Althouse: I'm going to have to use a household drill to make a hole in your boy's skull.

May 20, 2009

I'm going to have to use a household drill to make a hole in your boy's skull.

Said the country doctor, who'd never attempted such an operation before but was following the directions of the neurosurgeon on the telephone.

Blood clots liberated, the boy was saved.

30 comments:

Bissage said...: Twist, spade or auger bit?; 5/20/09, 12:32 PM
Hoosier Daddy said...: I heard the surgeon was Bob Villa's cousin.; 5/20/09, 12:40 PM
veni vidi vici said...: stories like this one refresh my faith in fellow man.

stories like the one yesterday featuring the quote of a 4-year old boy, "My daddy ate my eyes", no.

More of the former, less of the latter, please. (not at this blog per se, but rather in humanity generally); 5/20/09, 12:45 PM
Ann Althouse said...: @veni Oh, man, I'd missed that one.... Hard to imagine something worse than that...; 5/20/09, 12:52 PM
save_the_rustbelt said...: In my construction days I saw more than one hardhat release pressure on a crushed fingernail by drilling the nail with a power drill. Yikes.

Having purchased instruments for surgeons, the basic instruments for ortho and neuro surgery look a a lot like the tool section at True Value, shinier and more expensive though.

My favorite surgical instrument is a 24" bolt cutter, used by orthopedic surgeons to removed old hardware that has been calcified in place. It is sterilized, of course.; 5/20/09, 12:58 PM
Kylos said...: Bissage, I'm guessing twist. I sure hope they wouldn't need a hole big enough to be made by either a spade or auger bit.; 5/20/09, 1:05 PM
Greg Hlatky said...: I heard the surgeon was Bob Villa's cousin.

"On this episode of 'This Old Head'..."; 5/20/09, 1:15 PM
traditionalguy said...: So Natasha Richardson could be alive today with a household drill and the guts to use it.; 5/20/09, 1:58 PM
rhhardin said...: I expect that there will be more warning labels on power drills now.; 5/20/09, 2:18 PM
bearbee said...: Australia's universal health system needs to boost spending on Black & Decker equipment.; 5/20/09, 3:03 PM
Ron said...: So did he fix the hole with duct tape or bondo?; 5/20/09, 3:05 PM
john said...: Over a 20 year span, Doc Adams had reportedly removed more than 500 bullets from Matt Dillon's right shoulder. With little more than a bottle of whisky, a rusty scalpel, a hankerchief sling, and another bullet to bite on, old Doc had Dillon up and shooting again, usually within a half hour.; 5/20/09, 3:32 PM
John Bono said...: I'm reading a great new book on this very subject: "Medicine the Billy Mays Way."

Ch 1)Surgery prep the OxyClean Way,
Ch 2)Sucking Chest Wounds--Mighty Putty, Mighty Mendit?
Ch 3)Awesome Auger Liposuction
Ch 4)Zorbeeze those weeping pustules!
Ch 5)Kill Cancer with Kaboom Chemo!; 5/20/09, 3:36 PM
KCFleming said...: That surgeon had balls.

He said "It's not a personal achievement, it is just a part of the job."

That's what heroes always say.; 5/20/09, 4:14 PM
Cedarford said...: "Ron said...
So did he fix the hole with duct tape or bondo?"

Duct tape works on everything..from medical needs to female captives in your car trunk...

But my guess would be a piece of sterilized tin can cut with tin snips or a miracle ginsu knife that never dulls. And held in place with crazy glue.

Crazy glue. Now the fad amongst poor working people lacking health insurance, but not illegals or welfare mammas qualifying for charity care -to fill their own famaily's cavities with. Of course those that oppose universal care will say that it is a "motivator" to try and get a good government job safe from loss to China - that offers health insurance for making people wait hours in your little bureaucracy to be seen...

Why be a logger, a farmer, or store clerk with no health care when you can be a Motor vehicles clerk?
====================
"traditionalguy said...
So Natasha Richardson could be alive today with a household drill and the guts to use it."

Technically, you are right.

The bitch is the diagnosis.

Most fatal bacterial meningitis cases would be cured with 20 bucks worth of antibiotics if people could afford a doctor's visit, or the doctor managed to get the right diagnosis...; 5/20/09, 4:21 PM
Anthony said...: It's referred to as trepanation, trephination, trepanning, etc. Quite an old practice, as trepanned skulls have been found from several thousand years BC, many of which showed bone growth indicating survival for some period of time afterwards.; 5/20/09, 4:58 PM
KCFleming said...: "Most fatal bacterial meningitis cases would be..."

Most?!
Citation?

Clinical Features and Prognostic Factors in Adults with Bacterial Meningitis.
N Engl J Med 2005;352(9):950.

"The annual incidence of community-acquired bacterial meningitis was 2.6 cases per 100,000 adults.

The mortality rate was 21 percent and varied depending on the causative organism; it was 30 percent for pneumococcal meningitis, as compared with 7 percent for meningococcal meningitis and 20 percent for meningitis due to other pathogens (P=0.05).

Community-acquired bacterial meningitis has a high rate of an unfavorable outcome in adults (34 percent). Our multivariate model identified several unfavorable prognostic factors, most of which pointed to systemic compromise. A low level of consciousness on admission was predictive of an unfavorable outcome, as was a low cerebrospinal fluid white-cell count. Finally, factors predictive of pneumococcal infection were associated with an unfavorable outcome (advanced age; presence of otitis or sinusitis, pneumonia, or immunocompromised status; and absence of rash).

