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A Long-Distance Guide
Neurosurgeon David VanSickle was assisting in an operation at the Children's Hospital in Denver when his pager went off. From the description, he realized how desperate the doctor's patient was. VanSickle agreed to help. Leaving the primary neurosurgeon to finish the surgery, he found a quiet spot, clear of distractions, and prepared to guide Bergin's hands long-distance.The speakerphone was on the wall of the OR not far from the operating table. Listening to the spectral voice that issued from it, Bergin began. First, cutting through skin and muscle tissue on the shaved left side of Carter's head, he exposed the skull and prepared to enter the delicate world inside. Guided by the CT scan and VanSickle's advice, Bergin estimated the clot's location by measuring with the width of his fingers. But he could not be certain until the holes were drilled.
Hospitals equipped for neurosurgery have specially designed instruments, some with drills fitted with footplates and guards to prevent penetrating the dura and the brain. Bergin would be working with a standard orthopedic drill, an electrically powered stainless steel apparatus about the size of a hair dryer used more frequently on bone spurs and shoulders than skulls. He had to be careful not to go too deep and risk irreparable damage or death.
The moment had come, however. Bergin took the drill and bored into the bone. His goal was to cut two one-centimeter-wide holes, and then check his position with the clot. With only his sight and the feel of the drill in his hands, he needed to go just far enough to pass through the skull without puncturing the dura, and not a millimeter more.
It took five minutes to drill two vertical holes above Carter's ear. The crucial step was done.
VanSickle then instructed Bergin to cut the bone between each hole, connecting them like a connect-the-dots puzzle. This would create a two-centimeter-wide window between the holes and allow Bergin to look inside the skull, find the hemorrhaged clot and remove it. If things worked well, they would be near the clot's location. If not, he would have to drill new holes until he found the hemorrhage.
Bergin looked at his tools. He had nothing that would allow him to cut through the bone while protecting the brain beneath. Forced to improvise again, he selected an instrument used to file bone spurs and carefully sawed away the bone between each hole.
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