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A Nerve-Racking Moment
Finally, with the window successfully created, Bergin looked in on the dura -- the tough, fibrous membrane that wraps the brain. Relief filled him. He had drilled directly above the clot. They would be able to remove it through this aperture.Now the neurosurgeon directed Bergin as he and his team began to remove pieces of clotted blood. Using forceps and suction, they scooped the mass from the hole, but as the clotted blood came free, Bergin's nerves tightened. "There's fresh arterial blood," he told VanSickle.
Because more of the heart's pumping force is behind it, an arterial bleed applies greater pressure on the brain and it can be harder to stop. It was a nerve-racking moment. Yet, in calm voices, the two doctors conferred on a plan of action. To slow the leak, Bergin selected a common adhesive sponge called Gelfoam.
"Use it," VanSickle told him. They both hoped it would work.
Taking small forceps, about the size of eyebrow tweezers, Bergin inserted the sponge into the area and pushed it against the pulsing artery. He held pressure on the ruptured vessel, and hoped the sponge would adhere and seal the leak.
After a few moments, Bergin carefully relieved pressure, watching the point where the sponge was lodged. "The flow is slowing," he said.
"Tell me what the dura looks like," VanSickle asked. The dura's appearance would indicate what was happening to the brain. The brain's covering, VanSickle explained, should be lax, not tense and under pressure, not bulging like a balloon somewhere.
Bergin looked at the dura. It pulsated regularly, appearing soft and relaxed.
"That's a good sign," VanSickle responded. The pulsating meant blood and oxygen were entering the brain. The soft, lax appearance meant pressure had been alleviated. Bergin's efforts seemed to be working.
There was still the long flight to Denver. Worried that jostling during the flight might restart the bleeding, VanSickle advised Bergin to insert a drain through a separate incision in the scalp near where the clot had been. If the sponge patch broke, the drain would give the medical crew a way to draw blood to prevent another hemorrhage.
Working carefully, Bergin positioned the drain. Forty minutes after he first entered Carter's skull, he closed the incision and prepared the boy for transport. Only minutes after Bergin finished, the Denver plane touched down in Sidney, and an ambulance took Carter to the airport.
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