions, can our next step of treatment continue legally.

“Don’t worry, I can only make it short at this point. If you believe in us, we will definitely give 100% effort to do our best. However, this location of the steel bar is the first time we have encountered it. The risk of surgery is very high, and there are also great uncertainties in the recovery. I hope you can make a rational judgment. Let’s hope for the best result together, but be prepared for the worst, okay?” I said firmly.

She lowered her head with tears in her eyes. I know everyone is vulnerable and helpless at this time.

After thinking for a few seconds, she raised her head and said to me firmly, “Doctor, we transferred here immediately from the local hospital. We leave everything to you. We trust you. I agree to all treatment plans, and I have no regrets no matter what the result is.”

Looking at the determined eyes filled with tears of the patient’s family members, I know that we must go all out tonight and have a clear conscience no matter what the result is.

“Okay, let’s get ready right away.”

After saying that, I quickly contacted my colleagues in our department, and asked them to prepare for this special operation with me, and at the same time report the situation to the hospital.

Because I know that today is definitely a “big job” that can only be solved by a team.

After the personnel arrived quickly, we divided the work and planned an emergency operation to remove the steel bar. At the same time, the CTA results of the head had come out.

CTA means a lot to us.

Because the first thing we need to confirm through CTA is whether the steel bar has punctured the blood vessel.

In particular, the location where the patient was pierced is right in the internal carotid artery area next to the optic nerve, which is the main artery supplying blood to our skull. If this artery is punctured, then we can basically declare that our efforts today will end in the most tragic way.

I turned on the CTA and carefully observed the position of the steel bars and their relationship to the internal carotid artery.

Thank God!

The closest point of the steel bar to the artery was only 1.5mm.

What kind of luck is this!?

There was no time to rejoice, as the first big problem we had to solve was how to pull out the steel bar.

As I said earlier, we are facing a “dilemma”.

Both ends of the steel bar are about half a meter long, making it difficult to remove on the operating table. Therefore, before going to the operating table, the best option is to cut one end of the steel bar short, the shorter the better. Then, after pulling it out from the long side, the travel distance can be reduced to the shortest, and the damage and risk will be minimized.

But the question is, how to cut a steel bar that is about the thickness of a thumb?

If the steel bar is displaced too much or generates heat during the cutting process, tragedy may occur before it can be pulled out.

At this time, the problem obviously could not be answered in the hospital, so we thought of the firefighters.

The situation was immediately notified to the nearby fire brigade.

Soon a team of firefighters arrived.

The team leader was tall and strong with dark skin.

Without any unnecessary communication, after quickly communicating the situation, the fire captain gave two options.

First, use manual shears at the nearest end of the left steel bar. This can minimize the disturbance caused by shearing, but it may not be able to cut it open. Second, if manual shearing fails, use motorized hydraulic shears. This solution has enough power, but will be accompanied by disturbances and needs to be slightly farther away from the wound side as a backup solution.

The plan was finalized, and the operating room and colleagues had basically completed the preoperative work.

The patient has been sent to the operating room and we will start working right away.

We changed the firefighters into surgical isolation suits, and just as they were about to enter the operating room, a new problem arose.

A hydraulic device about the size of a small suitcase appeared in front of me, along with a strong smell of diesel.

“What is this?” I asked.

“Hydraulic shears, this requires diesel power,” the fire chief replied.

“This…” Although it is extremely urgent now, I am still in a dilemma.

The environment in the operating room is very special. As everyone knows, the operating room is an environment that requires “sterile” operations. In addition to professional equipment and sterile preparation of surgical personnel, the most important thing is the air environment in the operating room, which is “pure” air filtered by strict laminar flow equipment.

However, craniotomy is a surgery that requires the highest level of sterility. This huge diesel equipment and the exhaust gas it produces when working still made us feel at a loss.

Take and give up, these three words come to my mind.

But not every encounter has perfect questions and answers like in a textbook.

