Wracks, I want you to come in at night at the ER because that is when the action happens. Be sure to be here Friday or Saturday night on the Graveyard. Every week we have a gunshot or a bludgeoning event. We need the extra hands to tie sutures,” said Dr. Saber. “I will be here,” said Wracks
“We have a stat on a fight victim coming in” said the dispatcher. “Wracks, bring him in and work him up. Then call me.” Said Dr. Saber. The Paramedics brought the patient into the double doors of the ER. The ER had double electric doors in case a murderer wanted to finalize an act not perfected. We could lock them out. The patient was of average height and average build Caucasian male. He wore sweats and had no obvious odors diagnostic of metabolic conditions. Upon neurological exam, The Wracks find the pupils fixed and dilated. The breathing is intermittent but not agonal. There is no obvious bleeding from the nose, eyes or ear canals upon fundoscopic observation. The patient is unconscious and does not respond to pain from needle prick or skin pull. “Dr. Saber, I think we have a subarachnoid hemorrhage with antecedents of trauma to the face. “ Dr. Saber runs to console, grabs the phone and calls upstairs. “Wait with him!” Dr. Saber commands.
“Dr. Saber said you have good hands,” said the brain surgeon. He is a middle size man of obvious English ancestry with short brownish red wavy hair. He stands at middle build on the lean side like people who are always on the run from an adversary. His clothing is impeccable like he arrived from a ball at the palace of Versailles. His shoes look brand new like he never walked in them because he doesn’t have to. An aquiline gaze reveals steel grey eyes almost like the prince of Wales. He must be related. “I want you to assist me in neurosurgery tonight.” “I will teach you how.” The patient was already upstairs. He gestures to Wracks and says, “Take the elevator all the way up. They will let you in.” The elevator to the top surgical unit is slow and steady and quiet. The light blink by slowly as it rises to the place where God alone rules and man tries to cheat him of his due. Someone said to Wracks that the Obelisk was owned by a very rich man. the Wracks did not believe them because he was forever hungry and looking for food. Tonight, at eleven o’clock the Wracks will assist a brain surgeon and bring a dead man back to life. This is a third-year externship at Christmas when all his friends are surfing Pipe or the Con and he wasn’t. He was already scrubbed when the Wracks arrives as if he flew up to the surgical suite. There was Wracks, the brain surgeon and an older anesthesiologist who looked like he needed sleep too.
“I will teach you brain surgery,” said the brain surgeon. “First, the conditions.” “Cool your patient to 90 degrees Fahrenheit with a water blanket. This will slow the heart and make the neurons less irritable.” “ Then infuse urea to establish hyper osmotic equilibrium to prevent brain swelling. This is faster. Switch to mannitol post operative. Now infuse solumedrol to prevent inflammation. This takes 24 hours to begin to take effect. When the patient is readied by the anesthesiologist then we will begin. Anesthesiology must be light or the patient will stop breathing. The patient will be conscious. No matter what the patient says keep going. Learn to focus and block out everything but the job at hand.”
The patients head was shaved and the brain surgeon looked at the x-rays. Visualize in your mind where the lesion is from the x-rays. Take your own x-rays before surgery. Do not rely on anyone. Do not let anyone but licensed surgeons into the room.” “Now we will unearth the calvarium.” Said the brain surgeon.
The bone saw whirs at a high frightening screech. The saw is a small stainless steel orb that glints under the klieg lights and comes from a sterilized package. “Hold open the operating theatre for me,” he said. “Do not let go.” “The patient might move!” The saw whirred with a horrible whine and the frequency dulled as the blade cut the bone. Smoke arose from the cut and I started to vomit. “Dr. Saber said you were good.” “Are you good?” “I am good.” Says the Wracks and his senses came back to him. He pulled of the top of the patient’s skull and snipped the tentorial ligaments with a small scissors. “This is the durra mater and underneath the subarachnoid membrane. “ Under the durra mater, a skin like membrane stretched over the top of the brain was a mass of congealed blood. The patient started to speak in a childish voice a language the Wracks could not discern. “Do not listen,” he said. The brain then started to swell like a loaf of bread rising in an oven. It pushed out two inches high. “This is a bad one,” said the brain surgeon. “We will have to do a total lobectomy.” “I Want you to hold the suck and turn the fulgerator when I tell you to.” The Wracks held the suck stable. The surgeon literally sucked brain matter through a stylet into a huge plastic receptacle. The osterized brain matter was bright pink like Jell-O. The neurons are a light grey and the supporting structure of glial cells and myelin is alabaster white. The brain surgeon hit a capillary and the blood spurt two feet high like a small geyser. He clipped it with the forceps and said “burn it.” Wracks pressed the trigger of the fulgurator. The smell of burnt brain permeated the whole operating area. The wracks started to black out. “I am going Doctor,” said the Wracks. The brain surgeon commanded, “Hold the suck.” “I am going Dr,” the Wracks. The brain surgeon commanded “Hold the suck.” The Wracks slowly started to come back. Slowly, surely, he came back to consciousness. “Now we can continue.” He said. Small hemorrhages would occur as he aspirated brain tissue. The Wracks held the suck and triggered the burner as he commanded. “Our father who art in heaven.” And we continued. “Hallowed be thy name.” And we continued. “Thy kingdom come. Thy will be done.” “There” said the brain surgeon. “The bleeding and swelling have stopped and the patient still breathes.” He put the top of the skull back on the patient and secured it with staples. Then he sutured the scalp back into place. The clock says two A.M and I am spent. “You can go now.” Said the brain surgeon. “I am done here.”
The elevator from the top slowly descended to moral reality and the Wracks walked back into the ER. “Did he make it?” said Dr. Saber “He made it.” Says the Wracks. “Good “said Dr. Saber. “We have a gunshot wound to the abdomen in room 3 and I want you to wait there until the police arrive.” “o.K.,” says the wracks.
They said the patient was alive on a respirator until he was transferred to another hospital. The Wracks lost track of him. Some say he died some say he slipped away. Some say the event never happened. The Wracks never saw the brain surgeon again. He is a very busy man who lives on an airplane and flies all around the world cutting into people’s brain., They say he is the best in the world. Instead, the Wracks does neuro- surgery with an African American who hates to do colostomies. There was always action in the south, in the city, downtown, late at night during the summer externships at the hospital when the Wracks was a medical student.
“Where were you,” said Dr. Saber. We need suturing for a head wound in room two. the wracks went back to work for nothing to learn the craft in the days before the darkness in youth when achieving was so important and nothing else mattered. They still do not know how to prevent the brain from swelling during trauma. It is the increased intracranial pressure that stops the respiratory center from working., Pray to Yahweh and beg him to whisper the secret to a sincere dedicated surgeon. Mankind is depending on you. La Ilya alha Allah, Muhamed resund Allah.