Arriving to the board with a positive attitude hoping it will glide me into a great day at work. Doing breaks, and have great rooms. I have settled into my groove at this assignment and figured out how to get along with all the dynamic personalities I have run into. I am in the middle of my breaks when I get a call from charge, we are pulling you from breaks to help setup a emergency Craniotomy. I take it in stride and report to the board to figure out which room assignment we are using.
Going in room 12, I go to the room and assess the equipment in the room. Ensuring we will have the proper bed, supplies necessary to get the case started. Grabbing a friend to assist in retrieving some of the items needed to pin the head into the Mayfield. I begin to look through the chart to see if I can gain any insight into their history to prepare myself better. When I see she is only 18 years old, only medical history is headaches. All bloodwork is normal, no other concerning factors. I become immediately sullen with fears of my emotional state in caring for a child.
The patient quickly gets into the room, already intubated from the ER, and we transfer her onto the operating room table. As the neurosurgeon walks in Dr. R you can see the urgency in his eyes, as he and his PA begin to place xeroform in the patients ears, and apply the Mayfield, pinning the patients head in the optimum position to gain access to where he needs it. They begin shaving her head, as clumps of hair drop to the ground I think of the girls feminine security being removed, a potential comfort for her, as I love to play and braid hair I begin to mesh emotionally with the state of this child.
We turn the bed, and doctor begins to scrub in at the sink. Foley catheter placed, A-line started, IV access gain for anesthesia comfort. Surgeon walks in and he is gowned and gloved by the scrub, as I approach to tie him up, I can feel the heaviness in his aura. I wonder at that moment how hard it would be to be a doctor. Especially a neurosurgeon where a lot of outcomes can be so incredibly tragic. The weight of a child’s life in your hands, and no matter the skill set you have, being unable to change the outcome. One wrong move with an instrument could wipe away a part of this person they were never willing to lose.
As he approaches the bed with his PA, he makes incision and begins to remove the bone flap. As he feverishly dissects to find where the bleeding is coming from. No one in the room is talking or even breathing loudly, as we all know the seriousness of this situation. It appears this young lady had an arterial venous malformation that had ruptured. The volume and pace of him asking for instruments is increasing as he makes requests from the scrub for things. This scrub is moving through her setup like ballerina on stage, knowing every move and passing flawlessly to assist the surgeon in all attempts to save this young girls life. Dr. R is struggling; he cannot gain access to properly stop the bleeding.
He stops, and states “lets go to the cath lab”, and everyone in the room was shocked. We had not anticipated this, he wants to attempt to gain access in her femoral artery to try to band off the bleeder in the cath lab. He places an ioban over her open skill, and everyone begins to scramble to notify charge and cath lab of the plan. Young girl is whisked off to the cath lab as a last stitch effort to save her life. I commend Dr. R in that moment, instead of admitting defeat, he is giving all his efforts to attempt to save this young woman.
I am relieved at that point as the patient is whisked off to the cath lab, and she will eventually return after he attempts intra-arterial access. When she returns her bone flap was left off to allow any swelling post operatively to not compress other areas of her brain. She is closed and sent upstairs to the ICU. My drive home that night I was full of thoughts, full of wonders of how this young girl was doing, how were her parents doing, how was Dr. R doing?
Arriving back to work two days later I noticed the same name on the board, the same patient, and I wondered if they were putting the bone flap back on, but seemed much to soon. I inquired about the case, and was told it was actually going to be me doing it, and it was an organ harvesting, that she was brain dead. I took another deep breath, wondering how her family was doing, feeling the depths of emotions crushing my inner soul. Thinking of myself being worried about her hair, hoping she would be okay enough to one day braid it, dye it, to just be alive.
Beginning to setup the organ harvesting case I did something I typically avoid, I began reading the chart to learn more about this girl. Reading about how she was a young healthy girl who was adopted and had a bad relationship with adopted family and was homeless at the time of her headache. She was following a doctor for migraines, and she was advised to get a head CT that day, and went to a outpatient CT center where it was discovered she had a brain bleed. She had no family, struggling every day to get by I’m sure, was given up at birth I’m sure to have a better life, and here it ends.
Was this girl destined for a tragic life at birth? Was this the predetermined end that she never knew she had? I am sure she struggled with being adopted, going through those feelings of being given away. I pray she had good moments in her 18 years, I pray that her death was peace for her, while no one would choose that end for their child, I hope she had joy in her short time on earth. She gave life to someone else, she gave her organs to save someone, just as I hope that is what her birth mother did for her. I hope her soul is at peace as I continue to struggle with the idea that bad things do happen to good people.