At the same time, I looked at the director of anesthesia, Mr. Li Kang, who was standing next to me with a similarly troubled look on his face.

We both looked at each other and almost simultaneously responded in the same way: “Do it!”

For this choice, we must abandon the perfect standard surgical environment and buy time to remove this difficult problem that is inserted into the patient’s vital center.

Without any further hesitation, Teacher Li quickly induced anesthesia in the patient. As the white liquid was injected, the patient’s tense hands gradually relaxed and his breathing slowed down.

“Go to sleep, everything will be fine when you wake up.”

After Mr. Li finished the injection, he inserted a tracheal tube and the ventilator started running rhythmically.

“Everything is stable, anesthesia is successful, you can start.”

After Teacher Li finished speaking, the fire brigade started using manual shears first. The captain and his assistant stood on the left and right respectively. The captain on the left held the manual shears, while the assistant on the right held the end of the steel bar tightly.

“I’ll start cutting. You hold the steel bar steady and don’t move.” The captain carefully increased the force.

My colleagues and I who were standing nearby also tensed up and stared at the cold steel bar.

The motionless steel bar was enough to prove the captain’s rich experience. As beads of sweat flowed down his forehead, only a shallow bite mark was left on the surface of the steel bar.

“No, the steel bar is too thick. I can only use my strength. Even if it were normal, I wouldn’t be able to cut such thick steel bars. I can only use hydraulic shears.”

The mission failed, it seems that diesel guy will have to make some trouble after all.

“Okay, let’s continue to hurry up and shorten the length of one side as much as possible. You can judge based on your experience.” I said.

The fire chief took a quick look and said, “I think if we use hydraulic shears to cut it off from the left side 10cm away from the wound, based on my experience, we can minimize the vibration.”

“Okay, we believe you.”

With a roar, the most unusual sound was heard in the operating room, like the rumble of a small tractor, accompanied by a strong smell of kerosene, which quickly spread.

“Turn on the exhaust system to maximum and close the outer door to create negative pressure and minimize contamination.”

A capable and familiar voice of a middle-aged woman sounded. I turned around and saw that the head nurse of the operating room had arrived. It seemed that this unusual “operation” had caused everyone’s common concern.

The captain held the body of the hydraulic shears firmly. As the scissors gradually closed and pressed against the steel bar, his fine-tuning movements were almost static. The only sound that could be heard in the entire operating room was the rumbling sound of the machine.

Everyone’s eyes were once again focused on the scissors, and suddenly the steel bars seemed to shudder.

“Disconnected!” said the assistant.

There was a commotion and the machine stopped.

The joy in my heart is mixed with uncertainty and worry, which is hard to describe.

I believe that in the eyes of ordinary people, the operation just in those few seconds was almost perfect. It broke quickly and steadily without any delay. However, at the moment when the steel bar broke, a slight vibration that might have been caused by the fracture itself still gave me a twitch in my heart.

It is still unknown whether these tiny vibrations will touch the blood vessels, so even if the first step is completed successfully, no one dares to relax.

Without even having time to express their gratitude, the firefighters quickly packed up their equipment and evacuated the operating room.

Now it’s our turn.

The steel bars on both sides are now shorter on the left and longer on the right.

We need to pull out the steel bar from the right side, so let the patient’s head slightly tilted to the left to make it easier to exert force upwards to pull out the steel bar.

The key is, how to pull it out?

Pull it out directly?

Then the friction force exerted by the broken skull stump, soft tissue and brain tissue on the steel bar, combined with the fact that the internal carotid artery is only 1.5mm away from the steel bar…

It can be imagined that the consequence of direct extraction is that the patient will most likely die from secondary internal carotid artery rupture and bleeding!

So before we “pull out”, we have to “dig” first.

What to dig?

In fact, it is to expand and loosen the soft tissue of the wound and the skull fragments outward, exposing them to the extent that the contact between the brain tissue and the steel bars can be seen, thereby reducing friction to a minimum.