Prompt use of dexamethasone and appropriate antibiotics, together with optimal supportive care, can further reduce the mortality and morbidity associated with bacterial meningitis. Most risk factors for an unfavorable outcome that we identified indicated the presence of systemic compromise, a low level of consciousness, and infection with S. pneumoniae. Therefore, aggressive supportive care of patients with bacterial meningitis and systemic complications, preferably in specialized care units, is needed."; 5/20/09, 5:01 PM
KCFleming said...: "cured with 20 bucks worth of antibiotics if people could afford a doctor's visit"

A 2002 study from the Netherlands said that for the annual 1,125 cases of children presenting with meningeal signs, 20% prove to have actual bacterial meningitis.

They estimated that each case (diagnosis and treatment) costs about $6,527 euros, or about $6000 US then.; 5/20/09, 5:12 PM
Palladian said...: This comment has been removed by the author.; 5/20/09, 6:08 PM
Palladian said...: This comment has been removed by the author.; 5/20/09, 6:08 PM
Palladian said...: Fuck off, Pogo. Enough with your Jew doctoring!; 5/20/09, 6:09 PM
Anonymous said...: They didn't have a drill? That seems odd. Government health care?; 5/20/09, 6:28 PM
Penny said...: Pogo is dead right on this one. This doctor is a TRUE hero.

He didn't let the ghost of a future lawsuit get in his way when he flat out decided to do the best with what he had.

Can you imagine the mess for him if this hadn't worked? The same parents who are now forever grateful might have been the parents who force his leaving medicine because the cost of his liability insurance just went behind the moon. Their friends would be signing and forwarding on-line petitions so that said parents can move forward to demand a state law that would prohibit doctors from using "previously unspecified tools" in a hospital setting. Toolmakers would need to add an additional warning label....and on and on and on.

But hey! I'm just glad that rich, mf doctor got what was coming to him!; 5/20/09, 7:13 PM
Anonymous said...: Cedarford, crazy glue is also an excellent way to close those cuts you get on your fingers when you are chopping carrots and don't want to use a bandaid because the bandaid gets too much in the way.; 5/20/09, 8:11 PM
Anonymous said...: Penny, I believe that's, "etcetera, etcetera, etcetera."; 5/20/09, 9:41 PM
Penny said...: Precisely, Ted.; 5/20/09, 10:03 PM
NotWhoIUsedtoBe said...: At least he wasn't bored to death.; 5/20/09, 10:17 PM
Penny said...: That was my point exactly, JL. Or should I have said that was precisely my point?

Ted? What do you think?; 5/20/09, 10:23 PM
Anonymous said...: Tell you what, Penny. You call me "Ted," and I'll call you "Gene."; 5/20/09, 11:59 PM
James said...: Here's a quotation from the original novel of M*A*S*H, (1968). Duke Forrest, wielding the chisel, is actually a urologist.

"Trapper John looked at the note and then at the boy. He looked in his eyes. The right pupil was dilated and fixed. His pulse was slow, his blood pressure negligible.

"I'm afraid this one has an epidural hematoma," he said. "Duke, haven't you been that route a little?"

"Yeah," Duke said, "but not enough to be a pro."

"You're a pro now," Trapper said.

Duke quickly examined the patient. He found indications of pressure on the brain from blood accumulating between the skull and the outer brain lining.

"Right now," he ordered, "lug this one into the OR."

The Duke ran ahead of the stretcher. In the OR he encountered, fortunately, the boss, chief, honcho, leader and head coach of the operating room nurses, Captain Bridget McCarthy of Boston, Massachusetts.

"Quick, Knocko," he commanded, "y'all get me gloves, knife, hammer, chisel, Gelfoam and a drain."

Captain Bridget McCarthy was maybe thirty-five years old, five feet eight inches of solid maple, and she did not ordinarily tolerate much lip from the Swampmen or her immediate superior, Major Hot Lips Houlihan, either. This last endeared her to the Swampmen who did not call her "Knocko" for nothing, for they knew she could take out any one of them in a head-on. More than anything, however, she was also a nurse who had come specifically to be a nurse, so when Duke gave orders with fire in his eye she asked no questions and said, "Yes, sir."

The right temporal area was quickly shaved and scrubbed, and Duke incised down to the bone. He had no desire to go through the skull with a hammer and chisel, but he also had no choice. The appropriate drills for making burr holes were at the 6073rd with the neurosurgeons, so he did the best he could. With luck, or skill born of need, he cracked a jagged hole in the skull in less than a minute. As he broke through, blood flowed out in a torrent. The torrent quickly diminished to a dribble and then Duke exercised highly commendable surgical wisdom. The wise surgeon, particularly when out of his field, knows when to quit, so Duke refrained from looking for hemorrhage beneath the dura mater. He settled for the drainage of the epidural hemorrhage, and the pressure on the brain was relieved. He stuffed Gelfoam down toward the bleeding site, put in a rubber drain, closed the skin with silk sutures, and the soldier began to stir and moan. As his breathing improved and his pulse picked up, the Duke spake the words that, if they ever name a medical school after him, may be carved in stone over the entrance to the administration building:

"He might make it, even if all I really did was hit him in the head with an axe."; 5/21/09, 8:10 AM