A Silver Lining

Back in the days before cellphones and the internet, I was a physician specializing in vascular surgery. For one day every other week I was obliged to take call for my hospital’s emergency room, but I was seldom called. While I was in the hospital one day, I received a page from the emergency room. The ER doctor had admitted a twenty-year-old man in a coma following a car accident. I asked him why he called me and he responded that an X-ray of his arteries showed 90% blockages in both carotid arteries. These arteries are the main source of oxygen to the brain. As I scurried down to the ER, I wondered how the patient could experience simultaneous narrowing of both carotid arteries in a car accident. A paramedic filled me in. He explained that two men were driving in a sports car with the convertible top down and somehow they drove under a tractor trailer. The driver was killed instantly. 

The X-ray showed both arteries were narrowed just as they entered the bottom of the skull on their way to the brain. I knew that if I could fix one of the two arteries, I would restore oxygen to both sides of his brain, which might allow him to wake up.  But time was of the essence, since each minute without oxygen reduced his chances of  recovery. The patient’s brothers were waiting to talk with me. I explained that their brother would die without surgery, he had a slim chance of waking up and, by the way, they had no time to get a second opinion. They consented to the Hail Mary surgery. Outwardly I feigned confidence, but internally I was trembling. Although I had repaired hundreds of diseased carotid arteries in the middle of the neck, neither I nor, as best I could recall, anyone else had ever tried to repair the artery at the base of the skull. That area is crammed with tangled nerves, important blood vessels, salivary gland ducts, and tendons, the names of which I had long forgotten. 

I made a long cut in his neck, identified the carotid artery in the middle, and inched my way up to the base of the skull, but over an hour had already passed. I was working in a deep cavern of unfamiliar tissues. To repair the artery I would need to stop the circulation above and below the injury temporarily. I placed a clamp on the carotid artery below the injury, but the injury itself was flush with the skull.  and there was no way I could put a clamp on the other side of the injury to keep blood from filling my working space. I had a workaround. I made a small opening in the artery and the trickle of blood flowed back out proved the brain was aching for more oxygen. I passed a balloon-tipped catheter past the arterial narrowing without breaking off any of the material blocking the artery. I inflated the balloon at some distance higher in the skull. This little trick stopped the backbleeding and allowed me to work on the damaged vessel without blood obscuring my workspace. I took my first deep breath. 

I then opened the artery further, but the artery was so mangled, I realized I could not simply repair it—I would need to replace it with a substitute. I was grateful I had instructed my assistant to harvest a segment of vein from the thigh in case this very condition arose.

I started to sew one end of the substitute vein onto the transected carotid artery at the base of the skull, but the immovable bony skull bent my needle as soon as I got through the artery. At least I was able to tie a knot in the suture at that point but I would need to place 9 or 10 additional sutures to complete fusing the vein to the artery, each one adding precious time. Eventually I finished and I took another deep breath. Hooking up the other end and finishing the operation took only fifteen minutes. I checked to be sure there was good flow going to the brain.

I stepped out and returned to the brothers. I told them I was able to finish the operation, but that it took longer than I expected. I added that his brain had lacked oxygen for much too long, and that he would probably never wake up. He was still in a coma after two week when he was discharged to the care of his brothers, and two weeks later when I went to visit him in the brothers’ bungalow. I had won the battle, not the war, which is the precise definition of a Pyrrhic victory.  

 Twenty years later my office received a large heavy square envelope embellished with flowers and butterflies front and back. It was a wedding invitation, but neither my wife, Susie, nor I recognized either the bride or groom’s name. We thought it might be a patient, but a search of office files came up empty handed. Occasionally I receive a wedding invitation from a grateful patient inviting us to his grandchild’s wedding, but we turn those down unless we suspect the food will be exceptionally good or we will be with friends. I tossed the invitation in the waste basket, but two hours later, my secretary told us she found the groom’s name in old billing records. I asked her to retrieve the patient’s file from storage, and I sheepishly removed the invitation from the waste basket. The file arrived on my desk four days later. The groom was my patient. Susie and RSVP’ed yes.

On the wedding day, we arrived at the Sony Movie Studio, a lovely space for a wedding. I tried to guess who in the procession was my patient. Finally, a tall man wearing a brace laboriously inched his way down the aisle, and a beautiful woman in a white gown followed immediately after. My inner Sherlock Holmes was correct, and the two were married a few minutes later.

We lined up in the middle of the receiving line . The first person in the wedding party was one of the bridesmaids. We told her we were with the groom, and she then asked how we knew him. I responded that I had operated on him many years before. She suddenly froze and then shrieked at the top of her lungs. “It’s him. He’s here, He’s here.” The entire receiving line broke ranks and converged around me and my wife. For the next ten to fifteen minutes we all kissed, hugged, and high-fived nonstop. Of course, the groom was jubilant to meet me, as was I to see his animated face. He told me he first spoke four months after surgery, took his first steps at six months, walked unassisted after two years. and later returned as a cameraman at Sony where he met his wife. Susie and I felt guilty about holding up the remaining 150 guests, in part because we predicted the family would have to explain the delay and all the hoopla. He stepped back and the reception line re-formed.

We hugged goodbye and  Susie and I wandered over to the buffet line. My pager went off while we were eating.  I had forgotten to switch ER call with a colleague. Portable cell phones hadn’t yet been invented, but I did have the clunky version in my car. The two of us left the wedding without collecting contact information and sped off to the ER. I stood at the same X-ray view box where I had stood twenty years before.

Sadly, we never had contact with the family again, and once my patient slowly faded from my thoughts. I shuttered my practice years later in 2018, and two years after that, I shredded my records and wiped my hard drives clean. But what always remained was an indelible desire to learn whether the happy couple ever had children.