In order to save time, my colleagues and I, four of us, went on stage and divided into two groups. We prepared two sets of craniotomy instruments and worked on both sides at the same time to expose the wound tissue simultaneously.

After the steel bars and the skin in the surgical area were thoroughly disinfected and covered with a drape, although the tissue in the exposed surgical area could be seen, the protruding steel bars still looked so eye-catching.

As the word of this “special” event spread quietly, I glanced over and found that without my noticing, the operating room viewing area was already filled with people.

Colleagues all understood that the most difficult part of this operation, which was the next decisive point in the patient’s life or death, was about to come.

The pressure was so great that I didn’t have time to think too much. My assistant Xiao Ma and I were separating the skin, soft tissue, and skull around the steel bars step by step…

“Upper skull drill,” I said.

The nurse skillfully handed the instrument to me. I held the drill bit and drilled a hole with a radius of about 3 cm centered on the steel bar. Then I used a craniotomy cutter to start cutting the bone in a circular shape along the bone hole. We call it a “bone flap.”

Due to the particularity of cranial surgery, important brain tissue cannot withstand excessive displacement and traction under any circumstances, so our neurosurgery surgical field of view is a “conical field of view”.

This is how craniotomy is often performed.

We need to design a relatively enlarged circular cavity centered on the lesion on the skull to increase the flexibility of surgical exposure.

The milling cutter stopped and the bone flap was gently removed.

You can see where the steel bars and the meninges were pierced, neatly and clearly.

This indicates that the steel bars penetrated at a very high speed, so the possibility of radial damage was small.

It’s good news!

Continue to cut open the dura mater, and what is exposed before our eyes is the pulsating brain tissue. The brain works quietly in the cerebrospinal fluid, dancing gently with the beating of the pulse. The joys and sorrows of each of our lives rise and fall in this quiet dance.

With my mind highly focused, I saw the location of the steel bar, pierced the temporal lobe, and went deeper.

The direction was consistent with the preoperative positioning, and the steel bar just passed between the optic nerve and the internal carotid artery.

However, the specific damage needs further exploration.

“Put on the microscope,” I said.

At this time, it is the turn of our neurosurgery eye – the “neurosurgical operating microscope” to start working.

Under the guidance of the microscope, we separated and explored the interface between the steel bars and brain tissue little by little.

40 minutes passed.

These 40 minutes are almost the limit for bilateral craniotomy.

However, compared to the remaining battles, everything has just begun.

“Anesthesiologist, please pay attention to the blood pressure and control it at around 100/60 mmHg. Deepen the anesthesia,” I said.

After 40 minutes, the effectiveness of the anesthetic has greatly decreased and a second round of anesthesia must be given immediately.

Controlling the depth of anesthesia and stabilizing blood pressure during surgery are the key to ensuring long-term surgery.

With the superficial brain tissue of the temporal lobe well separated, I confirmed one good news and one bad news.

The good news is that the steel bar avoided a nearby main artery in the superficial brain tissue, and even the middle cerebral artery (one of the most important branches supplying blood circulation to the cerebral hemispheres), and the main trunk area was not damaged.

The bad news is that the tiny branches right next to it are not so lucky.

Abrasions and ruptures of small branch blood vessels are inevitable during the entire process.

However, in order to ensure the “safe evacuation” of the steel bars later, these broken small blood vessels must be “solidified”.

In surgical operations, hemostasis is the most basic and important operation.

Ligation with thread is the most commonly used method of stopping bleeding.

However, in neurosurgery, any knot tying is not allowed during intracranial operations.

In order to reduce the stimulation of foreign bodies on brain tissue, we often use bipolar electrocoagulation, which can briefly discharge and heat within a range of about 1mm to “coagulate” the tiny blood vessels and thus stop bleeding.

More than an hour passed slowly. In the operating room, apart from the ticking sounds of various instruments, the only sounds were the low whispers of colleagues cooperating with each other.

