Prisoner in Time (Time travel) (9 page)

“Oh Shit! Suction,” Dr. Warner called out in frantic tone.

As Dr. Fullerton moved the wand in to draw up the small reservoir of blood, Dr. Warner grabbed strips of cotton batting and held it around the burr hole. As one saturated, he added another.

“His brain’s under intense pressure,” Dr. Fullerton observed.

“How’re his sats?” Dr. Warner asked, his voice sounding harried.

“Still dropping, doctor. BP’s seventy-two over thirty-four, pulse is thirty-two, pulse ox seventy,” anesthesiologist Dr. Johnson shot back quickly.

“Hang a unit of o-negative,” he responded.

Nurse Holder nodded and quickly hurried for more blood.

As the stream of blood slowed to a small trickle, Dr. Warner continued with the next burr hole. He positioned the drill once more and began to bore his next hole. As before, Dr. Fullerton suctioned up the extraneous bone debris as well as the ever growing intensity of blood. Within minutes, the drill broke through and another large stream of blood shot out of the hole.

Instantly, both doctors worked frantically to absorb the growing pool of blood. Nurse Booker quickly handed rectangular cotton batting, while accepting saturated batting in return. As the flow began to slow, Dr. Warner began the final burr hole. Moments later, as the drill broke through the skull, more blood oozed from the hole. Once again, both doctors worked quickly to control the bleeding. In less than a minute, the flow slowed to a trickle.

“Dissector,” Dr. Warner asked.

“Dissector,” Nurse Booker responded in return, handed him the long metal instrument.

Sticking the small curved end into one of the burr holes, he carefully separated the dura membrane that protected the brain from the skull. Moving from hole to hole, he repeated the process.

“Ok, bone saw,” Dr. Warner asked.

Nurse Booker instantly handed him the device.

“Dr. Fullerton, you ready?”

“As I’ll ever be,” he replied grimly.

Dr. Warner inserted the edge of the blade into a burr hole and switched on the powered tool. The saw came to life and the loud roar of the motor completely drowned out all other sounds.

Moving in a straight line, Dr. Warner began to cut a path between two burr holes. Rocking the saw slightly backward to forward, he worked the blade through the bone. As bone dust and blood accumulated along the path, Dr. Fullerton cleared away the material. Several minutes later, Dr. Warner broke through, into the second burr hole.

He ran his gloved finger over the narrow slit in the skull and felt the cut line. Satisfied with his work, he continued on with the next line. He placed the saw blade back into the burr hole and switched on the power. Again, the saw roared to life. Cutting a new line perpendicular to the first, he worked the saw along the second leg of the rectangle. As he had done with the first, he rocked the saw back and forth, cutting small bits of bone along the line, a little at a time. Several minutes later, the saw broke through into the third burr hole.

With two legs of the rectangular bone flap now cut, he quickly repeated the process on the other two lines. With the five-by-four inch rectangular bone flap now completely sawn through, he reached for a dissector to help separate it from the dura laying just below the skull.

With Dr. Fullerton continuing to suction, Dr. Warner worked the dissection tool inside the burr holes, peeling the dura layer away from the inside surface of the bone flap. Several minutes later, he inserted a probe into a cut line and began to gently pry off the bone flap. Lifting if from the skull’s surface, he separated off the last of the dura connected to the rectangular piece of bone.

With the bone flap removed, the massive hematoma was now evident. Through the veil of the dura membrane, dark red clots of blood could be seen covering the surface of the brain.

“Wow, that’s not good,” Dr. Fullerton said cryptically.

“Yeah I know,” Dr. Warner concurred.

Looking over to anesthesiologist Dr. Johnson, he said, “Four ounces of Mannitol, stat.”

With a simple nod, he responded, “Administering now.”

“What is it doctor?” Nurse Booker asked, nervously.

Dr. Warner picked up a probe off the surgical tray and laid it on the surface of the dura.

“This membrane is the dura layer. It’s the first layer of protection covering the brain. If you look closely, it’s very tense and the edges are expanding up through the hole we just cut.”

Nurse Booker stared blankly back at Dr. Warner, unsure of his message.

“The pressures are forcing the dura out of the hole,” he responded, anticipating her next question. “We’re giving him Mannitol to help reduce the pressure.”

Nurse Booker nodded in understanding.

Looking over to Dr. Johnson, Dr. Warner called out, “Sats!”

“Still dropping… BP’s sixty-nine over thirty, pulse is thirty, pulse ox seventy,” he responded grimly. “We’re losing him. Whatever you’re going to do, you better do it now.”

“Eight blade,” Dr. Warner immediately responded.

Nurse Booker quickly handed him the scalpel. Starting at the corners of the rectangular hole, he punctured the dura and ran the scalpel diagonally across the membrane to the far corner. Instantly, a thick clot, as well as blood oozed from the incision.

Even before Dr. Warner could speak, Dr. Fullerton moved the suctioning wand in to remove the escaping fluid and matter.

Dr. Warner moved the scalpel to the other side of the incision and once again, made another diagonal cut across to the opposite corner.

“Forceps, retractor,” Dr. Warner said in a hurried voice.

Quickly, Nurse Booker handed him the instruments.

