During an expedition to the Antarctic, Russian surgeon Leonid Rogozov became seriously ill. He needed an operation - and as the only doctor on the team, he realised he would have to do it himself...
The Novolazarevskaya Station was up and running by the middle of February 1961, and with their mission complete the group settled down to see out the hostile winter months...
But by the end of April, Rogozov's life was in danger and he had no hope of outside help. The journey from Russia to the Antarctic had taken 36 days by sea, and the ship wouldn't be back for another year. Flying was impossible because of the snow and blizzards.
"He was confronted with a very difficult situation of life and death," says Vladislav. "He could wait for no help, or make an attempt to operate on himself."
"He had to open his own abdomen to take his intestines out," says Vladislav. "He didn't know if that was humanly possible."...
The commander in charge of the Novolazarevskaya base had to get Moscow's blessing for the operation to go ahead. "If my father was to fail and die it would definitely put a hard hat of negative publicity on the Soviet Antarctic programme," says Vladislav...
"Still no obvious symptoms that perforation is imminent, but an oppressive feeling of foreboding hangs over me… This is it… I have to think through the only possible way out - to operate on myself… It's almost impossible… but I can't just fold my arms and give up."...
Rogozov worked out a detailed plan for how the operation would unfold and assigned his colleagues specific roles and tasks.
He nominated two main assistants to hand him instruments, position the lamp, and hold a mirror - he planned to use the reflection to see what he was doing. The station director was also in the room, in case one of the others became faint.
"He was so systematic he even instructed them what to do if he was losing consciousness - how to inject him with adrenalin and perform artificial ventilation," says Vladislav. "I don't think his preparation could have been better."
A general anaesthetic was out of the question. He was able to administer a local anaesthetic to his abdominal wall but once he had cut through, removing the appendix would have to be done without further pain relief, in order to keep his head as clear as possible.
"My poor assistants! At the last minute I looked over at them. They stood there in their surgical whites, whiter than white themselves," Rogozov wrote later. "I was scared too. But when I picked up the needle with the novocaine and gave myself the first injection, somehow I automatically switched into operating mode, and from that point on I didn't notice anything else."
Rogozov had intended to use a mirror to help him operate but he found its inverted view too much of a hindrance so he ended up working by touch, without gloves.
As he reached the final and hardest part of the operation, he almost lost consciousness. He began to fear he would fail at the final hurdle.
"The bleeding is quite heavy, but I take my time... Opening the peritoneum, I injured the blind gut and had to sew it up," Rogozov wrote. "I grow weaker and weaker, my head starts to spin. Every four to five minutes I rest for 20 - 25 seconds.
"Finally here it is, the cursed appendage! With horror I notice the dark stain at its base. That means just a day longer and it would have burst… My heart seized up and noticeably slowed, my hands felt like rubber. Well, I thought, it's going to end badly and all that was left was removing the appendix."
But he didn't fail. After nearly two hours he had completed the operation, down to the final stitch.
Then, before allowing himself to rest, he instructed his assistants how to wash the surgical instruments and only when the room was clean and tidy did Rogozov take some antibiotics and sleeping tablets.
http://www.bbc.com/news/magazine-32481442
Courtesy of a colleague
On a lesser note, in the remote past I was interested in doing needle muscle biopsies. I had training in and had performed many open biopsies, but I knew of needle biopsies only from the literature. I have a neuromuscular disease, so doing a biopsy on myself had some diagnostic value. I decided this was the way to learn.
ReplyDeleteIt went well overall. When the needle popped through the fascia, I did feel lightheaded. The incredulous nurse practitioner with whom I worked provided moral support. The biopsy showed neurogenic atrophy, as anticipated.
Years ago, when I was in my pediatric neurology training, I did an open muscle biopsy on an adolescent male with congenital insensitivity to pain without anesthesia. It was a curious experience. When muscle tissue was being excised, he became a bit restless, but otherwise in no way acknowledged pain or discomfort.
ReplyDeleteIn a similar vein, see: http://www.nytimes.com/2012/11/18/magazine/ashlyn-blocker-feels-no-pain.html?_r=0