After anatomical separation, we can gradually see the blood vessels and nerves deep in the brain tissue.

At this moment, a piece of coagulated blood put our operation into trouble again.

This clot of blood should be left behind when the steel bar passed through.

But at this time, the gaps in the depths no longer allow us to attack deeper.

Our funnel-shaped field of vision has reached its limit, and the complex and fragile vascular and neural network does not allow excessive traction and separation.

We had a brief summary and discussion on the current situation.

“The steel bar currently appears to be in the middle and shallow layers of brain tissue and has not damaged the main blood vessels. This is good news.”

“Yes, but this blood clot…if we remove it hastily, what if it seals the damaged artery? Then…”

“Then there will be massive bleeding. Given the patient’s current condition, even if we quickly perform shock resuscitation, the chances of saving him are slim.”

……

After repeated consideration, we made the most important decision at the last moment – by slightly rotating the steel bar in situ and observing under a microscope whether the blood clot is loose and there is fresh bleeding, we can indirectly determine whether the internal carotid artery is damaged.

However, this step requires us to prepare for the worst.

The worst-case scenario is that the internal carotid artery has actually been punctured.

Why do I speculate this?

Because of the presence of this blood clot, there is a possibility of extreme danger.

That is, the blood clot only temporarily blocks the carotid artery, which may have already ruptured, so everything looks calm for now.

If this speculation is true, then after turning the steel bar, the blood clot will be moved, which means that the “Band-Aid” on the ruptured carotid artery has been removed. At this time, our only way is to quickly close the blood vessel with an artery clamp.

But the difficulty of this matter lies in the fact that although the blood vessels can be sutured, the difficulty of bilateral bleeding and suturing will make the suturing time unpredictable.

Once the blockage time exceeds 10 minutes, the cerebral infarction caused by the “cut-off” of blood supply to the patient’s brain tissue will be permanently irreversible.

Then after the operation, the possibility of either direct death or vegetative state (vegetative state) is extremely high.

Therefore, at this moment, turning this steel bar becomes the key point in determining the patient’s fate.

I gently held the broken end on the left side, and my colleague pinched one side of the steel bar on the other side, ready to exert force.

“Anesthesia teacher, get ready!”

“Everything is stable, get ready!” Master Ma responded.

I looked up at my colleague and said, “Turn!”

I could feel the force of my colleague’s rotation as I gently grasped the steel bar. As the steel bar loosened a little bit, our hearts were in our throats.

“Slow! Slow! Slow!”

Almost at the same time, we all shouted out involuntarily, feeling the rotation while staring at the blood clot deep inside.

“It seems to be moving.” I saw the blood clot loosened. “There is a little bleeding on the left side. Is the right side okay?”

“The right side is fine!” the colleague replied cautiously.

“Minor bleeding, no ruptured artery!”

I looked up at my colleague and the tension on my face eased a little.

Great! A simple test of slightly rotating the steel bar verified a very important piece of information – the blood clot temporarily blocked the artery and it was not ruptured at all.

“Let’s do that!”

“pull!”

After confirming with my eyes, without any hesitation, I firmly grasped one side of the steel bar and used the suction device to prepare for the possible blood clots.

I slowly applied force and watched the steel bar that had been lying in the patient’s skull for several hours slowly disappear from sight. I finally saw hope for the patient’s survival.

As the steel bars were detached, we quickly used a microscope to look deeper, holding our breath and closely scanning this hard-earned “battlefield”.

“The internal carotid artery is pulsating, strong and normal!”

At this moment, there was a sudden commotion and applause from the viewing room behind me. I then realized that my colleagues and interns behind me had been standing quietly and “watching” for a long time…

Yes, coming here for surgery can be said to have passed the most important and also the most dangerous moment of life and death.

Looking back on how long and worthwhile our efforts were for this short operation…

“The operation was successful, don’t worry.”

Although I was a little tired and had just left the operating room, I still said this as usual.

