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Frontier Medicine
In a room a hundred yards away, Dr. Edward P. Bergin was unaware of the battle to save Carter being fought in the ER. He was preparing for his first scheduled surgery of the morning, a routine gallbladder operation. A scrubbed staff and a fully prepared operating table were waiting for him.Just then a phone rang. It was Pierce calling from the ER. He had a critically ill patient. He wanted to know if Bergin could drill burr holes in the skull of a three-year-old boy.
Bergin felt himself tighten up. As a general surgeon he was the "turn-to guy," the doctor they called when other doctors needed something done beyond their realm of expertise; but this was a request for brain surgery, an area in which he had limited training -- and no neurosurgical tools on hand. Bergin also knew if Pierce was asking him, he was the only option left.
He hung up the phone and looked at his crew. Brain surgery was novel for them as well. But with no alternatives, you fall back on frontier medicine. You improvise; you do what is needed. Telling the anesthetist to hold the gallbladder patient, Bergin, in his teal-colored scrubs, hurried to the ER.
When he pulled back the curtains to the emergency room bay, Bergin saw a child who had regressed into flexor posturing -- arms bent inward, hands clenched into fists -- a sign of severe brain injury. Nurses were still bagging air into his lungs. The main thing Carter had going was his youth -- and strong little heart.
Bergin looked at the parents. "I'm sorry," he said, "but I have to try and do something or your son's not going to make it."
The Engstroms put themselves and their son in his hands.
Back in the brilliantly lit, tiled operating room, Bergin scrambled his team to gather an array of tools and prepare the boy for emergency surgery. As he rescrubbed, he searched his memory for anything he'd ever read about this operation. Then he made a quick decision. He'd call for help. He asked the staff to find a neurosurgeon somewhere, anywhere, who could walk him through the procedure. He'd use a speakerphone in the operating room.
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