Using his forceps, he pulled back the triangular flaps of the dural membrane and secured them in place with the retractors. With blood now freely flowing from the gaping hole, the source of the bleed virtually unknown, and the patient’s vitals continuing to fall, time and opportunity were quickly slipping from his grasp.

“I’ll take the suction, you work the irrigation,” Dr. Warner said to Dr. Fullerton. “We need to clean out these clots and find the bleeder… NOW!”

Dr. Warner took the suctioning wand from Dr. Fullerton. Using his forceps, he began to pull at the massive clot that covered the opening. As smaller clots pulled off from the main clot, he sucked them up with the wand. Breaking down the massive hematoma, he began to catch glimpses of the brain tissue underneath.

“Irrigation,” Dr. Warner called.

Quickly, Dr. Fullerton pointed another plastic wand at the clot. He depressed a button and released a flow of saline into the opening. Pointing the saline irrigator directly at the blood clot, the force of the water began to break it apart in small clumps. As the saline flooded the opening, the small clots drained out and were collected by suction. With the two doctors working together, the large gelatinous clot was nearly gone.

Watching the computer screen, the area just worked showed an absence of material. Beyond the cavity, hidden to the naked eye, the computer image showed more clotting. Using suction, Dr. Warner began to draw out the clot from areas hidden under the skull. Working the wand under the edge of the opening, large areas of the massive clot began to be drawn out. Within minutes, the two doctors had once again cleared away large areas of the hematoma.

Dr. Warner watched the saline enter the cavity and flush particles into the suction wand. As the color of the flow changed from red to clear, then back to red again, he knew the brain was still hemorrhaging. Concentrating on the larger area of discoloration, he began to test for bleeding. As the water flushed clear, he waited for the color to flow red. As it did, he placed cotton batting over the suspected area and watched for a stream of blood to darken.

“Dammit, I thought we had it,” he responded in a disappointed tone.

Leaving the cotton batting, Dr. Fullerton flushed more saline into the opening. As the clear flow turned back to red, Dr. Warner laid another piece of cotton over the suspected area. Both doctors watched intently.

Suddenly, the cotton batting began to change to red. Dr. Fullerton poured more saline over the area to flush the cotton clear. Again, the cotton turned a bright shade of red.

Using his forceps, Dr. Warner picked up the end of the cotton batting. Instantly, a tiny stream of blood erupted from a large vein. Dr. Fullerton pointed the saline over the area, then pulled it away. Again, a tiny stream of blood began to flow.

“Got it… there’s the bleeder,” Dr. Warner shouted excitedly.

“Good work,” Nurse Booker responded instantly.

“I need the bipolar Bovie, stat,” Dr. Warner said anxiously.

Nurse Booker handed him the cauterizing instrument, shaped like a pair of large tweezers. Quickly, he moved them to the opening and placed the two front points on each side of the bleeding vein. He energized the tip and instantly cauterized it. Dr. Fullerton flushed saline over the area once more. Moments later, the area flushed clear.

“I think we got it,” Dr. Warner shouted excitedly.

“Great job, doctor,” Dr. Fullerton responded.

Loud and disturbing, the unmistakable sound of flat-line sounded from the cardiac monitor.

“Shit, flatline!” Dr. Warner shouted. “Push another amp of epinephrine. Charge the paddles to fifteen.”

Nurse Holder rushed to the defibrillator and set the charge to fifteen joules. Handing the paddles to Dr. Warner, he positioned them on Bobby’s chest.

“Clear!” he shouted.

He depressed the buttons and instantly sent a charge across his heart. Bobby convulsed on the table, then lay flat.

“Still in v-fib,” Dr. Fullerton shouted.

“Charge to twenty,” Dr. Warner ordered. “Clear.”

Again, he depressed the buttons on the paddles and instantly, Bobby’s body convulsed on the table once more.

“V-fib,” Dr. Fullerton shouted simply.

“Dammit,” Dr. Warner shouted angrily. “Charge to forty.”

He replaced the paddles and called “clear” again. Like the two times before it, Bobby convulsed, then lay still as the cardiac monitor blared “flat-line”.

“Charge the paddles to fifty,” Dr. Warner shouted frantically. “Push another amp of epi.”

He slapped the paddles to Bobby’s chest and depressed the button. Again, his body heaved and contracted, then lay flat as the cardiac monitor reminded all of their failure.

“God Dammit,” Dr. Warner shouted loudly, his emotional state now slowly unraveling.

His mind raced as he considered his options. Desperate for a solution, he stared at the patient, trying to force a moment of clarity… but there was none to be found. Looking around the room, he searched the eyes of his colleagues hoping for answer, but he received only blank stares in return.

“Charge the paddles to sixty,” he demanded. “Push an amp of atropine.”

“Doctor?” Dr. Johnson shouted.

Placing the paddles once again, he called “clear”.

“Doctor?” Dr. Johnson shouted louder.

“I’m a little busy right now?” he shouted back in frustration.

“David, it’s no use. He’s gone,” Dr. Johnson responded, his tone now steady and sympathetic. “There was just too much damage.”

“No, I won’t accept that. There’s still time. I can save him.”