This sentence brought up a scene that I have seen over and over again in my many years of medical practice, and I never get tired of it—the patient’s family rubbed their hands together and cried with joy, almost collapsing on the ground, muttering, “Thank you, doctor! Thank you, doctor! God bless you, God bless you!”

I nodded and helped the patient’s family member up, but my heart was still heavy.

I never dare to express a sense of relief and triumph after an operation, let alone the joy and complete relaxation.

Many people say that doctors who perform surgery look particularly cold-blooded.

But what I want to say is that if the doctor on the operating table is not calm beyond ordinary people in the face of life and death, then any surgical action is likely to lead to a tragedy.

On the first day I entered neurosurgery, my mentor said something to me calmly.

“A qualified neurosurgeon must be bold and careful.”

On the operating table, emergencies occur one after another, and there is never a perfect plan.

Only by considering all aspects and putting all our efforts into action can we have a clear conscience and turn every bit of “luck” into a chance to survive. This is the “sharp blade” that we neurosurgeons should pursue to cut through all obstacles.

Moreover, I have an inevitable follow-up concern for this patient.

If the intracranial contusion and edema after the operation do not recover well, the life that has been saved from the brink of death may fall into a new predicament.

After the operation, the patient was observed in the ICU for about two weeks. After all indicators were stable, he was transferred to the general ward.

After staying in the general ward for 1 month, he met the discharge criteria.

All basic functions have returned to normal, including normal speech and walking out of bed.

But, one question still remains.

When he was discharged from the hospital, the patient’s vision in both eyes was much worse than before. He could see light and fuzzy shadows, but nothing else was clear.

Because, although the steel bar did not damage his internal carotid artery, it damaged the optic chiasm of the optic nerve near the internal carotid artery.

This shows that the optic nerve is not broken, but there is some contusion and edema.

So during the follow-up checkups, I was always very concerned about his vision recovery.

Fortunately, the patient’s condition improved each time after three follow-up examinations.

The first time I came, I had to be accompanied by a family member because my eyesight was still not very good. I could see the words clearly when I was quiet.

The second time, the patient came alone without any family members accompanying him, and his eyesight improved dramatically.

By the third time, my vision had generally returned to normal.

His experience is not only a medical miracle that we marvel at, but also a great fortune for him to have survived the disaster.

He experienced several life-and-death reversals on the operating table, and smoothly resolved all the risks of post-operative complications one by one.

After going through eighty-one tribulations, the only thing left was a scar, and everything else was normal.

Only then did I finally let go of the string in my heart that had been tense from the beginning.

On a night of duty, I walked out of the hospital building.

Under the hazy outline of the distant mountains, there are dots of starlight above.

At the foot of the mountain, right next to our hospital, is a large construction site. I didn’t pay much attention to it in the past. The tower crane had stopped working long ago, but there were still lights and slight sounds of night work on the site. Those sounds, which were a bit disturbing in the past, now sounded a little peaceful.

Doctor Jin’s science time:

Theory – Cranial brain protection structure

The human brain has three physical barriers: scalp, skull, and cerebrospinal fluid.

The scalp can absorb most of the light blows from blunt objects, while the skull is very tough and has a spherical shape. The toughness comes from the double-layer bone of the skull, with a mesh of bone sandwiched between the inner and outer plates, similar to the laminate flooring in life, which is the mainstay of the skull and brain to resist various strong external forces. The cerebrospinal fluid is the “water” in the internal cavity of the skull, which is ubiquitous and fills the space between the soft brain tissue and the hard skull, playing a role in buffering and shock absorption. Under the joint protection of the three, the skull and brain will not be easily injured.

Safety – Tips for self-rescue and rescue

Be sure to wear a safety helmet when going to a construction site. In rare events, a safety helmet can really save your life.

If you encounter a similar situation as this case, do not blindly move the patient or remove the foreign body by yourself. Call 120 in time and wait for professionals to arrive.