When God perched on my hands..............
The situation was truly grim and I was feeling completely helpless. These kind of situations are not totally unfamiliar to a surgeon, but with time, their frequency significantly diminishes.
I was deep under the jaw bone of the patient, just beside the carotid artery on one side, the trachea, oesophagus on the other, the cervico medullary spinal cord just a couple of millimeters below. I was attempting to fix the facet joints of the Atlanto axial joints by placing screws across the joints. The patient was a young guy,20 years and was almost paralyzed below the neck. He had sustained a fall and had lost power in all his limbs. He could not move his fingers, and had difficulty in breathing too. Xrays,CT scan and MRI confirmed the worst fears.
The higher cervical cord was squeezed and compressed greatly, by the marauding dens, the tooth like projection of the second cervical vertebra. The injury had snapped the ligament that holds the dens, and it tilted backwards and migrated upwards to compress the cervical cord.
The father had met me in the opd with tears in his eyes. It was his only child.
I assured him that I will do my best.
And here i was in a situation, that I thought I will never be able to salvage. I had exposed the facet joints, and whilst attempting to drill the joints, the fragile articular process gave way. There was no way, I could place the screws across the joints. The required trajectory was not possible as the lip of the facet was chippedb in my attempts to drill. A big road block. An ominous silence gripped the theater, like a pall of gloom. I could hear myself breathing, and my movements became purposeless. I just kept my instruments down, and sat down for a while. I need to devise a plan B, and quickly.
In these moments, one experiences the most profound sense of solitude, isolation and helplessness. I am all alone. My assistants look up to my sullen face with a sense of expectation. I know when I'm beaten. But I can't have the luxury of revealing my own fragility, and vulnerability.
I utter a silent prayer in all earnest.
I summon the last few drops of courage and hope, and get back to my feet.
I remove the packs that are placed in the incision. There had to be a solution.
I take a deep breath, and then, the next 45 minutes, I surrender to the Lord. I decide to fix the joints using plates and screws.
I really have no recollection of the exact sequence of events. I remember asking for the drill, choosing a point on the exposed bony facet, that was just about a centimeter in diameter, and then pressed the foot pad steading my hand. The whirr of the drill, the 3 seconds of feeling the drill beat violating the bone, and then off comes my foot. I felt a calmness spreading through my body, a stillness. My hands were powering on, and I watched then under the microscope. I didn't feel them connected to my body. I was a spectator, marveling at their fine controlled movements. I heard a voice asking for the 2 holed plates, and saw the gloved fingers placing the plates on either side. Then the screws were positioned and tightened.
Next thing, I saw was the:C arm images that confirmed adequate reduction and fixation of the joints.
I moved the microscope away. I looked at my hands and was glad to see them firmly glued to my own body.
They were possessed by a power divine. That's all I could conclude.
The patient now was moving his fingers with a smile on his face, the only testimony of the divine intervention.
The situation was truly grim and I was feeling completely helpless. These kind of situations are not totally unfamiliar to a surgeon, but with time, their frequency significantly diminishes.
I was deep under the jaw bone of the patient, just beside the carotid artery on one side, the trachea, oesophagus on the other, the cervico medullary spinal cord just a couple of millimeters below. I was attempting to fix the facet joints of the Atlanto axial joints by placing screws across the joints. The patient was a young guy,20 years and was almost paralyzed below the neck. He had sustained a fall and had lost power in all his limbs. He could not move his fingers, and had difficulty in breathing too. Xrays,CT scan and MRI confirmed the worst fears.
The higher cervical cord was squeezed and compressed greatly, by the marauding dens, the tooth like projection of the second cervical vertebra. The injury had snapped the ligament that holds the dens, and it tilted backwards and migrated upwards to compress the cervical cord.
The father had met me in the opd with tears in his eyes. It was his only child.
I assured him that I will do my best.
And here i was in a situation, that I thought I will never be able to salvage. I had exposed the facet joints, and whilst attempting to drill the joints, the fragile articular process gave way. There was no way, I could place the screws across the joints. The required trajectory was not possible as the lip of the facet was chippedb in my attempts to drill. A big road block. An ominous silence gripped the theater, like a pall of gloom. I could hear myself breathing, and my movements became purposeless. I just kept my instruments down, and sat down for a while. I need to devise a plan B, and quickly.
In these moments, one experiences the most profound sense of solitude, isolation and helplessness. I am all alone. My assistants look up to my sullen face with a sense of expectation. I know when I'm beaten. But I can't have the luxury of revealing my own fragility, and vulnerability.
I utter a silent prayer in all earnest.
I summon the last few drops of courage and hope, and get back to my feet.
I remove the packs that are placed in the incision. There had to be a solution.
I take a deep breath, and then, the next 45 minutes, I surrender to the Lord. I decide to fix the joints using plates and screws.
I really have no recollection of the exact sequence of events. I remember asking for the drill, choosing a point on the exposed bony facet, that was just about a centimeter in diameter, and then pressed the foot pad steading my hand. The whirr of the drill, the 3 seconds of feeling the drill beat violating the bone, and then off comes my foot. I felt a calmness spreading through my body, a stillness. My hands were powering on, and I watched then under the microscope. I didn't feel them connected to my body. I was a spectator, marveling at their fine controlled movements. I heard a voice asking for the 2 holed plates, and saw the gloved fingers placing the plates on either side. Then the screws were positioned and tightened.
Next thing, I saw was the:C arm images that confirmed adequate reduction and fixation of the joints.
I moved the microscope away. I looked at my hands and was glad to see them firmly glued to my own body.
They were possessed by a power divine. That's all I could conclude.
The patient now was moving his fingers with a smile on his face, the only testimony of the divine intervention.
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